Background

In contrast to continuous positive airway pressure (CPAP), the use of adaptive servo-ventilation (ASV) for treatment of central sleep apnoea (CSA) was associated with increased mortality in patients with chronic systolic heart failure (CHF). In order to characterize the interplay between sleep-disordered breathing, CHF and sympathovagal balance (SVB) this study investigated the effect of nocturnal CPAP and ASV on SVB in CSA patients with or without CHF.

Methods

Thirty-seven patients with ongoing positive airway pressure therapy (CPAP or ASV) for CSA (17 patients with systolic CHF - left ventricular ejection fraction <50% - and 20 patients with CSA but no CHF) underwent evaluation of SVB (spectral analysis of heart rate -HRV- and diastolic blood pressure variability) during full nocturnal polysomnography. The night was randomly split into equal parts including no treatment (NT), automatic CPAP and ASV. Data analysis was restricted to stable N2 sleep.

Results

In patients with CSA and systolic CHF, neither automatic CPAP nor ASV showed favourable effects on parameters reflecting SVB during N2 sleep (all p > 0.05). In contrast, in subjects with CSA without CHF automatic CPAP, but not ASV, favourably altered SVB by decreasing the low frequency and increasing the high frequency component of HRV (both p = 0.03).

Conclusions

Effects of various modes of positive airway pressure therapy of CSA on SVB during sleep depend on the mode of pressure support and underlying cardiac function. Automatic CPAP but not ASV favourably influences SVB in subjects without CHF, whereas both interventions leave SVB unchanged in patients with CHF.

中文翻译：

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适应性伺服通气疗法不能很好地改变睡眠收缩期心力衰竭和中枢性呼吸暂停患者的交感迷走神经平衡：初步数据。

背景

与持续气道正压（CPAP）相比，使用自适应伺服通气（ASV）治疗中枢性睡眠呼吸暂停（CSA）与慢性收缩性心力衰竭（CHF）患者死亡率增加相关。为了表征睡眠呼吸障碍，CHF和交感神经平衡（SVB）之间的相互作用，本研究调查了夜间CPAP和ASV对有或没有CHF的CSA患者的SVB的影响。

方法

对37例正在进行CSA气道正压通气治疗（CPAP或ASV）的患者（17例收缩期CHF-左室射血分数<50％-20例CSA但无CHF）进行了SVB评估（心脏频谱分析）夜间多导睡眠监测期间的心率（HRV-和舒张压变异性）。夜晚被随机分为相等的部分，包括不治疗（NT），自动CPAP和ASV。数据分析仅限于稳定的N2睡眠。

结果

在患有CSA和收缩期CHF的患者中，自动CPAP和ASV均未在N2睡眠期间对反映SVB的参数显示出有利影响（所有p  > 0.05）。相反，在没有CHF自动CPAP但没有ASV的CSA患者中，通过降低HRV的低频分量和高频分量（两者均为p  = 0.03），可以有利地改变SVB 。

结论

CSA的气道正压通气治疗的各种模式对睡眠期间SVB的影响取决于压力支持的模式和潜在的心脏功能。在没有CHF的受试者中，自动CPAP而非ASV会对SVB产生有利的影响，而两种干预措施均会使CHF患者的SVB保持不变。