Changes in cognitive function and daytime sleepiness in patients with chronic heart failure and Cheyne-Stokes respiration with adaptive servo ventilation treatment

Abstract

Study objectivesCheyne - Stokes respiration (CSR) is prevalent in patients with chronic heart failure (CHF). Adaptive Servo Ventilation (ASV) alleviates CSR and improves objective sleep quality. We investigated the effects of ASV on neurocognitive function in the symptomatic phenotype of patients with CSR and CHF. MethodsThis case series included patients diagnosed with stable CHF (NYHA ≥ II) and CSR (N = 8). Sleep and neurocognitive function were assessed at baseline and after 1- and 6-months following initiation of ASV treatment. ResultsIn CHF patients (n = 8, median age 78.0[64.5–80.8] years and BMI 30.0[27.0–31.5] kg/m2, median ejection fraction 30[24–45]%, Epworth Sleepiness Scale (ESS) score 11.5[9.0–15.0]), ASV markedly improved respiration during sleep (Apnea-Hypopnea Index (AHI) 44.1[39.0–51.5]n/h at baseline, 6.3[2.4–9.7]n/h at 6 months treatment, respectively, p < 0.01). The 6-min-walk test distance increased by treatment from (295.0[178.8–385.0] m to 356.0[203.8–495.0] m (p = 0.05)). Sleep structure was modified, and Stage 3 increased markedly from 6.4[1.7–20.1] % to 20.8[14.2–25.3] %, p < 0.02). Sleep latency in the Maintenance of Wakefulness Test increased from 12.0[6.0–30.0] min to 26.3[12.0–30.0] min, (p = 0.04). In the Attention Network Test, evaluating neurocognition, the number of lapses decreased from 6.0[1.0–44.0] to 2.0[0.3–8.0], (p = 0.05) and the overall number of responses to a preset stimulus increased after treatment (p = 0.04). ConclusionsASV treatment in CHF patients with CSR may improve sleep quality, neurocognition and daytime performance.