Kalp Yetmezliği Tanılı Hastalarda Adaptif Servoventilasyon Tedavisinin Etkileri

Yıl 2024, Cilt: 19 Sayı: 1, 1 - 7, 28.03.2024

Esra Yarar Behiye Deniz Kosovalı Nazan Bayram Meral Uyar Ayten Filiz

https://doi.org/10.17517/ksutfd.1172653

Öz

Amaç: Kronik kalp yetmezliği olan hastalarda obstrüktif apne, santral apne ve Cheyne-Stokes solunumu (CSR) gibi uykuya bağlı solunum bozuklukları (SRBD) görülebilir. SRBD kalp yetmezliğinin prognozunu etkileyebilir.
Çalışmanın amacı, kalp yetmezliği olan hastalarda uykuya bağlı solunum bozukluklarını ortaya çıkarmak ve yeni bir tedavi modalitesi olarak adaptif servo-ventilasyonun (ASV) etkilerini göstermektir.
Gereç ve Yöntem: Bu prospektif çalışmaya kalp yetmezliği olan 32 hasta dahil edildi. Bir gece polisomnografi (PSG) yapıldı.
Bulgular: PSG sonuçlarına göre SRBD oranı %96.7 idi. Apne-hipopne indeksi (AHİ) >5 olan tüm hastalara sürekli pozitif hava yolu basıncı (CPAP) ve ASV titrasyonları önerildi. Demografik ve klinik özellikler, semptomlar, PSG bulguları, Cheyne-Stokes solunumu (CSR) varlığı, ekokardiyografi sonuçları kaydedildi. ASV titrasyonu öncesi ve sonrası solunum fonksiyon testleri, yürüme testleri yapıldı, transferrin ve pro-BNP konsantrasyonları belirlendi. AHİ'ye göre gruplarda 30 hastanın 18'inde şiddetli obstrüktif uyku apne sendromu (OUAS), 4'ü orta OUAS, 5'i hafif OUAS ve 2'si santral uyku apnesi (CSA) olarak tanımlandı. Obstrüktif apne, santral apne, AHİ, uyarılma ve SpO2 min değerlerinde, PSG ve CPAP, ASV titrasyonlarında anlamlı düzelme saptandı (sırasıyla p=0,001, p=0,016, p=0,001, p=0,015 ve p=0,008). ASV ile tüm CSR'lerin ortadan kaldırıldığı belirlendi. ASV titrasyonu pro-BNP sonrası yürüme mesafesi ve FVC değerleri anlamlı olarak değiştiği saptandı (sırasıyla p=0,036, p=0,018 ve p=0,018).
Sonuç: Sonuç olarak, CPAP ile devam eden ancak bir gecelik ASV uygulaması ile ortadan kaldırılan CSR ve santral apneler belirlendi. ASV’nin ayrıca pro-BNP'yi azalttığı ve FVC ve yürüme mesafesi değerlerini önemli ölçüde artırdığı ortaya konuldu.

Anahtar Kelimeler

pro bnp, cheyne stokes solunumu, santral uyku apne, adaptif servoventilasyon, kalp yetmezliği

Impact of Adaptive Servo-Ventilation in Heart Failure Patients

Öz

Objective: Sleep-related breathing disorders (SRBD) as obstructive apnea, central apnea, and Cheyne-Stokes respiration (CSR), can be seen in patients with chronic heart failure. SRBD can influence the prognosis of heart failure. We aim to reveal sleep-related breathing disorders in heart failure patients and display the effects of adaptive servo-ventilation (ASV) as a new therapeutic modality.
Materials and Methods: In this prospective study, 32 patients with heart failure were included. One night polysomnography (PSG) was done.
Results: According to the results of PSG, the SRBD ratio was 96.7%. Continuous positive airway pressure (CPAP) and ASV titrations were offered to all patients with an apnea-hypopnea index (AHI) > 5. Demographics, clinical properties, symptoms, PSG findings, Cheyne-Stokes respiration (CSR), and echocardiography results were recorded. Before and after ASV titration, pulmonary function tests and walking tests were performed, and concentrations of transferrin and pro-BNP were recorded. In the groups according to the AHI, severe obstructive sleep apnea syndrome (OSAS) in 18 of 30 patients, four moderate OSAS, five mild OSAS, and two central sleep apnea (CSA). PSG and, CPAP, ASV titrations were done in 7 male and one female patient that obstructive apnea, central apnea, AHI, arousal, and SpO2 min values had significant improvements (p=0,001, p=0,016, p=0,001, p=0,015 and p=0,008 respectively). We determined all CSRs were eliminated with ASV. After ASV titration pro-BNP, walking distance, and FVC values changed significantly (p=0,036, p=0,018, and p=0,018 respectively).
Conclusion: As a result, we determined CSR and central apneas persisted with CPAP but were eliminated with a one-night ASV application. ASV also decreased pro-BNP and increased FVC and walking distance values significantly.

