Chronic heart failure (CHF) is a syndrome that affects millions worldwide.
CHF occurs in around 10% people over 65 years of age
Consolidated data for western countries indicate that new diagnoses of CHF each year are 1–4 per 1000 population.1
Up to 73% of HF patients experience sleep-disordered breathing2 with either Cheyne-Stokes respiration (CSR)/central sleep apnea (CSA) or obstructive sleep apnea (OSA).
Cheyne-Stokes respiration occurs when periods of hyperventilation with waxing/waning tidal volume alternate with periods of central hypopnea/apnea.
CSR is a common form of SDB in patients with severe left ventricular dysfunction.3
What are the consequences of CSR?
Nocturnal CSR is associated with increased mortality4 in CHF patients and is also an independent risk factor for cardiac transplantation.
CSR is expected to accelerate the progression of heart failure by causing:
- Repetitive hypoxia
- Increased afterload
- Increased sympathetic activity5
- Oscillations in heart rate and blood pressure
The sleep fragmentation resulting from CSR also diminishes quality of life by causing fatigue and daytime sleepiness.
What are the benefits of CSR treatment with Adaptive Servo-Ventilation?
If CSR persists, despite optimal pharmacological therapy, positive airway pressure (PAP) treatment is indicated.
Various methods have been used to treat CSR—oxygen therapy, continuous positive airway pressure therapy (CPAP), bi-level ventilatory support and Adaptive Servo-Ventilation (ASV-CS).
A study6comparing the effects of one night of each of these therapies demonstrated superior results with ASV-CS technology.
Several studies have shown the long-term advantages of ASV-CS technology in treating patients with stable CHF:
- Fewer respiratory events7
- Improved sleep quality 8
- Higher average left ventricular ejection fraction9,10
- Increased exercise capacity 11
References
1. McMurray JJ et al. Epidemiology, aetiology, and prognosis of heart failure. Heart 2000; 83(5): 596. Better is Roger VL, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011, 123(4):e18-e209.
2. Ferreira S, et al. Prevalence and characteristics of sleep apnoea in patients with stable heart failure: Results from a heart failure clinic. BMC Pulm Med. 2010, 10:9
3. Lanfranchi PA, et al. Central sleep apnea in left ventricular dysfunction. Prevalence and implications for arrhythmic risk. Circulation 2003, 107: 727.
4. Javaheri S, et al. Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol. 2007, 49(20):2028-34.
5. Garcia-Touchard A, et al. Central sleep apnea: implications for congestive heart failure. Chest. 2008, 133(6):1495-504.
6. Vogt-Ladner, et al. Treatment of sleep-disordered breathing in heart failure. Oral presentation. ATS. May 2002.
7. Philippe C, et al. Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period. Heart. 2006, 92(3):337-42.
8. Fietze I, et al. Bi-level positive pressure ventilation and adaptive servo ventilation in patients with heart failure and Cheyne-Stokes respiration. Sleep Med. 2008, 9(6):652-9.
9. Takama N, et al. Effectiveness of Adaptive Servo-Ventilation for Treating Heart Failure Regardless of the Severity of Sleep-Disordered Breathing. Circ J. 2011, 75(5):1164-9.
10. Koyama T, et al. Short-term prognosis of adaptive servo-ventilation therapy in patients with heart failure. Circ J. 2011, 75(3):710-2.
11. Schadlich S, et al. [Cardiac function in patients with congestive heart failure and Cheyne-Stokes respiration in long-term treatment with adaptive servo ventilation (AutoSet CS)] Z Kardiol. 2004, 93(6):454-62.