The purpose of this study is to assess the effects of long-term domiciliary bilevel noninvasive positive presurre ventilation (NPPV) on sleep apnea (AP), cardiac function and sympathetic nervous activity in stable congestive heart failure (CHF).
The subjects were 6 patients with CHF (5 dilated cardiomyopathy and 1 old myocardial infarction) who completed 1 year of domiciliary NPPV, and divided into central SA (central apnea index (CAI)≥8615;3 cases) and obstructive SA (CAI <8315). These patients were examined with SpO2, chest and abdominal wall motion, nasal air flow sensor and electrocardiographic monitoring system (TEIJIN, Morpheus C) and urinary noradrenaline level during sleep under room air and NPPV before (Control;C) and after 1 month (1M), 4 month (4M) and 1 year (1Y) of domiciliary NPPV. Next morning mood index (NMI), chest rentgenogram, Doppler-echocardiography, respiratory function, serum noradrenaline and Epworth sleepiness scale (ESS) were also evaluated before and after 1M, 4M and 1Y of NPPV.
Apnea hypopnea index (AHI) improved from 23/h (C;Air) to 9 (C;NPPV), 9 (1M;NPPV), 10 (4M;NPPV) and 10 (1Y;NPPV), and obstructive SA contributed to this. CAI improved from 11 (C;Air) to 2 (C;NPPV), 2(1M;NPPV), 3 (4M;NPPV) and 1 (1Y;NPPV), although CAI of 1M;Air, 4M;Air or 1Y;Air did not show significant change, and central SA contributed. Left ventricular (LV) systolic dimension decreased from 50mm (C) to 46 (1M), 43 (4M) and 43 (1Y), and obstructive SA contributed. LV ejection fraction and % fractional shortening increased from 42, 21 (C) to 51, 28 (1M), 53, 29 (4M), and 56, 32 (1Y), respectively. Right ventricular systolic pressure decreased from 43mmHg (C) to 35 (1M), 33 (4M) and 35 (1Y), and central SA contributed. Serum noradrenaline had decreased tendency in 1M and 1Y.
Long-term domiciliary bilevel NPPV improved SA, cardiac function and sympathetic nervous activity in patients with stable CHF.
Long-term domiciliary bilevel NPPV may be the useful complementary therapy to improve SA, cardiac function and sympathetic nervous activity in patients with stable CHF.
H. Koito, None.