Abstract
Adaptive servoventiation therapy (ASV) is designed to treat hypocapnic central sleep apnoea (Cheyne-Stokes respiration) in heart failure (HF) . It remains unclear whether this therapy increases stroke volume (SV) and if, this is mediated by a decrease in cardiac afterload due to increased parasympathetic nervous activity (PNA) or by a change in baroreceptor reflex sensitivity.
12 patients with HF (12 male; 70 ± 9 years; NYHA ≥ II; EF ≤ 45% and Cheyne- Stokes respiration) and 14 healthy volunteers (13 male, 24 ± 4 years, EF ≥ 60%, AHI < 5/h) were ventilated non-invasively for 1 h with ASV (PaceWave™). Hemodynamic effects were analyzed non-invasively and compared to findings 30 min before and after ASV.
Changes in SV on ASV were significantly different between both groups (+5 ± 8% in HF patients vs. -4 ± 9% in volunteers, p=0.01). HF demonstrated a significant increase in markers of PNA (HFnuRRI) during ASV (56 ± 21 % vs. 68 ± 20 % on ASV; p=0.02), whereas volunteers showed a shift towards an increase in markers of sympathetic nervous activity (SNA, LFnudBP) during ASV (44 ± 12 % vs. 48 ± 8 % on ASV; p=0.04). Noteworthy those changes in autonomic function did not translate into a change in the mean total slope of the baroreceptor reflex neither in patients nor in volunteers.
ASV treatment in HF patients with Cheyne-Stokes respirations leads to an increase in SV likely mediated by a decrease in cardiac afterload due to an increased vagal activity. Baroreceptor reflex sensitivity remains largely unaffected.
- © 2014 ERS