To evaluate the effects of one month of domiciliary noninvasive positive pressure ventilation (NIPPV) on sleep apnea (SA), cardiac function and sympathetic nervous activity in stable congestive heart failure (CHF).
The subjects were 7 patients (pts) with stable CHF (5; dilated cardiomyopathy, 2; old myocardial infarction). These pts were divided into 2 groups (central apnea index (CAI) ≥15 (CSA group) and CAI<15 (OSA group)) and examined with SpO2, chest and abdominal motion, nasal air flow and ECG monitoring system (Morpheus C; Teijin), urinary noradrenaline and next morning mood during sleep at night under room air (Control) and NIPPV before and after one month of domiciliary NIPPV. Echo-Doppler cardiography, respiratory function, serum norepinephrine, Epworth sleepiness scale (ESS) were also evaluated before and after one month of NIPPV.
Apnea hypopnea index (AHI; /hr) improved significantly from 26±10 (Before, air) to 13±10 (Before, NIPPV), 11±8 (After, NIPPV) and 21±11 (After, air). After one month AHI decreased even without NIPPV, whichi was due to improvement of OSA. CAI improved from 12±10 (Before, air) to 2±2 (Before, NIPPV) and 4±6 (After, NIPPV). CAI in after, air did not change (11±10) and CSA contributed to this. Next morning mood improved only in after, air. LVEF (%) and %FS (%) after one month of NIPPV increased from 22±6 to 28±4 and 43±10 to 52±6, respectively. Systolic LV dimension (LVDs;mm), systolic RV pressure (RVsP;mmHg), s-noradrenaline and ESS after one month of NIPPV decreased from 49±4 to 45±5, 42±5 to 35±9, 0.48±0.28 and 12±6 to 8±6, respectively. CSA contributed to improvement of LVDs and RVsP, and OSA contributed to improvement of LVDs, %FS and LVEF. No significant change was seen in LA dimension, diastolic LV dimesion, respilatory function or u-noradrenaline.CONCLUSIONS: One month of domiciliary NIPPV is an effective therapy in imprving SA, day time sleepiness, cardiac function and sympathetic nervous activity in stable CHF.
One month of domiciliary NIPPV is a useful complimentary therapy for treating stable CHF.
H. Koito, None.