Abstract 11182: Effect of Adaptive Servo Ventilation on Autonomic Nervous Balance: Analysis of Heart Rate Variavility by Wireless Holter ECG
Background: Activation of sympathetic nervous system plays a critical role in chronic heart failure (CHF) and is associated with adverse clinical outcome. Heart rate variability (HRV) is useful for measurement of impaired parasympathetic control and increased sympathetic dominance. Adaptive servo ventilation (ASV) is a ventilator support system designed to normalize ventilation in CHF patients with sleep disordered breathing (SDB). However, the effect of ASV on autonomic nervous system is still unclear.
Methods: Twenty six CHF patients with moderate-severe SDB (mean LVEF 42.6%) were examined. We performed overnight polysomnography, 24 hr wireless Holter ECG monitoring, and measured levels of urinary cathecholamines for two consecutive days (baseline and on ASV).
Results: ASV significantly improved SDB parameters including apnea hypopnea index (35.1 to 9.9 /h, P<0.01), central apnea index (4.9 ± to 1.2 /h, P<0.05), obstructive apnea index (9.8 to 2.6 /h, P<0.01), arousal index (21.5 to 11.0 /h, P<0.01), lowest SPO2 (82.4 to 86.5%, P<0.01), and slow wave sleep (4.0 to 16.9%, P<0.05) compared to baseline. ASV stabilized HRV parameters for autonomic nervous balance in night time such as standard deviation of all NN intervals (SDNN night time: 110.7 to 95.4 ms, P<0.05), the square root of the mean of the sum of the squares of differences between adjacent NN intervals (rMSSD night time: 97.8 to 84.1 ms, P<0.05), and power in the very low frequency range (VLF night time: 2865.9 to 1954.3 ms2, P<0.05). Furthermore, ASV decreased parameters of sympathetic nervous activity in not only night time but also day time such as square root of LF (all day: 29.2 to 25.1, P<0.05; awake: 27.9 to 23.5, P<0.05; sleep: 31.1 to 26.0 ms2, P<0.05), LF/HF (all day: 2.28 to 1.99, P<0.05; awake: 2.69 to 2.26, P<0.05; sleep: 1.68 to 1.33 ms2, P<0.05), and daily excretion of urinary cathecholamines (0.450 to 0.358 mg/day, P<0.05). Finally, ASV decreased numbers of premature ventricular contraction (PVC: 724.0 to 454.8 beats/day, P<0.05; PVC%: 0.81 to 0.56, P<0.05).
Conclusions: Overnight use of ASV attenuated sympathetic nervous activity not only in night time but also in daytime. ASV stabilize autonomic nervous balance, resulting in decrease of ventricular arrhythmias.
- © 2012 by American Heart Association, Inc.