Adaptive servoventilation improves cardiac function and respiratory stability

Cheyne-Stokes respiration (CSR) in patients with chronic heart failure (CHF) is of major prognostic impact and expresses respiratory instability. Other parameters are daytime pCO(2), VE/VCO(2)-slope during exercise, exertional oscillatory ventilation (EOV), and increased sensitivity of central CO(2) receptors. Adaptive servoventilation (ASV) was introduced to specifically treat CSR in CHF. Aim of this study was to investigate ASV effects on CSR, cardiac function, and respiratory stability. A total of 105 patients with CHF (NYHA >= II, left ventricular ejection fraction (EF) <= 40%) and CSR (apnoea-hypopnoea index >= 15/h) met inclusion criteria. According to adherence to ASV treatment (follow-up of 6.7 +/- 3.2 months) this group was divided into controls (rejection of ASV treatment or usage <50% of nights possible and/or <4 h/night; n = 59) and ASV (n = 56) adhered patients. In the ASV group, ventilator therapy was able to effectively treat CSR. In contrast to controls, NYHA class, EF, oxygen uptake, 6-min walking distance, and NT-proBNP improved significantly. Moreover, exclusively in these patients pCO(2), VE/VCO(2)-slope during exercise, EOV, and central CO(2) receptor sensitivity improved. In CHF patients with CSR, ASV might be able to improve parameters of SDB, cardiac function, and respiratory stability.