抄録
Background: Sleep-disordered breathing (SDB), including Cheyne-Stokes respiration with central sleep apnea (CSR-CSA), causes a deterioration in the prognosis of patients with chronic heart failure (CHF). Adaptive servo-ventilation (ASV) and oxygen therapy (O2) are useful for improving the CSR-CSA of CHF. The purpose of the present study was to examine the short-term effects of ASV and O2 on suppressing SDB (CSR-CSA dominant) in CHF, and the accompanying neurohumoral abnormalities (cardiac overload, sympathetic nervous activation, and myocardial damage). Methods and Results: Forty-two patients with CHF and SDB (mean LVEF 34.6%, apnea hypopnea index (AHI) 39.0/h, central apnea index (CAI) 17.6/h, obstructive apnea index (OAI) 2.6/h) were enrolled. We performed polysomnography (baseline, O2, and ASV) for 3 consecutive days, and we measured levels of atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP), noradrenalin, urinary catecholamines, and high-sensitivity troponin T. Both O2 and ASV reduced the AHI, CAI, arousal index, mean heart rate during sleep, and the levels of noradrenalin, urinary catecholamines, and high-sensitivity troponin T. However, only ASV, not O2, decreased the levels of ANP and BNP. Conclusions: ASV reduces cardiac overload, attenuates sympathetic nervous activity and ongoing myocardial damage effectively in CHF patients with SDB, and for patients who cannot use ASV, O2 is an alternative therapy. (Circ J 2012; 76: 2153–2158)
