Acute hemodynamic effects of adaptive servo ventilation in patients with pulmonary hypertension
Shusuke YagiMasashi AkaikeTakashi IwaseKenya KusunoseToshiyuki NikiKoji YamaguchiKunihiko KoshibaYoshio TaketaniNoriko TomitaHirotsugu YamadaTakeshi SoekiTetsuzo WakatsukiMasataka Sata
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Positive airway pressure
Cheyne–Stokes respiration
Central sleep apnea
Central sleep apnea
Cheyne–Stokes respiration
Positive airway pressure
Apnea–hypopnea index
Hypopnea
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Cheyne–Stokes respiration
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Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) is associated with a poor prognosis in patients with heart failure (HF). However, some patients do not respond to continuous positive airway pressure (CPAP), so other therapeutic modalities should be considered, such as bi-level positive airway pressure (PAP), which also assists respiration and might be effective for such patients.The 20 patients with HF because of left ventricular systolic dysfunction were assessed: 8 had ischemic etiology, and all had severe CSA according to the apnea - hypopnea index (AHI) determined by polysomnography. All diagnosed patients underwent repeat polysomnography using CPAP. The AHI improved significantly in 11 (AHI <15), but only slightly in 9, in whom the AHI remained high (>or=15). Bi-level PAP titration significantly improved the AHI in the latter group. Those who were unresponsive to CPAP had significantly lower PaCO(2), higher plasma brain natriuretic peptide (BNP), longer mean duration of CSR and fewer obstructive episodes than CPAP responders. After 6 months of positive airway support with either CPAP (n=9) or bi-level PAP (n=7), BNP levels significantly decreased and left ventricular ejection fraction significantly increased.Bi-level PAP could be an effective alternative for patients with HF and pure CSR-CSA who are unresponsive to CPAP.
Cheyne–Stokes respiration
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THREE CLASSES OF CENTRAL SRBD ARE DISTINGUISHED: 1. Central sleep apnea (CSA), 2. Cheyne-Stokes Respiration as a subgroup of CSA and 3. central hypoventilation syndromes. Reduced or completely absent central respiratory drive without upper airway obstruction is the common feature of central SRBD. Hypoventilation syndromes most often occur secondary in patients with neuromuscular, pulmonary or sceletal diseases or in patients with massive obesity. In patients with hypoventilation during sleep nocturnal and exertional dyspnea and headaches are frequently reported symptoms. Excessive daytime sleepiness is the key symptom in patients with central sleep apnea syndrome. Cheyne-Stokes Respiration is frequent in heart failure patients but in many cases does not cause symptoms specific for the breathing disorder. If there are symptoms or if ambulatory recording of breathing during sleep suggests a sleep related breathing disorder, polysomnography is then performed to definitively rule out or confirm the diagnosis and to initiate treatment, if needed. The indication for treatment in asymptomatic patients with central sleep apnea and Cheyne-Stokes Respiration may be difficult, as there are very little data concerning the long-term benefit in these patients. Symptomatic patients and those with severe central sleep apnea should be treated. Oxygen and CPAP may be effective in 20-30% of patients each. If these treatment options are ineffective, non-invasive pressure support ventilaiton can be used. In patients suffering from hypoventilation syndromes the treatment of choice is non-invasive pressure support ventilaiton combined with supplemental oxygen, if required.
Central sleep apnea
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Cheyne–Stokes respiration
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The risk factors, clinical manifestations, pathophysiology, diagnosis and treatment options for central sleep apnea and Cheyne-Stokes respiration in patients with heart failure are highlighted in this review. The effectiveness and prospects of therapeutic approaches are discussed: CPAP therapy, adaptive servo ventilation, transvenous stimulation of the phrenic nerve.
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A 57-year-old man was admitted with dyspnea. Clinical evaluation revealed atrial fibrillation and congestive heart failure (CHF). Standard medical therapy of CHF failed to completely improve the dyspnea and polysomnography revealed Cheyne-Stokes respiration with central sleep apnea (CSR-CSA). He was equipped with noninvasive positive pressure ventilation (NPPV) with bilevel positive airway pressure (BiPAP). The combined therapy of medical treatment of the CHF and administration of NPPV with BiPAP reduced the CSR-CSA. This regimen resulted in marked improvement of cardiac function, evaluated by echocardiography, and reduction of plasma concentration of brain natriuretic peptide. After the patient recovered from CHF and was discharged from hospital, he continued to use NPPV with BiPAP at home. In patients with CHF, it is important to be aware of sleep-related breathing disorders because treatment will not only improve the hypoxemia, but also the cardiac dysfunction. (Circ J 2004; 68: 878 - 882)
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Obstructive sleep apnea (OSA) is characterized by repetative obstruction of the upper airway. Positive airway pressure has evolved as the preferred therapeutic modality for OSA. PAP can be used successfully to treat both OSA and central sleep apnea (CSA). PAP usage affects a variety of medical diseases. Proper titration and attention to compliance is paramount in proper usage of PAP. Finally, auto-titrating devices and adaptive servo ventilation may be used to treat and possibly diagnose sleep disorder breathing and the later may have role in treating complex sleep apnea. Keywords: Obstructive sleep apnea, positive airway pressure, continuous positive airway pressure, bilevel positive airway pressure, apnea hypopnea index, central sleep apnea, Cheyne-Stokes respiration, auto-titrating positive airway pressure, adaptive servo ventilation
Central sleep apnea
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