Trilevel adaptive servoventilation for the treatment of central and mixed sleep apnea in chronic heart failure patients

Background: Sleep-disordered breathing (SDB) inpatients with heart failure (HF) is of major prognostic impact, though treatment of simultaneously occurring central and mixed apnea events is challenging. The objective was to examine long-term effects of a new trilevel adaptive servoventilation (ASV) therapy in patients with systolic or diastolic HF. Methods: A total of 45 consecutive patients with a history of HF, elevated N-terminal prohormone of brain natriuretic peptide levels, objective signs of cardiac dysfunction, and moderate to severe SDB (apnea-hypopnea index [AHI] >= 15/h) with combined central and mixed respiratory events were included in this study and ASV therapy (SOMNOvent CR, Weinmann) was offered. Results: In 38 patients (84%), ASV therapy was successfully initiated, with 23 (51%) patients showing appropriate compliance (device use >= 4 h/night for >= 5 d/w) after 3.6 +/- 1.2 months. In these patients ASV therapy and HF status were re-evaluated. A sustained reduction was achieved in AHI (42.8 +/- 17.5/h vs 8.9 +/- 5.8/h; p < 0.001) and oxygen saturation. Improvements also were recorded in New York Heart Association (NYHA) functional class (2.4 +/- 0.5-1.9 +/- 0.4; p < 0.001) and oxygen uptake during cardiopulmonary exercise testing (VO2 peak, 13.64 +/- 3.5-15.8 +/- 5.8 ml/kg/min; p < 0.002). Conclusion: In selected HF patients, trilevel ASV therapy is able to treat SDB with combined central and mixed respiratory events. This treatment is associated with an improvement in HF symptoms and objective cardiopulmonary performance. (c) 2013 Elsevier B.V. All rights reserved.