Background Congestive heart failure （CHF） is associated with Cheyne-Stokes respiration （CSR）, which may hasten CHF. Adaptive servoventilation （ASV） is a novel method of ventilatory support designed for removal o...Background Congestive heart failure （CHF） is associated with Cheyne-Stokes respiration （CSR）, which may hasten CHF. Adaptive servoventilation （ASV） is a novel method of ventilatory support designed for removal of CSF in CHF patients. This study compares the efficacy of ASV in patients with CHF and CSR with the efficacy of oxygen therapy. Methods Fourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were each performed for two weeks. Comparison before and after each treatment was made for the following items： a） parameters of sleep respiration, sleep structure and quality; b） left ventricle ejection fraction （LVEF） and 6-minute walk distance. Results Compared with the baseline levels of apnoea hypopnoea index of 34.5±6.1 before treatment, the apnoea hypopnoea index significantly decreased following oxygen therapy to 27.8±8.2, P〈0.05 and further reduced following ASV treatment to 6.5 ±0.8, P〈0.01. The minimal pulse oxygen saturation markedly increased following oxygen therapy from a baseline of （84.3±2.6）% to （88.6±3.7）%, P〈0.05 and further increased following ASV treatment （92.1 ±4.9）%, P〈0.01. Stages Ⅰ ＋Ⅱ sleep as percentage of total sleep time decreased from （81.9±7.1）% to （78.4±6.7）% following oxygen therapy and further to （72.4±5.0）% following ASV treatment. Stages Ⅲ＋Ⅳ sleep as percentage of total sleep time decreased from （8.4±5.5）% to （6.0±3.0）% following oxygen therapy and but increased to （11.9 ± 5.4）% following ASV treatment. The arousal index of 30.4 ±8.1 before treatment significantly decreased following oxygen therapy to 25.6±5.7, P〈0.05 and further declined following ASV treatment to 18.2±6.1, P〈0.01. No significant difference was shown in above percentages between day 14 of oxygen therapy and before treatment （P 〉 0.05）. LVEF was significantly higher on day 14 of ASV treatment （37.2 ±4.1）% than on day 14 of oxygen therapy （33.2 ± 5.1）% and before treatment （30.2±4.6）% （all P〈0.05）. Six-minute walk distance was the shortest before treatment （226±28） m, longer on day 14 of oxygen therapy （289±26） m, and the longest on day 14 of ASV treatment （341 ±27） m （all P 〈 0.01）. Conclusion ASV treatment is of better efficacy and greater clinical significance in improvement of CHF by eliminating CSR than oxygen therapy.展开更多
Adaptive servo-ventilation(ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea(CSA). Heart failure patients often have sleep...Adaptive servo-ventilation(ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea(CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea(OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure(CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatmentemergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.展开更多
基金This research was funded by Jiangsu Committee of Science and Technology (No. BZ2003048).
文摘Background Congestive heart failure （CHF） is associated with Cheyne-Stokes respiration （CSR）, which may hasten CHF. Adaptive servoventilation （ASV） is a novel method of ventilatory support designed for removal of CSF in CHF patients. This study compares the efficacy of ASV in patients with CHF and CSR with the efficacy of oxygen therapy. Methods Fourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were each performed for two weeks. Comparison before and after each treatment was made for the following items： a） parameters of sleep respiration, sleep structure and quality; b） left ventricle ejection fraction （LVEF） and 6-minute walk distance. Results Compared with the baseline levels of apnoea hypopnoea index of 34.5±6.1 before treatment, the apnoea hypopnoea index significantly decreased following oxygen therapy to 27.8±8.2, P〈0.05 and further reduced following ASV treatment to 6.5 ±0.8, P〈0.01. The minimal pulse oxygen saturation markedly increased following oxygen therapy from a baseline of （84.3±2.6）% to （88.6±3.7）%, P〈0.05 and further increased following ASV treatment （92.1 ±4.9）%, P〈0.01. Stages Ⅰ ＋Ⅱ sleep as percentage of total sleep time decreased from （81.9±7.1）% to （78.4±6.7）% following oxygen therapy and further to （72.4±5.0）% following ASV treatment. Stages Ⅲ＋Ⅳ sleep as percentage of total sleep time decreased from （8.4±5.5）% to （6.0±3.0）% following oxygen therapy and but increased to （11.9 ± 5.4）% following ASV treatment. The arousal index of 30.4 ±8.1 before treatment significantly decreased following oxygen therapy to 25.6±5.7, P〈0.05 and further declined following ASV treatment to 18.2±6.1, P〈0.01. No significant difference was shown in above percentages between day 14 of oxygen therapy and before treatment （P 〉 0.05）. LVEF was significantly higher on day 14 of ASV treatment （37.2 ±4.1）% than on day 14 of oxygen therapy （33.2 ± 5.1）% and before treatment （30.2±4.6）% （all P〈0.05）. Six-minute walk distance was the shortest before treatment （226±28） m, longer on day 14 of oxygen therapy （289±26） m, and the longest on day 14 of ASV treatment （341 ±27） m （all P 〈 0.01）. Conclusion ASV treatment is of better efficacy and greater clinical significance in improvement of CHF by eliminating CSR than oxygen therapy.
基金Partly supported by a Grant-in-Aid for Scientific Research(C),No.26507010a grant to the Respiratory Failure Research Group from Ministry of Health,Labor and Welfare,Japan
文摘Adaptive servo-ventilation(ASV) has been developed as a specific treatment for sleep-disordered breathing, in particular Cheyne-Stokes respiration with central sleep apnea(CSA). Heart failure patients often have sleep-disordered breathing, which consists of either obstructive sleep apnea(OSA) or CSA. Other medical conditions, such as stroke, acromegaly, renal failure, and opioid use may be associated with CSA. Continuous positive airway pressure(CPAP) therapy is widely used for patients with OSA, but some of these patients develop CSA on CPAP, which is called treatmentemergent CSA. CPAP can be useful as a treatment for these various forms of CSA, but it is insufficient to eliminate respiratory events in approximately half of patients with CSA. As compared to CPAP, ASV may be a better option to treat CSA, with sufficient alleviation of respiratory events as well as improvement of cardiac function in heart failure patients. In patients without heart failure, ASV can also alleviate CSA and relieve their symptom. Recently, ASV has been widely used for patients with various forms of CSA. ASV may be also used in the setting without CSA, but it should be assessed more carefully. Clinicians should have a better understanding of the indications for ASV in each setting.
