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Pneumologie 2002; 56(5): 282-287
DOI: 10.1055/s-2002-30698
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Positivdruckverfahren bei Cheyne-Stokes-Atmung infolge chronischer Herzerkrankung

Positive Pressure Ventilation in Cheyne-Stokes RespirationB.  Schönhofer1 , T.  Barchfeld1 , S.  Suchi1 , J.  Kerl1 , A.  Simon1 , D.  Köhler1
  • 1Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg-Grafschaft (Prof. Dr. Dieter Köhler)
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Publication History

Publication Date:
21 May 2002 (online)

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Zusammenfassung

Die kongestive Kardiomyopathie mit Cheyne-Stokes-Atmung (CSA) ist mit einer hohen Mortalitätsrate assoziiert. Continuous positive airway pressure (CPAP) bessert die Prognose. Wir berichten in dieser retrospektiven Untersuchung über unsere Ergebnisse zur Differenzialtherapie mit unterschiedlichen Positivdruckverfahren bei CSA. Der Beobachtungszeitraum reichte von 1995-1999. Einschlusskriterien waren ein Respiratory Disturbance Index > 10/h und mehr als 50 % zentrale und/oder gemischtförmige Apnoen. Jeder Patient wurde über jeweils 4 Wochen mit CPAP, Bilevel CPAP im Spontanmode (d. h. BiPAP S oder ST Modus) und BiPAP im kontrollierten Mode (d. h. BiPAP T) behandelt. Responder für das jeweilige Positivdruckverfahren wurden nach subjektiven und objektiven Kriterien definiert. Es wurden 41 männliche Patienten eingeschlossen. Die Responder verteilten sich folgendermaßen: CPAP: n = 13 Patienten (31,7 %), BiPAP S/ST: n = 9 Patienten (22,0 %) und BiPAP T: n = 12 Patienten (29,3 %). Insgesamt 7/41 Patienten (17,1 %) lehnten eine langfristige Therapie mit einem Positivdruckverfahren ab. Die überwiegende Mehrheit der Patienten mit CSA lässt sich mit CPAP bzw. BiPAP S/ST befriedigend einstellen. Auch wenn sich in der BiPAP-T-Respondergruppe die Atmung im Schlaf weitgehend normalisierte, kam diese Beatmungsform langfristig nur bei etwa 29 % der Patienten zur Anwendung.

Abstract

Cheyne-Stokes respiration (CSR) is found in patients with chronic left ventricular failure and associated with a reduced prognosis. Continuous positive airway pressure (CPAP) improves the survival rate. In this retrospective study we report on the effect of different positive pressure ventilation modes in CSR. The observation period lasted from 1995 - 1999. Inclusion criteria was CSR with a respiratory disturbance index > 10/h whereas > 50 % of the events had to be central and/or mixed. In each patient a 4 week lasting intervention with each of CPAP, Bilevel CPAP in spontan mode (i.e. BiPAP S or BiPAP ST) and BiPAP in controlled mode (i.e. BiPAP T) was performed. Responder were defined by subjective and objective criteria. In total 41 males were included. Responder were distributed as follows: CPAP: n = 13 patients (31.7 %), BiPAP S/ST: n = 9 patients (22.0 %) and BiPAP T: n = 12 patients (29.3 %). In total 7 from 41 patients (17.1 %) rejected a long-term treatment with positive pressure ventilation.

The majority of patients with CSR responded to CPAP and BiPAP S/ST mode. Compared to the other responder groups the best quality was reached with BiPAP T. However the latter was performed only by 29 % of the population.

