0
Clinical Investigations: CARDIOLOGY |

Nocturnal Continuous Positive Airway Pressure Improves Ventilatory Efficiency During Exercise in Patients With Chronic Heart Failure*

Michael Arzt, MD; Martina Schulz, MD; Roland Wensel, MD; Sylvia Montalvàn, MD; Friedrich C. Blumberg, MD; Günter A. J. Riegger, MD; Michael Pfeifer, MD
Author and Funding Information

*From the Department of Internal Medicine II (Drs. Arzt, Wensel, Montalvàn, Blumberg, Riegger, and Pfeifer), Pneumology, University of Regensburg, Regensburg; and Lungenfachklink Donaustauf (Dr. Schulz), Donaustauf, Germany.

Correspondence to: Michael Arzt, MD, 65 High Park Ave #2012, Toronto, ON, M6P 2R7, Canada; e-mail: michael.arzt@utoronto.ca



Chest. 2005;127(3):794-802. doi:10.1378/chest.127.3.794
Text Size: A A A
Published online

Objectives: Chronic heart failure is closely related to impaired cardiorespiratory reflex control, including decreased ventilatory efficiency during exercise (V̇e/V̇co2-slope) and central sleep apnea (CSA). Continuous positive airway pressure (CPAP) and nocturnal oxygen therapy alleviate CSA. The aim of the present study was to compare the effects of nocturnal CPAP and oxygen therapy on V̇e/V̇co2-slope.

Design and setting: Prospective controlled trial at a university hospital.

Patients: Twenty-six stable patients with chronic heart failure and CSA.

Intervention and measurements: Ten patients received nocturnal oxygen, and 16 patients were assigned to CPAP treatment. At baseline and after 12 weeks of treatment, symptom-limited cardiopulmonary exercise testing was performed on a cycle ergometer. Expiratory gas was analyzed breath by breath for evaluation of ventilation and ventilatory efficiency in combination with arteriocapillary blood gas analysis during rest and exercise.

Results: CPAP treatment significantly reduced the V̇e/V̇co2-slope (31.2 ± 1.6 vs 26.2 ± 1.0, p = 0.005) and improved the left ventricular ejection fraction (LVEF) [31.7 ± 2.6% vs 35.7 ± 2.7%, p = 0.041]. CPAP treatment significantly reduced the apnea-hypopnea index (AHI) [35.9 ± 4.0/h vs 12.2 ± 3.6/h, p = 0.002]. Peak oxygen consumption (V̇o2) [16.2 ± 1.1 L/min/kg vs 16.3 ± 1.2 L/min/kg, p = 0.755] remained similar after CPAP treatment. Oxygen therapy reduced the AHI (28.8 ± 3.2/h vs 8.7 ± 4.1/h, p = 0.019), but did not improve exercise capacity (peak V̇o2, 15.4 ± 1.5 L/min/kg vs 15.6 ± 1.9 L/min/kg, p = 0.760), LVEF (30.9 ± 2.4% vs 32.5 ± 2.3%, p = 0.231), or the V̇e/V̇co2-slope (30.0 ± 1.5 vs 29.8 ± 1.5, p = 0.646).

Conclusion: Nocturnal CPAP and oxygen therapy alleviate CSA to a similar degree. Only CPAP therapy may improve ventilatory efficiency during exercise and may have favorable effects on LVEF. Therefore, our data suggest that CPAP is advantageous compared to oxygen in the treatment of CSA in patients with chronic heart failure.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543