PURPOSE: The purpose of this study is to assess the long term effects of domiciliary bilevel noninvasive positive pressure ventilation (NPPV) on sleep apnea, cardiac function, sympathetic nervous activity and heart rate variability in stable congestive heart failure.
METHODS: We examined 10 patients with congestive heart failure with Spo2, chest and abdominal motion, nasal air flow sensor and electrocardiographic monitoring system (TEIJIN, Morpheus C) during sleep under room air (Air) and bilevel NPPV before (Control;C) and after 1 month (1M), 4 months (4M), 1 year (1Y) and 3 years (3Y) of domiciliary NPPV.
RESULTS: Three of 10 patients could not attach the nasal mask. One of them died suddenly 1 month later. One of the rest 7 patients rejected to continue NPPV after 1M because of uncomfortableness. Tow of 6 patients who continued NPPV more than 1Y and had severe heart failure died of the progression of heart failure. Apnea hypopnea index (AHI) and central apnea index (CAI) improved from 23/h;11/h (C;Air) to 9;2 (C;NPPV), 9;2 (1M;NPPV), 10;3 (4M;NPPV), 10;1 (1Y;NPPV) and 12;1 (3Y;NPPV), respectively. The percent fractional shortening and the left ventricular ejection fraction increased from 21%;42% (C) to 28;51 (1M), 29;53 (4M), 32;56 (1Y) and 30;56 (3Y), respectively. Mean heart rate decreased from 65bpm (C) to 59 (1Y) and 60 (3Y). Serum noradrenaline decreased in 1M and 1Y. Four patients who completed 3Y of domiciliary NPPV had especially good physical condition.
CONCLUSION: The domiciliary bilevel NPPV for 3 years improved a sleep apnea, cardiac function and sympathetic nervous activity in patients with congestive heart failure, and the patients who completed 3 years of domiciliary bilevel NPPV had improved quality of life.
CLINICAL IMPLICATIONS: The long term domiciliary bilevel NPPV may be the useful treatment to improve the sleep apnea, cardiac function, sympathetic nervous activity and quality of life in patients with stable congestive heart failure.
DISCLOSURE: Hitoshi Koito, None.