The purpose of this study is to assess three months effects of adaptive servo-ventilation (ASV) on sleep apnea, quality of life (QOL) and cardiac function in patients with congestive heart failure (CHF) and sleep apnea treated with bilebel positive airway pressure (PAP).
Subjects were 9 patients with CHF and sleep apnea who were treated with bilevel PAP and converted to the ASV. We performed pulse oxymetry, nasal air flow, chest and abdominal wall motion and electrocardiographic monitoring system (TEIJIN, Morpheus C) on room air (Control;C), bilevel PAP and ASV, and after 3 months of domiciliary ASV (3M;ASV). New York Heart Association (NYHA) functional class and minimum symptom appearing activity (METs) by questionare of specific activity scale, Epworth sleepiness scale, chest rentogenogram, Doppler echocardiogrphy, respiratory function, and serum and urinary noradrenaline level were compared before and after 3 months of domiciliary ASV. Acceptability questionares of bilevel PAP and ASV were also evaluated.
The ASV had better acceptance of insupiratry and expiratory air feeling, respiratory synchronization with the apparatus and sleep quality. Apnea hypopnea index (AHI;/h) improved from 22(c) to 12(bilevel PAP), 5(ASV) and 9(3M;ASV). Central apnea index (CAI;/h) decreased from 7.5(C) to 0.3(bilevel PAP), 0.4(ASV) and 1.0(3M;ASV). Oxygen desaturation index ≥ 4% (ODI4%;/h) improved from 30(C) to 14(bilevel PAP), 6(ASV) and 9(3M;ASV). The NYHA functional class and minimum symptom appearing activity improved from 2.4;4.1(C) to 2.1;4.8(3M;ASV), respectively. Cardiothoracic ratio (%) decreased from 55(C) to 53(3M;ASV). Left ventricular (LV) diastolic and systolic diameter (mm) and LV mass (g) decreasde from 60;43;260(C) to 55;39;210(3M;ASV), respectively. Degree of mitral regurgitation improved from 1.9(C) to 1.6(3M;ASV). FEV1.0% (%) increased from 77(C) to 80(3M;ASV).
These results suggest that ASV have better acceptance than bilevel PAP, and 3 months of domiciliary ASV is useful for improving sleep apnea, QOL and cardiac function in patients with CHF.
Three months of domiciliary ASV is the useful therapy for CHF, and ASV has superior acceptance to bilevel PAP.
Hitoshi Koito, No Financial Disclosure Information; No Product/Research Disclosure Information