Sleep Center, Toranomon Hospital, Tokyo, Japan.
Circ Heart Fail. 2010 Jan;3(1):140-8. doi: 10.1161/CIRCHEARTFAILURE.109.868786. Epub 2009 Nov 20.
In patients with chronic heart failure (CHF), the presence of sleep-disordered breathing, including either obstructive sleep apnea or Cheyne-Stokes respiration-central sleep apnea, is associated with a poor prognosis. A large-scale clinical trial showed that continuous positive airway pressure (CPAP) did not improve the prognosis of such patients with CHF, probably because of insufficient sleep-disordered breathing suppression. Recently, it was reported that adaptive servo-ventilation (ASV) can effectively treat sleep-disordered breathing. However, there are no specific data about the efficacy of flow-triggered ASV for cardiac function in patients with CHF with sleep-disordered breathing. The aim of this study was to compare the efficacy of flow-triggered ASV to CPAP in patients with CHF with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea.
Thirty-one patients with CHF, defined as left ventricular ejection fraction <50% and New York Heart Association class >or=II, with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea, were randomly assigned to either CPAP or flow-triggered ASV. The suppression of respiratory events, changes in cardiac function, and compliance with the devices during the 3-month study period were compared. Although both devices decreased respiratory events, ASV more effectively suppressed respiratory events (DeltaAHI [apnea-hypopnea index], -35.4+/-19.5 with ASV; -23.2+/-12.0 with CPAP, P<0.05). Compliance was significantly greater with ASV than with CPAP (5.2+/-0.9 versus 4.4+/-1.1 h/night, P<0.05). The improvements in quality-of-life and left ventricular ejection fraction were greater in the ASV group (DeltaLVEF [left ventricular ejection fraction], +9.1+/-4.7% versus +1.9+/-10.9%).
These results suggest that patients with coexisting obstructive sleep apnea and Cheyne-Stokes respiration-central sleep apnea may receive greater benefit from treatment with ASV than with CPAP.
在慢性心力衰竭（CHF）患者中，存在睡眠呼吸障碍，包括阻塞性睡眠呼吸暂停或 Cheyne-Stokes 呼吸-中枢性睡眠呼吸暂停，与预后不良相关。一项大规模临床试验表明，持续气道正压通气（CPAP）并未改善此类 CHF 患者的预后，可能是因为睡眠呼吸障碍的抑制作用不足。最近，有报道称适应性伺服通气（ASV）可有效治疗睡眠呼吸障碍。然而，对于伴有睡眠呼吸障碍的 CHF 患者，流量触发的 ASV 对心功能的疗效尚无具体数据。本研究旨在比较流量触发的 ASV 与 CPAP 治疗伴有阻塞性睡眠呼吸暂停和 Cheyne-Stokes 呼吸-中枢性睡眠呼吸暂停的 CHF 患者的疗效。
31 例 CHF 患者（定义为左心室射血分数<50%且纽约心脏协会分级≥II 级），同时伴有阻塞性睡眠呼吸暂停和 Cheyne-Stokes 呼吸-中枢性睡眠呼吸暂停，被随机分为 CPAP 组或流量触发的 ASV 组。比较了 3 个月研究期间呼吸事件的抑制、心功能的变化以及对装置的顺应性。虽然两种装置均降低了呼吸事件，但 ASV 更有效地抑制了呼吸事件（DeltaAHI[呼吸暂停低通气指数]，ASV 组为-35.4+/-19.5；CPAP 组为-23.2+/-12.0，P<0.05）。ASV 的顺应性显著高于 CPAP（5.2+/-0.9 比 4.4+/-1.1 小时/夜，P<0.05）。ASV 组的生活质量和左心室射血分数的改善更大（DeltaLVEF[左心室射血分数]，+9.1+/-4.7%比+1.9+/-10.9%）。
这些结果表明，同时伴有阻塞性睡眠呼吸暂停和 Cheyne-Stokes 呼吸-中枢性睡眠呼吸暂停的患者可能从 ASV 治疗中获益更多，而不是 CPAP 治疗。
