Adaptive servoventilation improves cardiac function in patients with chronic heart failure and Cheyne-Stokes respiration

doi:10.1016/j.ejheart.2008.04.007

European Journal of Heart Failure 2008 10(6):581-586; doi:10.1016/j.ejheart.2008.04.007

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Adaptive servoventilation improves cardiac function in patients with chronic heart failure and Cheyne–Stokes respiration

Olaf Oldenburg^a^,*, Anke Schmidt^b, Barbara Lamp^a, Thomas Bitter^a, Bogdan G. Muntean^a, Christoph Langer^a and Dieter Horstkotte^a

^a Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum Bad Oeynhausen, Germany
^b Cardiac Research Unit Bad Oeynhausen, Germany

^* Corresponding author. Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr, University Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany. Tel.: +49 5731 97 1258; fax: +49 5731 97 2194. E-mail address: akohlstaedt{at}hdz-nrw.de

Abstract

Background and aims: Sleep disordered breathing (SDB), especially Cheyne–Stokesrespiration (CSR) is common in patients with chronic heart failure(CHF). Adaptive servoventilation (ASV) was recently introducedto treat CSR in CHF. The aim of this study was to investigatethe effects of ASV on CSR and CHF parameters.

Methods: In 29 male patients (63.9±9 years, NYHA $≥$ II, left ventricularejection fraction [LV-EF] $≤$ 40%), cardiorespiratory polygraphy,cardiopulmonary exercise (CPX) testing, and echocardiographywere performed and concentrations of NT-proBNP determined beforeand after 5.8±3.5 months (median 5.7 months) of ASV (AutoSetCS^TM2, ResMed) treatment. All patients also received guideline-drivenCHF therapy.

Results: Apnoea–hypopnoea-index was reduced from 37.4±9.4/hto 3.9±4.1/h (p<0.001). Workload during CPX testingincreased from 81±26 to 100±31 W (p=0.005), oxygenuptake (VO₂) at the anaerobic threshold from 12.6±3 to15.3±4 ml/kg/min (p=0.01) and predicted peak VO₂ from58±12% to 69±17% (p=0.007). LV-EF increased from28.2±7% to 35.2±11% (p=0.001), and NT-proBNP levelsdecreased significantly (2285±2192 pg/ml to 1061±1293pg/ml, p=0.01).

Conclusions: In selected patients with CHF and CSR, addition of ASV to standardheart failure therapy is able to improve SDB, CPX test results,LV-EF and NT-proBNP concentrations.

Key Words: Adaptive servoventilation • Chronic heart failure • Cheyne–Stokes respiration • Sleep disordered breathing

Received November 26, 2007; Revised March 20, 2008; Accepted April 11, 2008

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