Changes in cognitive function and daytime sleepiness in patients with chronic heart failure and Cheyne-Stokes respiration with adaptive servo ventilation treatment.

STUDY OBJECTIVES: Cheyne - Stokes respiration (CSR) is prevalent in patients with chronic heart failure (CHF). Adaptive Servo Ventilation (ASV) alleviates CSR and improves objective sleep quality. We investigated the effects of ASV on neurocognitive function in the symptomatic phenotype of patients with CSR and CHF. METHODS: This case series included patients diagnosed with stable CHF (NYHA ≥ II) and CSR (N = 8). Sleep and neurocognitive function were assessed at baseline and after 1- and 6-months following initiation of ASV treatment. RESULTS: In CHF patients (n = 8, median age 78.0[64.5-80.8] years and BMI 30.0[27.0-31.5] kg/m2, median ejection fraction 30[24-45]%, Epworth Sleepiness Scale (ESS) score 11.5[9.0-15.0]), ASV markedly improved respiration during sleep (Apnea-Hypopnea Index (AHI) 44.1[39.0-51.5]n/h at baseline, 6.3[2.4-9.7]n/h at 6 months treatment, respectively, p < 0.01). The 6-min-walk test distance increased by treatment from (295.0[178.8-385.0] m to 356.0[203.8-495.0] m (p = 0.05)). Sleep structure was modified, and Stage 3 increased markedly from 6.4[1.7-20.1] % to 20.8[14.2-25.3] %, p < 0.02). Sleep latency in the Maintenance of Wakefulness Test increased from 12.0[6.0-30.0] min to 26.3[12.0-30.0] min, (p = 0.04). In the Attention Network Test, evaluating neurocognition, the number of lapses decreased from 6.0[1.0-44.0] to 2.0[0.3-8.0], (p = 0.05) and the overall number of responses to a preset stimulus increased after treatment (p = 0.04). CONCLUSIONS: ASV treatment in CHF patients with CSR may improve sleep quality, neurocognition and daytime performance.

Quality of life in patients with congestive heart failure and central sleep apnea.

OBJECTIVE: To assess the impact of Cheyne-Stoke respiration-central sleep apnea (CSR-CSA) on quality of life (QOL) in patients with congestive heart failure (CHF). QOL was established using the MLHFQ (Minnesota Living with Heart Failure Questionnaire), and the FOSQ (Functional Outcomes of Sleep Questionnaire). METHODS: We examined 90 patients with CHF. The diagnosis of CSR-CSA was performed by polysomnography. We established a correlation between the apnea-hypopnea index (AHI) and the MLHFQ and FOSQ scores. RESULTS: Five patients were excluded (obstructive sleep apnea). Of the 85 remaining patients, 25 presented CSR-CSA. The mean MLHFQ score was higher in patients with CHF and CSR-CSA (25.8+/-2.97 vs. 16.6+/-2.05; p=0.01), and showed a significant yet moderate correlation with the AHI. A lower mean FOSQ score was obtained for the group of patients with CHF and CSR-CSA (78.4+/-4.31 vs. 88.47+/-2.4; p=0.03), showing weak negative correlation with the AHI. CONCLUSION: According to the MLHFQ scores, it seems that CHF patients with CSR-CSA have a worse QOL than those with CHF alone. Although this could be attributable to a greater impairment of heart function in the former group, the FOSQ scores indicate some influence of their sleep disorder on the impairment of QOL.

[Adaptive servoventilation: effect on Cheyne-Stokes-Respiration and on quality of life]. / Adaptive Servoventilation bei chronischer Herzinsuffizienz: Wirkung auf Cheyne-Stokes-Atmung und Lebensqualität.

BACKGROUND: Adaptive servo-ventilation (ASV) (AutoSetCS, ResMed) is a novel non-invasive ventilation modality for the treatment of Cheyne-Stokes-Respiration (CSR) in patients with heart failure. This study aimed to investigate the effect of ASV on sleep disordered breathing (SDB), afternoon nap duration, urine voidings, and quality of life. METHODS: 11 patients with CSR due to heart failure (EF < 40 %) were treated with ASV for a period of 6 weeks. Apnea-Hypopnoe-Index (AHI), Arousalindex (AI), duration of afternoon nap, number of voidings, and heart specific quality of life were assessed before and at the end of the treatment period. RESULTS: The average usage time of ASV was 5.8 +/- 2.1/h per day. With ASV the AHI was reduced from 48.2 +/- 11.6 to 6.4 +/- 8.3/h (p < 0.001) and the AI from 33.9 +/- 12.5 to 18.4 +/- 9.3 /h (p < 0.05). The afternoon nap duration was significantly less (1.4 +/- 0.6 vs. 0.7 +/- 0.4 hours per day; p = 0.004) as was the number of nocturnal voidings (2.9 +/- 0.7 vs. 1.1 +/- 0.3 per night; p = 0.007). There was a significant improvement in heart specific quality of life as measured with the Minnesota Living with heart failure questionnaire (43.5 +/- 21.1 vs. 27.6 +/- 15.7 (p = 0.02). CONCLUSION: ASV is well tolerated and improves SDB and quality of life of patients with heart failure with CSR.