Abstract 14144: Adaptive Servo Ventilation Improves Cardiovascular Disability Status and Long-term Prognosis in Heart Failure Patients with Central Sleep Apnea
Background: About a third of heart failure (HF) patients have Chyene-Stokes Respiration with Central Sleep Apnea (CSR-CSA) and this sleep breathing disorder worsens the cardiovascular disability status and prognosis of HF patients. Adaptive Servo Ventilation (ASV) normalizes CSR-CSA. However, impact of ASV on cardiovascular disability status and prognosis in HF patients with CSR-CSA was not fully investigated. In this study, we examined the hypothesis that ASV improves cardiovascular disability status as well as long-term prognosis through the enhancement of cardiac function in HF patients with CSR-CSA.
Methods: Fifteen HF patients with CSR-CSA (12 males, 3 females, mean age of 78.5±7.5) were included. Among them, 4 patients were categorized in NYHA IV, 7 were in NYHA III and 4 were in NYHA II. HF with CSR-CSA was diagnosed as (1) existence of CSR-CSA and (2) apnea-hypopnea index (AHI) >20 by using polysomnography. Inspiratory and expiratory positive airway pressure of ASV in each HF patients was titrated manually. Prognosis including changes of cardiovascular disability status and echocardiography were evaluated in mean follow-up of 20.6 months.
Results: After application of ASV, AHI was dramatically decreased (58.8±18.1 to 10.2±7.8, p<0.01) and CSR disappeared in all 15 patients. Among them, 4 patients were able to successfully withdraw ASV and transfer to CPAP therapy in 5.0±2.6 months of ASV employment. The cardiovascular disability status improved in all patients except 3 patients with class II who remained in class II. Echocardiography showed an improvement of left ventricular ejection fraction (LVEF) from 51.6 (19 to 76) to 62.3 (37 to 69) %, although patients with good LVEF (<60%) did not show further augmentation of LVEF. Four patients died during the follow-up period, 3 of them died of unrelated to exacerbation of HF (malignancy, pneumonia and aortic dissection, respectively). Remaining 1 patient died suddenly after 21 months of ASV discontinuation.
Conclusion: These results suggested that ASV improves cardiovascular disability status as well as long-term prognosis at least partly through the enhancement of LVEF in HF patients with CSR-CSA. More widespread applying of ASV is encouraged in HF patients with CSR-CSA.
- © 2010 by American Heart Association, Inc.