Literatur

  • 1 Andreas S. Central sleep apnea and chronic heart failure.  Sleep. 2000;  23 Suppl 4 220-223
    PubMedGoogle Scholar
  • 2 Hanly P J, Zuberi-Khokhar N S. Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure.  Am J Respir Crit Care Med. 1996;  153 272-276
    CrossrefPubMedGoogle Scholar
  • 3 Javaheri S, Parker T J, Wexler L. et al . Occult sleep-disordered breathing in stable congestive heart failure.  Ann Intern Med. 1995;  122 487-492
    PubMedGoogle Scholar
  • 4 Javaheri S, Parker T J, Liming J D. et al . Sleep apnea in 81 ambulatory male patients with stable heart failure.  Circulation. 1998;  97 2154-2159
    PubMedGoogle Scholar
  • 5 Bradley T D, Floras J S. Pathophysiologic and therapeutic implications of sleep apnea in congestive heart failure.  J Card Fail. 1996;  2 223-240
    PubMedGoogle Scholar
  • 6 Armstrong P W, Moe G W. Medical advances in the treatment of congestive heart failure.  Circulation. 1993;  88 2941-2952
    PubMedGoogle Scholar
  • 7 Javaheri S, Parker T J, Wexler L. et al . Effect of theophylline on sleep disordered breathing in heart failure.  N Engl J Med. 1996;  335 562-567
    CrossrefPubMedGoogle Scholar
  • 8 Franklin K A, Eriksson P, Sahlin C. et al . Reversal of central sleep apnea with oxygen.  Chest. 1997;  111 163-169
    PubMedGoogle Scholar
  • 9 Javaheri S, Ahmed M, Parker T J. et al . Effects of nasal O2 on sleep-related disordered breathing in ambulatory patients with stable heart failure.  Sleep. 1999;  22 1101-1106
    CrossrefPubMedGoogle Scholar
  • 10 Naughton M T, Liu P P, Bernard D C. et al . Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure.  Am J Respir Crit Care Med. 1995;  151 92-97
    CrossrefPubMedGoogle Scholar
  • 11 Sin D D, Logan A G, Fitzgerald F S. et al . Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration.  Circulation. 2000;  102 61-66
    CrossrefPubMedGoogle Scholar
  • 12 Teschler H, Döhring J, Wang Y M. et al . Adaptive pressure support servo-ventilation.  Am J Respir Crit Care Med. 2001;  164 614-619
    CrossrefPubMedGoogle Scholar
  • 13 Willson G N, Wilcox P, Piper A J. et al . Noninvasive pressure preset ventilation for the treatment of Cheyne-Stokes respiration during sleep.  Eur Respir J. 2001;  17 1250-1257
    CrossrefPubMedGoogle Scholar
  • 14 Tobin M J, Cohn M A, Sackner M A. Breathing abnormalities during sleep.  Arch Intern Med. 1983;  143 1221-1228
    CrossrefPubMedGoogle Scholar
  • 15 Feigenbaum H. Echocardiography. Philadelphia: Lea & Febiger 1994
    Google Scholar
  • 16 Johns M W. Sleepiness in different situations measured by the Epworth Sleepiness Scale.  Sleep. 1994;  17 703-710
    PubMedGoogle Scholar
  • 17 StatSoft .STATISTICA for Windows. In: Tulsa, OK 2000
    Google Scholar
  • 18 Lanfranchi P A, Braghiroli A, Bosimini E. et al . Prognostic value of nocturnal Cheyne-Stokes Respiration in chronic heart failure.  Circulation. 1999;  (99) 1435-1440
    PubMedGoogle Scholar
  • 19 Bradley T D. Hemodynamic and sympathoinhibitory effects of nasal CPAP in congestive heart failure.  Sleep. 1996;  19 (10 Suppl) 232-235
    PubMedGoogle Scholar
  • 20 Kaye D M, Mansfield D, Aggarwal A. et al . Acute effects of continuous positive airway pressure on cardiac sympathetic tone in congestive heart failure.  Circulation. 2001;  103 2336-2338
    PubMedGoogle Scholar
  • 21 Solin P, Bergin P, Richardson M. et al . Influences of pulmonary capillary wedge pressure on central apnea in heart failure.  Circulation. 1999;  99 1574-1579
    CrossrefPubMedGoogle Scholar
  • 22 Acosta B, DiBenedetto R, Rahimi A. et al . Hemodynamic effects of noninvasive bilevel positive airway pressure on patients with chronic congestive heart failure with systolic dysfunction.  Chest. 2000;  118 1004-1009
    CrossrefPubMedGoogle Scholar
  • 23 Bradley T D, Holloway R M, McLaughlin P R. et al . Cardiac output response to continuous positive airway pressure in congestive heart failure.  Am Rev Respir Dis. 1992;  145 377-382
    PubMedGoogle Scholar
  • 24 Liston R, Deegan P C, McCreery C. et al . Haemodynamic effects of nasal continuous positive airway pressure in severe congestive heart failure.  Eur Respir J. 1995;  8 430-435
    CrossrefPubMedGoogle Scholar
  • 25 Kiely J L, Deegan P, Buckley A. et al . Efficacy of nasal continuous positive airway pressure therapy in chronic heart failure: importance of underlying cardiac rhythm.  Thorax. 1998;  53 957-962
    PubMedGoogle Scholar
  • 26 Philip-Joet F F, Paganelli F F, Dutau H L. et al . Hemodynamic effects of bilevel nasal positive airway pressure ventilation in patients with heart failure.  Respiration. 1999;  66 136-143
    CrossrefPubMedGoogle Scholar

PD Dr. B. Schönhofer

Edward Hines Jr., VA and Loyola University, Chicago Division of Pulmonary and Critical Care Medicine

Building 1, Room E438, Route 111N

Hines, IL 60078, USA

Email: Bernd.Schoenhofer@t-online.de

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