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Adaptive servo-ventilation therapy of central sleep apnoea and its effect on sleep quality

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Abstract

Objectives

Poor sleep quality is common in patients with chronic heart failure (CHF). This study tested the hypothesis that adaptive servo-ventilation (ASV) therapy in CHF patients whose central sleep apnoea (CSA) was not suppressed by continuous positive airway pressure (CPAP) (CPAP-non-responders) would improve sleep quality compared to CPAP-responders receiving ongoing CPAP therapy.

Methods

Eighty-two patients with CHF (65 ± 9 years, left ventricular ejection fraction 35 ± 16 %) and CSA [apnoea–hypopnoea index (AHI) ≥15/h] were retrospectively studied. Within an average of 47 days, patients were reevaluated on CPAP therapy and stratified according to their suppression of CSA: 34 were CPAP-non-responders switched to ASV therapy the following day and 48 were CPAP-responders who continued on CPAP therapy. Polysomnographic parameters were assessed in the diagnostic night and on the last night of PAP therapy (CPAP or ASV) before the patient was discharged with the final pressure settings.

Results

Compared with the CPAP group, the ASV group had significantly greater reductions from baseline in AHI (−37 ± 15/h vs −28 ± 18/h, p = 0.02), arousal index (−12.7 ± 13.6/h vs −6.8 ± 12.5/h, p = 0.04) and sleep stage N1 (−9 ± 14 % vs −2 ± 12 %, p = 0.03). In addition, the ASV group gained significantly more rapid eye movement (REM) sleep compared with the CPAP group (+5 ± 9 % vs +1 ± 9 %, p = 0.02).

Conclusions

CPAP therapy is effective in reducing AHI in a significant proportion of CHF patients with reduced ejection fraction and CSA. Treatment of CSA with ASV in CHF patients reduces sleep fragmentation and improves sleep structure to a significantly greater extent than changes seen in responders to CPAP therapy.

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Acknowledgments

Medical editing assistance was provided by Nicola Ryan, independent medical writer, funded by ResMed.

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Author notes

    Authors and Affiliations

    1. Department of Internal Medicine II, Cardiology and Pneumology, Centre for Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

      Andrea Hetzenecker, Tatjana Roth, Christoph Birner, Lars S. Maier, Michael Pfeifer & Michael Arzt

    2. Department of Pneumology, Donaustauf Hospital, Donaustauf, Germany

      Michael Pfeifer

    3. Clinic for Pulmonology, Hospital of the Order of St. John of God Regensburg, Regensburg, Germany

      Michael Pfeifer

    Authors
    1. Andrea Hetzenecker
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    2. Tatjana Roth
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    6. Michael Arzt
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    Correspondence to Michael Arzt.

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    Conflict of interest

    Michael Arzt has received unrestricted grant support from Philips Home Healthcare Solutions (Murrysville, PA, USA), ResMed (Martinsried, Germany) and the German Foundation for Cardiac Research (Deutsche Stiftung für Herzforschung). Michael Arzt is the holder of an endowed professorship from the Free State of Bavaria at the University of Regensburg that was donated by Philips Home Healthcare Solutions (Murrysville, PA, USA) and ResMed (Martinsried, Germany). Tatjana Roth, Andrea Hetzenecker, Christoph Birner, Lars S. Maier and Michael Pfeifer have reported that they have no potential conflicts of interest with any companies/organizations whose products or services may be discussed in this article. The content is entirely the responsibility of the authors, and sponsors had no role in the design or conduct of the study.

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    A. Hetzenecker and T. Roth were contributed equally to this work.

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    Hetzenecker, A., Roth, T., Birner, C. et al. Adaptive servo-ventilation therapy of central sleep apnoea and its effect on sleep quality. Clin Res Cardiol 105, 189–195 (2016). https://doi.org/10.1007/s00392-015-0904-6

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    • DOI: https://doi.org/10.1007/s00392-015-0904-6

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