Treatment options in Cheyne-Stokes respiration

Area of Science:

• Cardiology
• Respiratory Medicine
• Sleep Medicine

Background:

• Approximately 50% of heart failure patients experience sleep-disordered breathing, often a mix of obstructive and central types.
• Cheyne-Stokes respiration (CSR), characterized by fluctuating tidal volume, is a significant concern in heart failure, affecting patient survival and quality of life.
• The exact pathophysiology of CSR involves complex respiratory drive imbalances, including heightened CO2 sensitivity and altered apneic thresholds.

Purpose of the Study:

• To review the current understanding and management of Cheyne-Stokes respiration (CSR) in patients with heart failure.
• To evaluate the efficacy and evidence supporting various treatment modalities for CSR in this population.
• To highlight the emerging role of adaptive servoventilation (ASV) in managing CSR and related sleep breathing disorders.

Main Methods:

• Review of existing literature on sleep-disordered breathing in heart failure, focusing on CSR.
• Analysis of treatment options including oxygen, continuous positive airway pressure (CPAP), and adaptive servoventilation (ASV).
• Discussion of the pathophysiological mechanisms contributing to CSR in heart failure.

Main Results:

• Continuous positive airway pressure (CPAP) has demonstrated benefits in improving left ventricular function, with some retrospective data suggesting mortality reduction.
• However, prospective trials have not consistently confirmed mortality benefits of CPAP for CSR in heart failure.
• Adaptive servoventilation (ASV) has shown superiority over CPAP in managing CSR, but its long-term impact on cardiac parameters and survival is still under investigation.

Conclusions:

• CSR is a critical complication of heart failure that necessitates effective management strategies.
• While CPAP offers some cardiac benefits, its effect on mortality in CSR patients remains uncertain.
• ASV represents a promising therapeutic option for CSR in heart failure, warranting further long-term research into its efficacy and safety.