Noninvasive pressure preset ventilation for the treatment of Cheyne-Stokesrespiration during sleep

Cheyne-Stokes respiration (CSR) during sleep is common in patients with con gestive heart failure (CHF), This pattern of breathing fragments sleep, lea ding to daytime symptoms of sleepiness and fatigue. It was hypothesized tha t by controlling CSR with noninvasive pressure preset ventilation (NPPV), t here would be a decrease in sleep fragmentation and an improvement in sleep quality. Nine patients (eight males, one female; mean +/- SD 65 +/- 11 yrs) with sym ptomatic CSR diagnosed on overnight polysomnography (apnoea/hypopnoea index (AHI) 49 +/- 10(.)h(-1), minimum arterial oxygen saturation (S-a,O-2, 77 /-7%) and CHF (left ventricular ejection fraction 25 +/-8%) were studied. A fter a period of acclimatization to NPPV (variable positive airway pressure (VPAP) II ST (TM), Sydney, NSW, Australia and bilevel positive airway pres sure (BIPAP)(TM), Murraysville, PA. USA, sleep studies were repeated on the rapy. NPPV almost completely abolished CSR in all patients with a reduction in AA I from 49 +/- 10 to 6 +/- 5(.)h(-1) (p < 0.001). Residual respiratory event s were primarily due to upper airway obstruction at sleep on-set. Arousal i ndex was markedly decreased from 42 +/- 6 to 17 +/-7(.)h(-1) (p < 0.001). S leep architecture showed a trend toward improvement with a reduction in sta ge 1 and 2 (79 +/- 7% during the diagnostic night rer sus 72 +/- 10%, durin g NPPV, (p=0.057)), whilst sleep efficiency, slow-wave sleep (SWS), and rap id eye movement (REM) were not altered. Controlling Cheyne-Stokes respiration with noninvasive pressure preset vent ilation resulted in reduced arousal and improved sleep quality in the patie nts with congestive heart failure. Noninvasive pressure preset ventilation should be considered a potential therapy for Cheyne-Stokes respiration in c ongestive heart failure in those patients who do not respond or fail to tol erate nasal continuous positive airway pressure therapy.