Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan.
J Card Fail. 2012 Oct;18(10):769-75. doi: 10.1016/j.cardfail.2012.08.360.
Adaptive servoventilation (ASV) improves cardiac function and sympathetic nerve activity in patients with heart failure (HF). However, the mechanisms underlying these improvements remain obscure.
We compared muscle sympathetic nerve activity (MSNA) and cardiorespiratory polygraphy and echocardiography findings at baseline and at 3.5 ± 0.8 months' follow-up in 32 patients with HF (New York Heart Association functional class II or III; ejection fraction <45%) and central sleep apnea (CSA; apnea-hypopnea index [AHI] ≥15/h) who consented (n = 20; ASV group) or declined (n = 12; non-ASV group) to undergo ASV treatment. Compliance with ASV and changes in AHI were determined from data collected by integral counters in devices and from cardiorespiratory polygraphic findings, respectively. Ejection fraction and MSNA significantly changed in the ASV (both P < .001) but not the non-ASV group. Although changes in AHI and MSNA correlated, the average use of ASV did not. In contrast, changes in AHI and the average use of ASV were independent predictors of changes in ejection fraction (both P < .01).
ASV decreases MSNA and improves cardiac function in association with suppression of CSA in patients with HF.
适应性伺服通气（ASV）可改善心力衰竭（HF）患者的心脏功能和交感神经活性。然而，这些改善的机制仍不清楚。
我们比较了 32 例 HF 合并中枢性睡眠呼吸暂停（CSA；呼吸暂停低通气指数[AHI]≥15/h）患者的基线和 3.5±0.8 个月随访时的肌肉交感神经活性（MSNA）和心肺多导睡眠图及超声心动图检查结果，这些患者同意（n=20；ASV 组）或不同意（n=12；非 ASV 组）接受 ASV 治疗。通过设备中的积分计数器收集的数据和心肺多导睡眠图检查结果来确定 ASV 的依从性和 AHI 的变化。ASV 组的射血分数和 MSNA 均显著变化（均 P<.001），而非 ASV 组则无变化。尽管 AHI 和 MSNA 的变化相关，但 ASV 的平均使用量却不相关。相反，AHI 的变化和 ASV 的平均使用量是射血分数变化的独立预测因子（均 P<.01）。
ASV 可降低 HF 患者的 MSNA 并改善心脏功能，同时抑制 CSA。
