PMID- 21393364
OWN - NLM
STAT- MEDLINE
DCOM- 20110622
LR  - 20191210
IS  - 1468-3296 (Electronic)
IS  - 0040-6376 (Linking)
VI  - 66
IP  - 5
DP  - 2011 May
TI  - Complex sleep apnoea in congestive heart failure.
PG  - 402-7
LID - 10.1136/thx.2010.146522 [doi]
AB  - BACKGROUND: Sleep disordered breathing is common and of prognostic significance 
      in patients with congestive heart failure (CHF). Complex sleep apnoea (complexSA) 
      is defined as the emergence of central sleep apnoea during continuous positive 
      airway pressure (CPAP) treatment in patients with obstructive sleep apnoea (OSA). 
      This study aims to determine the prevalence and predictors for complexSA in 
      patients with CHF with OSA, and to assess the effects of treatment with adaptive 
      servoventilation. METHODS: 192 patients with CHF (left ventricular ejection 
      fraction (LVEF) </=45%, New York Heart Association (NYHA) class >/=2) and OSA 
      (apnoea-hypopnoea index (AHI) >/=15) were investigated using echocardiography, 
      cardiopulmonary exercise testing, measurement of hyperoxic, hypercapnic 
      ventilatory response, 6 min walk test and measurement of N-terminal pro-brain 
      natriuretic peptide (NT-proBNP) prior to CPAP introduction. If patients 
      demonstrated complexSA (AHI >15/h with <10% obstructive events) during CPAP 
      titration, adaptive servoventilation was introduced and the investigations were 
      repeated at 3 monthly follow-up visits. RESULTS: ComplexSA developed in 34 
      patients (18%) during CPAP titration. After adjustment for demographic and 
      cardiac parameters, measures of CO(2) sensitivity (higher hyperoxic, hypercapnic 
      ventilatory response) were independently associated with complexSA. Patients 
      using adaptive servoventilation had improved AHI, NYHA class, NT-proBNP 
      concentration, LVEF, hyperoxic, hypercapnic ventilatory response, oxygen uptake 
      during cardiopulmonary exercise testing and the relationship between minute 
      ventilation and the rate of CO(2) elimination (VE/Vco(2) slope) at last 
      individual follow-up (14+/-4 months). CONCLUSION: There is a high prevalence of 
      complexSA in patients with OSA and CHF, and those who develop complexSA have 
      evidence of higher respiratory controller gain before application of CPAP. 
      Treatment with adaptive servoventilation effectively suppressed complexSA and had 
      positive effects on cardiac function and respiratory stability.
FAU - Bitter, Thomas
AU  - Bitter T
AD  - Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr University Bochum, 
      Georgstrasse 11, D-32545 Bad Oeynhausen, Germany.
FAU - Westerheide, Nina
AU  - Westerheide N
FAU - Hossain, Mohammed Sajid
AU  - Hossain MS
FAU - Lehmann, Roman
AU  - Lehmann R
FAU - Prinz, Christian
AU  - Prinz C
FAU - Kleemeyer, Astrid
AU  - Kleemeyer A
FAU - Horstkotte, Dieter
AU  - Horstkotte D
FAU - Oldenburg, Olaf
AU  - Oldenburg O
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20110310
PL  - England
TA  - Thorax
JT  - Thorax
JID - 0417353
SB  - IM
MH  - Aged
MH  - Continuous Positive Airway Pressure
MH  - Exercise Test/methods
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*complications/diagnostic imaging
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Polysomnography
MH  - Positive-Pressure Respiration/methods
MH  - Risk Factors
MH  - Sleep Apnea, Central/*etiology/therapy
MH  - Sleep Apnea, Obstructive/etiology/therapy
MH  - Treatment Outcome
MH  - Ultrasonography
EDAT- 2011/03/12 06:00
MHDA- 2011/06/23 06:00
CRDT- 2011/03/12 06:00
PHST- 2011/03/12 06:00 [entrez]
PHST- 2011/03/12 06:00 [pubmed]
PHST- 2011/06/23 06:00 [medline]
AID - thx.2010.146522 [pii]
AID - 10.1136/thx.2010.146522 [doi]
PST - ppublish
SO  - Thorax. 2011 May;66(5):402-7. doi: 10.1136/thx.2010.146522. Epub 2011 Mar 10.