Einfluss der Adaptiven Servoventilation auf das BNP bei Patienten mit Cheyne-Stokes-Atmung und leicht- bis mittelgradiger systolischer und diastolischer Herzinsuffizienz

Zusammenfassung

Hintergrund: CPAP hat unterschiedliche Effekte auf eine zentrale Schlafapnoe mit Cheyne-Stokes-Atmung (CSA-CSR), während die Adaptive Servoventilation (ASV) effektiver in der Normalisierung der Atmung bei Herzinsuffizienzpatienten ist. Ziel der Untersuchung war es nachzuweisen, dass eine AHI-Normalisierung durch ASV erhöhte BNP-Werte auch von Patienten mit milder systolischer und diastolischer Herzinsuffizienz reduziert.

Methode: Von April 2004 bis Oktober 2006 wurden Patienten mit CSA-CSR – ohne und mit begleitender obstruktiver Schlafapnoe (OSA) –, klinischen Zeichen der Herzinsuffizienz – unabhängig von der EF – und erhöhten BNP-Werten (> 100 pg/ml) mit ASV therapiert, sofern CPAP nicht zu einer AHI-Reduktion < 15/h geführt hatte. Nach 6 Wochen erfolgten eine Polysomnografie und BNP-Bestimmung.

Resultate: 15 männliche Patienten (AHI 48,3 ± 14,6/h) erfüllten die Einschlusskriterien; 7 hatten eine CSA-CSR + OSA, 8 eine CSA-CSR. Nach 6-wöchiger ASV-Therapie sank das BNP von 415 ± 196 pg/ml auf 264 ± 146 pg/ml (p = 0,0009). Die BNP-Reduktion war nur signifikant in der CSA-CSR + OSA Subgruppe (p = 0,0002).

Schlussfolgerung: ASV kann den AHI von Patienten mit milder systolischer und diastolischer Herzinsuffizienz und CSA-CSR±OSA normalisieren. Dies führt zu einer signifikanten BNP-Reduktion und legt nahe, dass auch in dieser Herzinsuffizienzgruppe eine Beseitigung der zentralen Schlafapnoe eine Verbesserung der Herzfunktion bewirkt.

Abstract

Background: CPAP therapy has a variable effect on central sleep apnea with Cheyne-Stokes respiration (CSA-CSR). Adaptive servoventilation (ASV) is more effective in normalising breathing in patients with heart failure. We hypothesised that, by normalising AHI, ASV reduces elevated BNP levels in patients with mild systolic and diastolic heart failure.

Methods: From April 2004 to October 2006, patients with CSA-CSR with and without concomitant obstructive sleep apnea (OSA), clinical evidence of heart failure, regardless EF, and elevated BNP levels (> 100 pg/mL) were selected for treatment with ASV, unless CPAP therapy had reduced AHI to < 15 per hour of sleep. Follow-up polysomnographies and BNP analyses were performed after 6 weeks.

Results: 15-male patients (AHI 48.3 ± 14.6/h) fulfilled all inclusion criteria; 7 patients had CSA-CSR + OSA, 8 had CSA-CSR. After 6 weeks of ASV, BNP decreased from 415 ± 196 pg/mL to 264 ± 146 pg/mL (p = 0.0009). There was only a significant BNP reduction in the CSA-CSR+OSA subgroup (p = 0.0002).

Conclusion: ASV can normalise AHI in patients with mild systolic and diastolic heart failure and CSA-CSR ± OSA, thus leading to a significant reduction of BNP levels. These findings suggest that effective suppression of sleep apnoea in such heart failure patients improves cardiac function.

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