Abstract 9558: Overnight Use of Adaptive Servo Ventilation Reduces Cardiac Overload and Improves Renal Function in Patients with Chronic Heart Failure and Cheyne-Stokes Respiration

Abstract

Background: Cheyne-Stokes respiration associated with central sleep apnea (CSR-CSA) deteriorates the prognosis of patients with chronic heart failure (CHF). Adaptive servo ventilation (ASV) is a new therapeutic modality to treat CSR-CSA. Renal function plays critical roles in the progression of CHF and is a strong predictor of clinical outcomes. Cystatin C is a more sensitive marker of renal function than creatinine. The purpose of the present study was to examine whether ASV is effective for cardiac overload and renal dysfunction in CHF with CSR-CSA. Methods and Results: Forty two patients with CHF and CSR-CSA (mean age 62.0 ± 11.8, male 37, New York Heart Association functional class 2.5 ± 0.6, mean left ventricular ejection fraction 34.6 ± 12.6%) were examined. We performed polysomnography for consecutive two days (baseline and on ASV), and measured levels of plasma N terminal pro B-type natriuretic peptide (NT-pro BNP), cystatin C, and estimated glomerular filtration rate (eGFR) by the MDRD formula. ASV significantly imporved apnea hypopnea index (39.0 ± 17.3 to 9.9 ± 7.9 /h, P<0.01), central apnea index (17.6 ± 14.2 to 1.1 ± 1.6 /h, P<0.01), arousal index (25.9 ± 9.0 to 16.7 ± 7.5 /h, P<0.01), mean SPO 2 (94.7 ± 2.8 to 96.7 ± 1.6%, P<0.01), and lowest SPO 2 (79.1 ± 8.9 to 89.2 ± 5.8%, P<0.01) compared to baseline. ASV reduced mean heart rate (72.1 ± 10.8 to 67.4 ± 9.8 bpm, P<0.01). ASV decreased levels of log NT-pro BNP (3.032 ± 0.725 to 2.955 ± 0.714, P<0.01) and cystatin C (1.337 ± 0.546 to 1.284 ± 0.471 mg/l, P<0.05), and improved eGFR (67.1 ± 32.4 to 70.4 ± 36.2 ml/min/1.73cm 2 , P<0.01). Conclusions: ASV improved CSR-CSA, reduced cardiac overload, and protected renal function in chronic heart failure patients with Cheyne-Stokes respiration. ASV has short-term (overnight) beneficial effects on not only CSR-CSA but also renal function. ASV might be a promising useful tool for chronic heart failure as an important non-pharmacotherapy.