Oldenburg Olaf, Schmidt Anke, Lamp Barbara, Bitter Thomas, Muntean Bogdan G, Langer Christoph, Horstkotte Dieter
Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
Eur J Heart Fail. 2008 Jun;10(6):581-6. doi: 10.1016/j.ejheart.2008.04.007. Epub 2008 May 16.
Sleep disordered breathing (SDB), especially Cheyne-Stokes respiration (CSR) is common in patients with chronic heart failure (CHF). Adaptive servoventilation (ASV) was recently introduced to treat CSR in CHF. The aim of this study was to investigate the effects of ASV on CSR and CHF parameters.
In 29 male patients (63.9+/-9 years, NYHA> or =II, left ventricular ejection fraction [LV-EF]< or =40%), cardiorespiratory polygraphy, cardiopulmonary exercise (CPX) testing, and echocardiography were performed and concentrations of NT-proBNP determined before and after 5.8+/-3.5 months (median 5.7 months) of ASV (AutoSet CS2, ResMed) treatment. All patients also received guideline-driven CHF therapy.
Apnoea-hypopnoea-index was reduced from 37.4+/-9.4/h to 3.9+/-4.1/h (p<0.001). Workload during CPX testing increased from 81+/-26 to 100+/-31 W (p=0.005), oxygen uptake (VO2) at the anaerobic threshold from 12.6+/-3 to 15.3+/-4 ml/kg/min (p=0.01) and predicted peak VO2 from 58+/-12% to 69+/-17% (p=0.007). LV-EF increased from 28.2+/-7% to 35.2+/-11% (p=0.001), and NT-proBNP levels decreased significantly (2285+/-2192 pg/ml to 1061+/-1293 pg/ml, p=0.01).
In selected patients with CHF and CSR, addition of ASV to standard heart failure therapy is able to improve SDB, CPX test results, LV-EF and NT-proBNP concentrations.
睡眠呼吸障碍（SDB），尤其是潮式呼吸（CSR）在慢性心力衰竭（CHF）患者中很常见。自适应伺服通气（ASV）最近被用于治疗CHF患者的CSR。本研究的目的是探讨ASV对CSR和CHF参数的影响。
对29例男性患者（63.9±9岁，纽约心脏协会心功能分级≥II级，左心室射血分数[LV-EF]≤40%）进行了心肺多导睡眠图、心肺运动（CPX）测试和超声心动图检查，并在接受ASV（AutoSet CS2，瑞思迈公司）治疗5.8±3.5个月（中位数5.7个月）前后测定NT-proBNP浓度。所有患者均接受了遵循指南的CHF治疗。
呼吸暂停低通气指数从37.4±9.4次/小时降至3.9±4.1次/小时（p<0.001）。CPX测试期间的工作量从81±26瓦增加到100±31瓦（p=0.005），无氧阈值时的摄氧量（VO2）从12.6±3毫升/千克/分钟增加到15.3±4毫升/千克/分钟（p=0.01），预计峰值VO2从58±12%增加到69±17%（p=0.007）。LV-EF从28.2±7%增加到35.2±11%（p=0.001），NT-proBNP水平显著降低（从2285±2192皮克/毫升降至1061±1293皮克/毫升，p=0.01）。
在选定的CHF和CSR患者中，在标准心力衰竭治疗基础上加用ASV能够改善SDB、CPX测试结果、LV-EF和NT-proBNP浓度。
