PURPOSE: The purpose of this study is to evaluate one year effects of adaptive servo-ventilation (ASV) on sleep apnea (SA), quality of life (QOL) and cardiac function in patients with congesitive heart failure (CHF) and sleep apnea.
METHODS: Subjects were 9 patients with CHF and SA who were treated with bilevel positive airway pressure (PAP) and converted to ASV. The patients were performed pulse oxymetry, nasal air flow, chest and abdominal wall motion and electrocardiographic monitoring system (TEIJIN, Morpheus C) before bilebel-PAP treatment (B), on room air just before ASV (Control;C), after 3 months of domiciliary ASV (3M;ASV) and 1 year of ASV (1Y;ASV). New York Heart association (NYHA) functional class and minimum symptom appearing activity (METs), Epworth Sleepiness scale, chest rentogenogram, Doppler echocardiography, respirtory function, and serum and urinary noradrenaline level were compared before and after 3 months and 1 year of domciliary ASV.
RESULTS: Apnea hypopnea index (AHI;/h) improved from 35(B) and 22(C) to 9(3M) and 6.5(1Y). Central apnea index (CAI;/h) decreased from 13.6(B) and 7.5(C) to 1.0(3M) and 0.4(1Y).Oxygen desaturation index (ODI4%;/h) improved from 30(C) to 9(3M) and 6(1Y). The NYHA class improved from 2.7(B) and 2.4(C) to 2.1(3M) and 2.3(1Y), and minimum symptpm appearing activity increased from 4.1(C) to 4.8(3M) and 4.5(1Y). Cardiothoracic ratio (%) reduced from 55(B) and 55(C) to 53(3M) and 52(1Y).Although no significant reduction of enddiastolic left ventricular diameter was seen, endsystolic dimension reduced and fractionl shortening ratio (%FS;%) and ejection fraction (EF;%) improved from 29;54(B) and 28;52(C) to 30;55(3M) and 35;63(1Y), respecrively. Right ventricular systolic pressure and degree of the mitral regurgitation improbed in one year of ASV.Urinary and serum noradrenaline decreased from 150;0.4(C) to 112;0.4(3Y) and 113;0.3(1Y), respectively.
CONCLUSION: These results suggest that one year of domiciliary ASV is useful for improving SA, QOL, cardiac function and sympathetic nervous activity in patients with CHF and SA.
CLINICAL IMPLICATIONS: One year of domiciliary ASV is the useful therapy for CHF with SA.
DISCLOSURE: Hitoshi Koito, No Financial Disclosure Information; No Product/Research Disclosure Information