Efficacy of nasal bi-level positive airway pressure in congestive heart failure patients with Cheyne-Stokes respiration and central sleep apnea

Background Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) contributes to the poor prognosis in patients with congestive heart failure (CHF). Bi-level positive airway pressure (bi-level PAP) may be an effective alternative for treating CSR-CSA and CHF. Methods and Results Fourteen patients with CSR-CSA were divided into 2 groups, a control group that included 7 patients who decided to receive only conventional medications and a group of 7 patients that received bi-level PAP. Left ventricular ejection fraction (LVEF), mitral regurgitation (MR) area, plasma brain natriuretic peptide (BNP) concentration and the New York Heart Association (NYHA) functional class were evaluated initially (baseline) and 3 months later. In the control group, there were no significant changes in cardiac function during the study period. In contrast, in the group that received bi-level PAP, there were significant improvements in LVEF (from 36.3 +/- 2.9% to 46.0 +/- 4.0%, p=0.02), MR area (from 30.4 +/- 7.6% to 20.0 +/- 5.1%, p=0.02), BNP (from 993.6 +/- 332.0pg/ml to 474.0 +/- 257.6pg/ml, p=0.02) and NYHA functional class (from 3.1 +/- 0.1 to 2.1 +/- 0.1, p=0.03). Conclusion Treatment with bi-level PAP improved cardiac functions in CHF patients with CSR-CSA.