Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) has been detected in as many as 50% of patients with chronic congestive heart failure(CHF). The presence of CSR-CSA in a patient with CHF confers a worse prognosis. Unfortunately,there are few data on treating CSR-CSA in patients with CHF. The plasma concentration of several neurohormones has been shown to be independent markers of left ventricular ejection fraction(LVEF) and mortality in patients with heart failure.Our study was to compare the effects of assisted ventilation(Autoset CS, ResMed, Australia) on clinical outcomes and plasma BNP concentrations in elderly patients with heart failure and CSR-CSA.
25 consecutive patients with stable heart failure were underwent overnight polysomnographic study, echocardiographic evaluation and 6 minute walk test before and after treatment. In addition to standard therapy,patients with CSR-CSA(n=16) were treated by Autoset CS for 4 weeks. Plasma BNP concentrations were measured by radioimmunoassay.
Plasma BNP levels were significantly greater in patients with CSR-CSA than in patients without CSR-CSA[458.6±228.6ng/L(n=16) vs 245.4±212.4ng/L(n=9), p<0.01]. Plasma BNP levels were negatively correlated with LVEF(r=-0.78, p<0.01) and 6 minute walk distance(r=-0.58, p<0.05). There was positive correlation between BNP and central apnea-hypopnea index(AHI, r=0.64, p<0.05) in patients with CSR-CSA. Autoset CS treatment was associated with decrease of plasma BNP levels(458.6±228.6ng/L to 245.4±181.4ng/L, p<0.05) and improvement of central AHI(31.5±9.6 per hour to 10.1±7.6 per hour,p<0.001), LVEF(0.29±0.18 to 0.38±0.22, p<0.05) and exercise capacity(220±114 meters to 332±121 meters, p<0.01).
CSR-CSA is also common in elderly heart failure patients.Autoset CS is effective in treating CSR-CSA in heart failure patients according to clinical and neurohormonal changes.
CSR-CSA should be a target for current heart failure treatment strategies.BNP plasma levels could reflect the level of therapeutic success in patients with heart failure.
Y.M. Yuan, None.