Respiratory effects of adaptive servoventilation therapy in patients with heart failure and cheyne-stokes respiration compared to healthy volunteers.

Background: Nocturnal adaptive servoventilation (ASV) therapy is now frequently used to treat Cheyne-Stokes respiration (CSR), which is highly prevalent in patients with moderate-to-severe heart failure (HF) and characterized by periodical breathing (hyperventilation). Objectives: This study analyzed and compared the acute effects of a novel ASV device on carbon dioxide pressure (pCO(2)) and oxygen saturation (SaO(2)) in HF patients with CSR and healthy volunteers. The influence of being asleep or awake on the ASV algorithm was also determined. Methods: All subjects underwent ASV (PaceWave (TM), ResMed) for 1 h. Transcutaneous pCO(2) (PtcCO(2)) and SaO(2) were assessed transcutaneously, while wakefulness was analyzed using EEG recordings. Assessments were made 30 min before and after ASV, and during 1 h of ASV. Results: Twenty HF patients (19 male; age 79 +/- 12 years) and 15 volunteers (13 male, age 25 +/- 4 years) were included. When awake, ASV was associated with a trend towards a decrease in PtcCO(2) and an increase in SaO(2) versus baseline in HF patients (34.4 +/- 3.2 to 33.7 +/- 3.8 mm Hg and 93.8 +/- 2.6 to 94.9 +/- 2.6%, respectively) and volunteers (39.5 +/- 3.0 to 38.2 +/- 3.8 mm Hg and 96.9 +/- 1.3 to 97.8 +/- 0.9%). While asleep during ASV, PtcCO(2) increased to 36.3 +/- 3.8 mm Hg and SaO(2) decreased to 93.8 +/- 2.6% in HF patients, with similar changes in volunteers (PtcCO(2) 41.7 +/- 3.0 mm Hg, SaO(2) 97.1 +/- 1.2). All comparisons were statistically significant (p <= 0.05, except the PtcCO(2) decrease in both groups when awake). Conclusions: ASV therapy might result in hyperventilation when subjects are awake, but while asleep, PtcCO(2) increased to mid-normal values, effects that would be favorable in HF patients with CSR. (C) 2015 S. Karger AG, Basel