Source: Annual Congress 2002 - Auto-CPAP in sleep apnoea: clinical aspects
Disease area: Sleep and breathing disorders

Abstract

Chronic hyperventilation and hypocapnoea have been implicated in the pathogenesis of Cheyne-Stokes respiration &/or central sleep apnoea, which are commonly seen in CHF. Aim: To compare the effectiveness of two interventions designed to increase PaCO₂ on sleep disordered breathing (SDB) in CHF; adaptive pressure support servo-ventilation (ASV: AutoSetCS, ResMed Ltd) and added external deadspace (DS). Method: 8 male patients mean (SEM) age 65.6 (3.05) yrs, with stable CHF were randomised to 3 nights of polysomnography; control (C), ASV and DS (500ml). Sleep and breathing parameters were compared using repeated measures ANOVA and paired t-tests. Results: PetCO₂ showed a significant increase (p<0.05) from wake to stable NREM sleep during C, ASV and DS. Compared to C, ASV showed a trend in reducing RDI (p= 0.12) but DS did not. DS increased arousal index (AI), decreased total sleep time (TST) and sleep efficiency (SE) whilst ASV did not affect these parameters. Conclusion: ASV showed a trend towards improving SDB in CHF patients. Despite increasing PetCO₂, DS did not stabilise breathing, possibly due to an increase in sleep fragmentation. (Support from ResMed Ltd & The Wellcome Trust)

TABLE 1: GROUP MEAN (SEM) RESULTS

	PetCO2 (mmHg)
	wake(w)	sleep (s)	Δ (s-w)	RDI (e/hr)	AI (e/hr)	TST (hr)	SE (%)
C	33.8 (2.2)	35.3(1.8)	2.4 (0.9)	30.4(9.1)	27.5(5.9)	5.1(0.3)	80.1(4.8)
ASV	31.8 (2.8)	37.0(2.7)	4.8 (1.5)	19.5(5.6)	23.4(3.9)	5.2(0.5)	79.9(5.5)
DS	37.2 (2.6)	40.7(2.9)	3.5 (1.4)	34.5(10.6)	45.1(6.6)	3.7(0.4)	58.8(4.7)
ANOVA	0.24	0.24	0.44	0.29	0.01	0.01	0.01

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Citations should be made in the following way:
I. Szollosi, M. J. Morrell, A. J. Coats, A. K. Simonds (London, United Kingdom). Comparison of adaptive pressure support servo-ventilation and deadspace on sleep-disordered breathing in patients with congestive heart failure (CHF). Eur Respir J 2002; 20: Suppl. 38, 175

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