Zusammenfassung
Hintergrund: Die adaptive Servoventilation (ASV) (AutoSetCS®, ResMed) ist ein spezielles nicht-invasives
Beatmungsverfahren für die Behandlung der Cheyne-Stokes-Atmung (CSA) von Patienten
mit Herzinsuffizienz. Ziel dieser Studie war es, die Effekte der ASV auf die Beeinflussung
der schlafbezogenen Atmungsstörung (SBAS), der Mittagsschlafdauer, der Nykturie und
der herzspezifischen Lebensqualität zu untersuchen. Methodik: 11 Patienten mit CSA infolge Herzinsuffizienz (EF < 40 %) wurden über 6 Wochen mit
ASV behandelt. Vor und am Ende der Behandlungsperiode wurden Apnoe-Hypopnoe-Index
(AHI), Arousalindex (AI), Nykturie, Mittagsschlafdauer und herzspezifische Lebensqualität
bestimmt. Ergebnisse: Die durchschnittliche Nutzungsdauer der ASV betrug 5,8 ± 2,1/h pro Tag. Der AHI konnte
mithilfe der ASV von 48,2 ± 11,6 auf 6,4 ± 8,3/h gesenkt werden (p < 0,001). Der AI
nahm von 33,9 ± 12,5 auf 18,4 ± 9,3/h ab (p < 0,05). Die tägliche Mittagsschlafdauer
verkürzte sich von 1,4 ± 0,6 auf 0,7 ± 0,4 Stunden (p = 0,004). Eine Besserung der
Nykturie von 2,9 ± 0,7 auf 1,1 ± 0,3 Male pro Nacht (p = 0,007) ließ sich gleichfalls
nachweisen. Die herzspezifische Lebensqualität besserte sich, der Fragebogenscore
(Minnesota Living with Heart Failure Questionnaire) nahm von 43,5 ± 21,1 auf 27,6
± 15,7 (p = 0,02) ab. Schlussfolgerung : Die ASV wird von Patienten mit Herzinsuffizienz und CSA gut toleriert und bessert
die schlafbezogene Atmungsstörung und Lebensqualität dieser Patienten.
Abstract
Background: Adaptive servo-ventilation (ASV) (AutoSetCS®, ResMed) is a novel non-invasive ventilation
modality for the treatment of Cheyne-Stokes-Respiration (CSR) in patients with heart
failure. This study aimed to investigate the effect of ASV on sleep disordered breathing
(SDB), afternoon nap duration, urine voidings, and quality of life. Methods: 11 patients with CSR due to heart failure (EF < 40 %) were treated with ASV for a
period of 6 weeks. Apnea-Hypopnoe-Index (AHI), Arousalindex (AI), duration of afternoon
nap, number of voidings, and heart specific quality of life were assessed before and
at the end of the treatment period. Results: The average usage time of ASV was 5.8 ± 2.1/h per day. With ASV the AHI was reduced
from 48.2 ± 11.6 to 6.4 ± 8.3/h (p < 0.001) and the AI from 33.9 ± 12.5 to 18.4 ±
9.3 /h (p < 0.05). The afternoon nap duration was significantly less (1.4 ± 0.6 vs.
0.7 ± 0.4 hours per day; p = 0.004) as was the number of nocturnal voidings (2.9 ±
0.7 vs. 1.1 ± 0.3 per night; p = 0.007). There was a significant improvement in heart
specific quality of life as measured with the Minnesota Living with heart failure
questionnaire (43.5 ± 21.1 vs. 27.6 ± 15.7 (p = 0.02). Conclusion: ASV is well tolerated and improves SDB and quality of life of patients with heart
failure with CSR.
Literatur
1
Remme W J, Swedberg K,. Task Force for the Diagnosis and Treatment of Chronic Heart
Failure, European Society of Cardiology .
Guidelines for the diagnosis and treatment of chronic heart failure.
Eur Heart J 2001.
Sep;
22 (17)
1527-1560
2
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
3
Javaheri S, Parker T J, Liming J D. et al .
Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their
prevalences, consequences, and presentations.
Circulation.
1998;
97
2154-2159
4
Andreas S, Hagenah G, Moller C. et al .
Cheyne-Stokes respiration and prognosis in congestive heart failure.
Am J Cardiol.
1996;
78
1260-1264
5
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
6
Teschler H, Dohring J, Wang Y M. et al .
Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration
in heart failure.
Am J Respir Crit Care Med.
2001;
164
614-619
7
Andreas S, Clemens C, Sandholzer H. et al .
Improvement of exercise capacity with treatment of Cheyne-Stokes respiration in patients
with congestive heart failure.
J Am Coll Cardiol.
1996;
27
1486-1490
8
Krachman S L, D'Alonzo G E, Berger T J. et al .
Comparison of oxygen therapy with nasal continuous positive airway pressure on Cheyne-Stokes
respiration during sleep in congestive heart failure.
Chest.
1999;
116
1550-1557
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
10
Javaheri S.
Treatment of central sleep apnea in heart failure.
Sleep.
2000;
23 Suppl 4
224-227
11
Andreas S, Bingeli C, Mohacsi P. et al .
Nasal oxygen and muscle sympathetic nerve activity in heart failure.
Chest.
2003;
123
366-371
12
Andreas S, Weidel K, Hagenah G. et al .
Treatment of Cheyne-Stokes respiration with nasal oxygen and carbon dioxide.
Eur Respir J.
1998;
12
414-419
13
Naughton M T, Benard D C, Liu P P. et al .
Effects of nasal CPAP on sympathetic activity in patients with heart failure and central
sleep apnea.
Am J Respir Crit Care Med.
1995;
152
473-479
14
Naughton M T, Rahman M A, Hara K. et al .
Effect of continuous positive airway pressure on intrathoracic and left ventricular
transmural pressures in patients with congestive heart failure.
Circulation.
1995;
91
1725-1731
15
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
16
Willson G N, Wilcox I, Piper A J. et al .
Treatment of central sleep apnoea in congestive heart failure with nasal ventilation.
Thorax.
1998;
53 Suppl 3
S41-S46
17
Takasaki Y, Orr D, Popkin J. et al .
Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart
failure.
Am Rev Respir Dis.
1989;
140
1578-1584
18
Buckle P, Millar T, Kryger M.
The effect of short-term nasal CPAP on Cheyne-Stokes respiration in congestive heart
failure.
Chest.
1992;
102
31-35
19
Köhnlein T, Welte T, Tan L B. et al .
Assisted ventilation for heart failure patients with Cheyne-Stokes respiration.
Eur Respir J.
2002;
20
934-941
20
Pepperell J CT, Maskell N A, Jones D R. et al .
A Randomised Controlled Trial of Adaptive Ventilation for Cheyne-Stokes Breathing
in Heart Failure.
Am J Resp Crit Care Med.
2003;
in press: (doi: 10.1164/rccm.200212-1476OC)
Dr. Volker Töpfer
Ruhrlandklinik
Tüschener Weg 40
45239 Essen
eMail: Volker-Toepfer@t-online.de