Treatment of sleep apnea in chronic heart failure patients with auto-servo ventilation improves sleep fragmentation: a randomized controlled trial |
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| Affiliation: | 1. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany;2. Center for Pneumology, Donaustauf Hospital, Donaustauf, Germany;3. Centre de Médecine du Sommeil, Hopital Antoine Beclere, Clamart, France;4. Department of Medicine, Perleman School of Medicine, University of Pennsylvania, USA;5. Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA;6. Centre de Recherche, IUCPQ, Universite Laval, Quebec, Canada;7. Department of Respiratory Medicine, Prince Philip Hospital and Swansea College of Medicine, Wales, UK;8. Clinic for Pulmonology, Hospital of the Order of St. John of God Regensburg, Germany;1. Neurology Service, Hospital Clínic de Barcelona, IDIBAPS, Barcelona, Spain;2. CIBERNED, Barcelona, Spain;1. Department of Neurology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea;2. Department of Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea;3. Department of Biomedical Engineering, Keimyung University School of Medicine, Daegu, Republic of Korea;4. Department of Psychiatry, Yale University, School of Medicine, New Haven, CT, USA |
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| Abstract: | BackgroundImpaired sleep efficiency is independently associated with worse prognosis in patients with chronic heart failure (CHF). Therefore, a test was conducted on whether auto-servo ventilation (ASV, biphasic positive airway pressure [BiPAP]–ASV, Philips Respironics) reduces sleep fragmentation and improves sleep efficiency in CHF patients with central sleep apnea (CSA) or obstructive sleep apnea (OSA).MethodsIn this multicenter, randomized, parallel group trial, a study was conducted on 63 CHF patients (age 64 ± 10 years; left ventricular ejection fraction 29 ± 7%) with CSA or OSA (apnea–hypopnea Index, AHI 47 ± 18/h; 46% CSA) referred to sleep laboratories of the four participating centers. Participants were randomized to either ASV (n = 32) or optimal medical treatment alone (control, n = 31).ResultsPolysomnography (PSG) and actigraphy at home (home) with centralized blinded scoring were obtained at baseline and 12 weeks. ASV significantly reduced sleep fragmentation (total arousal indexPSG: −16.4 ± 20.6 vs. −0.6 ± 13.2/h, p = 0.001; sleep fragmentation indexhome: −7.6 ± 15.6 versus 4.3 ± 13.9/h, p = 0.003, respectively) and significantly increased sleep efficiency assessed by actigraphy (SEhome) compared to controls (2.3 ± 10.1 vs. −2.1 ± 6.9%, p = 0.002). Effects of ASV on sleep fragmentation and efficiency were similar in patients suffering from OSA and CSA.ConclusionsAt home, ASV treatment modestly improves sleep fragmentation as well as sleep efficiency in CHF patients having either CSA or OSA. |
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