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Published ahead of print on August 19, 2003, doi:10.1164/rccm.200212-1476OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 9, November 2003, 1109-1114

A more recent version of this article appeared on November 1, 2003
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Submitted on January 22, 2003
Accepted on August 13, 2003

A Randomised Controlled Trial of Adaptive Ventilation for Cheyne-Stokes Breathing in Heart Failure

Justin C T Pepperell1*, Nick A Maskell1, David R Jones1, Beverly A Langford-Wiley1, Nicky Crosthwaite1, John R Stradling1, and Robert J O Davies1

1 Oxford Centre for Respiratory Medicine, Sleep Unit and Respiratory Trials Unit, Churchill Hospital, Oxford, United Kingdom

* To whom correspondence should be addressed. E-mail: Justin.Pepperell{at}orh.nhs.uk.

Heart failure is associated with Cheyne-Stokes breathing, which fragments patients' sleep. Correction of respiratory disturbance may reduce sleep fragmentation and excessive daytime sleepiness. This randomised prospective parallel trial assesses whether nocturnal assist servo ventilation improves daytime sleepiness compared to control. 30 subjects (29 male) with Cheyne-Stokes breathing (mean apnoea hypopnoea index 19.8 ( 2.6), and stable symptomatic chronic heart failure (New York Heart Association NYHA class II - IV) were treated with one month's therapeutic (n=15) or sub-therapeutic adaptive servo ventilation. Daytime sleepiness (Osler Test) was measured before and after the trial with change in measured sleepiness the primary endpoint. Secondary endpoints included Brain natriuretic peptide levels and catecholamine excretion. Active treatment reduced excessive daytime sleepiness; mean Osler change +7.9 mins (SEM 2.9); compared to control; change -1.0 mins (SEM 1.7); difference 8.9 mins (95% CI 1.9 to 15.9 mins, p=0.014, unpaired t-test). Significant falls occurred in plasma BNP and urinary metadrenaline excretion. We conclude that Adaptive Servo Ventilation produces an improvement in excessive daytime sleepiness in patients with Cheyne Stokes breathing and chronic heart failure. This study suggests improvements in neurohormonal activation with this treatment.
Key words: sleep apnea, brain natriuretic peptide, placebo, positive airway pressure, randomised controlled trial




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