Anahtar Kelimeler

Heart Failure, Pro-BNP, Adaptive servo-ventilation (ASV), Cheyne-Stokes respiration (CSR), OSAS., central apnea syndrome

Kaynakça

• Momomura S. Treatment of Cheyne-Stokes respiration-central apnea in patients with heart failure. J Cardio. 2012;59:110-16.
• Davies RJ, Harrington KJ, Ormerod OJ, Stradling JR. Nasal continuous positive airway pressure in chronic heart failure with sleep-disordered breathing. Am Rev Respir Dis. 1993;147:630-634.
• Sullivan CE. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet. 1981;1:862-5.
• Philippe C, Stoica-Herman M, Drouot X, Raffestin B, Escourrou P, Hittinger L, et al. Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of cheyne-stokes respiration in heart failure over a six month period. Heart. 2006;92:337-342.
• Wittmer VL, Simoes GMS, Sogame LCM, Vasquez EC. Effects of continuous positive airway pressure on pulmonary function and exercise tolerance in patients with congestive heart failure. Chest. 2006;130(1):157-63.
• Faggiano P, Lombardi C, Sorgato A, Ghizzoni G, Spedini C, Rusconi C. Pulmonary function tests in patients with congestive heart failure: effects of medical therapy. Cardiology. 1993;83(1-2):30-5.
• Pepperell JC, Maskell NA, Jones DR, Langford-Wiley BA, Crosthwaite N, Stradling JR, et al. A randomized controlled trial of adaptive ventilation for cheyne- stokes breathing in heart failure. Am J Respir Crit Care Med. 2003;168:1109-1114.
• Teschler H, Döhrıng J, Wang YM, Berthon-Jones M. Adaptive pressure support servo-ventilation. Am J Respir Crit Care Med. 2001;164:614–619.
• Schadlich S, Königs I, Kalbitz F, Blankenburg T, Busse HJ, Schütte W. Cardiac efficiency in patients with cheyne-stokes respiration as a result of heart insufficiency during long-term nasal respiratory treatment with adaptive servo-ventilation. Z Kardiol. 2004;93(6):454-462.
• Yoshihisa A, Suzuki S, Miyata M, Yamaki T, Sugimoto K, Kunii H, et al. A single night beneficial effects of adaptive servo-ventilation on cardiac overload, symphathetic nervous activity, and myocardial damage in patients with chronic heart failure and sleep-disordered breathing. J Circ 2012;62:102-13.
• Hastings P, Vazir A, Meadows GE, Dayer M, Poole-Wilson PA, McIntyre HF, et al. Adaptive servo-ventilation in heart failure patients with sleep apnea. Int J Cardio. 2010;139:17-24.
• Vogt-Ladner G, Schacher C, Ditterich W, Vogt M, Teschler H, Worth H. Nocturnal oxygen therapy versus adaptive servo-ventilation in patients with severe chronic heart failure and Cheyne-Stokes respiration. Am J Respir Crit Care Med. 2002; 165:A247.
• Oldengurg O, Schmidt A, Lamp B, Bitter T, Muntean BG, Langer C, et al. Adaptive servo-ventilation improves cardiac function in patients with chronic heart failure and Cheyne-Stokes respiration. Eur J Heart Fail. 2008;10(6):581-586.
• Gorg R, Pocker M, Pitt B. Heart failure in 1990’s: Evalution of a major public health problem in cardiovasculer medicine. J Am Coll Cardiol. 1993;22(Suppl A):3A.
• Bradley T, Logan A, Kimoff J, Series F, Morrison D, Ferguson K, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2005;353:2025-2033.
• Heidenreich PA, Bozkurt B, David Aguilar, Larry AA, Joni JB, Monica MC, et al. Management of Heart Failure Guideline 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Am Coll Cardiol. 2022 May, 79 (17) 1757–1780. DOI: 10.1016/j.jacc.2021.12.012.