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First published online on October 20, 2007
Chest, doi:10.1378/chest.07-1620
A more recent version of this article appeared on July 1, 2008
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Effects of Dynamic Bilevel Positive Airway Pressure Support on Central Sleep Apnea in Men with Heart Failure

Michael Arzt, MD1; Roland Wensel, MD, PhD1; Sylvia Montalvan, MD2; Thomas Schichtl, MD1; Stephan Schroll, MD1; Stephan Budweiser, MD2; Friedrich C. Blumberg, MD3; Günther A.J. Riegger, MD1 and Michael Pfeifer, MD1,2

1Department of Internal Medicine II, Pneumology, University of Regensburg, Franz-Josef- Strauß-Allee 11, 93042 Regensburg, Germany 2Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany 3Prosper Hospital, Mühlenstraße 27, 45659 Recklinghausen, Germany

michael.arzt{at}klinik.uni-regensburg.de

Abstract

BackgroundTreatment with continuous positive airway-pressure (CPAP) improves cardiac function in chronic heart failure (CHF) patients with central sleep apnoea and Cheyne Stokes respiration (CSR-CSA) by stabilising ventilation, but frequently central apnoeas and hypopnoeas persist. Our objective was to test the hypothesis, that flow-targeted dynamic bilevel positive airway-pressure-support effectively suppresses CSR-CSA in CHF patients.

MethodsWe studied 14 CHF patients with CSR-CSA (and residual CSA on PAP therapy) during three consecutive nights: (a) Diagnostic polysomnography, (b) CPAP (n=10) or bilevel positive airway-pressure (BIPAP, n=4) titration and (c) dynamic bilevel positive airway-pressure-support with an expiratory positive airway-pressure (EPAP) set to suppress obstructive respiratory events and an inspiratory positive airway-pressure (IPAP) dynamically ranging between 0-15 cmH2O above the EPAP.

ResultsCPAP or BIPAP significantly reduced the apnoea hypopnoea-index (AHI, 46±4 to 22±4/hour, p=0.001) compared to the first night without treatment. Dynamic bilevel positive airway-pressure-support (EPAP 6.5±1.7 cmH2O, maximal IPAP 21.9±2.1 cmH2O) further reduced the AHI to 4±1 per hour of sleep compared to the untreated (p<0.001) and CPAP- or BIPAP-night (p=0.002). After the first night of dynamic bilevel positive airway-pressure-support patients rated on an analogue scale (range 0-10) the treatment as comfortable (6.9±0.6) and the sleep quality as improved compared to previous nights (7.4±0.6).

ConclusionFlow-targeted dynamic bilevel positive airway-pressure-support effectively suppresses CSR-CSA in patients with CHF and is well tolerated.

Key Words: cardiology • central sleep apnea • ventilation


Related Editorial

Filling in the Gaps: The Role of Noninvasive Adaptive Servoventilation for Heart Failure-Related Central Sleep Apnea
Lee K. Brown
Chest 2008 134: 4-7. [Full Text] [PDF]





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