Ushijima Ryuichi, Joho Shuji, Akabane Takashi, Oda Yoshitaka, Inoue Hiroshi
Second Department of Internal Medicine, University of Toyama.
Circ J. 2014;78(6):1387-95. doi: 10.1253/circj.cj-13-1468. Epub 2014 Apr 4.
Long-term adaptive servoventilation (ASV) increases cardiac function more effectively than continuous positive airway pressure (CPAP), possibly via alleviation of sympathetic overactivation. The present study evaluated the effect of ASV and CPAP at comparable pressure on muscle sympathetic nerve activity (MSNA) in patients with heart failure (HF) and with or without periodic breathing (PB).
A total of 57 patients with HF (ejection fraction <0.45) were randomized to receive CPAP (n=28) or ASV (n=29). Respiratory profiles and MSNA were continuously monitored before and during CPAP and ASV (30min) at pressures of 6.5 and 6.6cmH2O, respectively. The severity of respiratory instability was determined using the coefficient of variation of tidal volume (CV-TV). Although heart rate and blood pressure remained unchanged, only ASV improved CV-TV. MSNA decreased in the ASV (P<0.001), but not in the CPAP group. The change in CV-TV independently predicted changes in MSNA (P<0.001). Device type and PB significantly interacted with changes in MSNA (P<0.05) and ASV exerted sympathoinhibitory effects in patients with PB, whereas CPAP did not. A sympathoinhibitory effect in patients without PB was not evident in either treatment arm.
ASV probably exerts its sympathoinhibitory effects in patients with HF and PB through pressure support.
长期适应性伺服通气（ASV）比持续气道正压通气（CPAP）能更有效地增强心功能，可能是通过减轻交感神经过度激活来实现的。本研究评估了在可比压力下，ASV和CPAP对心力衰竭（HF）患者且伴有或不伴有周期性呼吸（PB）时肌肉交感神经活动（MSNA）的影响。
总共57例HF患者（射血分数<0.45）被随机分为接受CPAP组（n = 28）或ASV组（n = 29）。分别在6.5和6.6cmH₂O压力下，于CPAP和ASV治疗前及治疗期间（30分钟）持续监测呼吸参数和MSNA。使用潮气量变异系数（CV-TV）来确定呼吸不稳定的严重程度。尽管心率和血压保持不变，但只有ASV改善了CV-TV。ASV组的MSNA降低（P<0.001），而CPAP组未降低。CV-TV的变化独立预测了MSNA的变化（P<0.001）。设备类型和PB与MSNA的变化存在显著交互作用（P<0.05），ASV对伴有PB的患者具有交感神经抑制作用，而CPAP则没有。在两个治疗组中，对不伴有PB的患者的交感神经抑制作用均不明显。
ASV可能通过压力支持对伴有PB的HF患者发挥其交感神经抑制作用。
