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Adaptive servo-ventilation and deadspace: effects on central sleep apnoea.
I Szollosi1, D M O'Driscoll, M J Dayer
1Academic Unit of Sleep and Breathing, Royal Brompton and Harefield NHS Trust, London, UK.
Journal of Sleep Research
|May 18, 2006
Summary
Adaptive servo-ventilation (ASV) and deadspace (DS) reduce central sleep apnoea (CSA) in heart failure patients. However, DS increases sleep fragmentation and arousals, unlike ASV, likely due to higher CO2 levels.
Area of Science:
- Cardiology
- Pulmonology
- Sleep Medicine
Background:
- Central Sleep Apnoea (CSA) is prevalent in heart failure patients.
- Adaptive Servo-Ventilation (ASV) and Deadspace (DS) are known to treat CSA by increasing PaCO2.
- The impact of elevated CO2 on sleep arousability is not fully understood.
Purpose of the Study:
- To compare the effects of ASV and DS on sleep and breathing in heart failure patients with CSA.
- To investigate the impact of these interventions on the Arousal Index (ArI).
Main Methods:
- Ten male heart failure patients with CSA underwent polysomnography.
- Three nights of interventions: control (C), ASV, and DS, in a randomized order.
- Measurements included apnoea-hypopnoea index and end-tidal CO2 (PetCO2).
Main Results:
- Both ASV and DS significantly reduced the apnoea-hypopnoea index compared to control.
- DS, but not ASV, decreased total sleep time and increased spontaneous Arousal Index.
- DS caused a greater increase in PetCO2 from wakefulness to sleep compared to ASV and control.
Conclusions:
- While both ASV and DS stabilize ventilation in heart failure patients with CSA, DS leads to increased sleep fragmentation.
- This sleep fragmentation with DS may be linked to elevated PetCO2 and respiratory effort.
- ASV appears to be a more favorable treatment for CSA in heart failure, preserving sleep architecture.
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