Abstract
Chronic heart failure (CHF) has been shown to be associated with an increased incidence of sleep-disordered breathing. Whether treatment with noninvasivepositive-pressure ventilation (NPPV), including continuous positive airway pressure, bi-level positive airway pressure and adaptive servo-ventilation, improves clinical outcomes of CHF patients is still debated. 2,832 CHF patients were enrolled in our analysis. NPPV was significantly associated with improvement in left ventricular ejection fraction (39.39% vs. 34.24%; WMD, 5.06; 95% CI, 3.30-6.81; P < 0.00001) and plasma brain natriuretic peptide level (268.23 pg/ml vs. 455.55 pg/ml; WMD, −105.66; 95% CI, [−169.19]-[−42.13]; P = 0.001). However, NPPV did not reduce all-cause mortality (0.26% vs. 0.24%; OR, 1.13; 95% CI, 0.93-1.37; P = 0.22) or re-hospitalization rate (57.86% vs. 59.38%; OR, 0.47; 95% CI, 0.19-1.19; P = 0.02) as compared with conventional therapy. Despite no benefits on hard endpoints, NPPV may improve cardiac function of CHF patients. These data highlight the important role of NPPV in the therapy of CHF.
Highlights
Sleep-disordered breathing (SDB), including Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) and obstructive sleep apnea (OSA), is highly prevalent in patients with chronic heart failure (CHF)
noninvasive positive pressure ventilation (NPPV) was significantly associated with improvement in left ventricular ejection fraction (39.39% vs. 34.24%; weighted mean difference (WMD), 5.06; 95% CI, 3.30-6.81; P < 0.00001) and plasma brain natriuretic peptide level (268.23 pg/ml vs. 455.55 pg/ml; WMD, -105.66; 95% CI, [-169.19]-[-42.13]; P = 0.001)
Large scale studies revealed that the prevalence of SDB in CHF patients is about 69% ~76% [1]
Summary
Sleep-disordered breathing (SDB), including Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) and obstructive sleep apnea (OSA), is highly prevalent in patients with chronic heart failure (CHF). NPPV has been recommended and widely used in the respiratory management of patients with acute heart failure (AHF) [6, 7]. Mainly including angiotensinconverting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) and β-blockers, has substantially improved the prognosis of patients with mild to moderate CHF, but the prognosis of patients with severe CHF remains poor.
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