Effect of Continuous Positive Airway Pressure on Sleep Structure in Heart Failure Patients with Central Sleep Apnea

摘要: SLEEP STRUCTURE IS INVARIABLY DISRUPTED BY AROUSALS FROM IN PATIENTS WITH APNEA.1,2 OBSTRUCTIVE APNEA (OSA), arousals from sleep that typically terminate apneas, trigger activation of the pharyngeal dilator muscles and facilitate resumption airflow. Indeed, several studies report 75% to 80% obstructive events are terminated by arousals.3,4 Accordingly, in OSA, considered be an important defense mechanism for reestablishing airway patency, thus preventing asphyxia. On other hand, this protective inevitably disrupts sleep. When OSA is alleviated continuous positive pressure (CPAP), frequency immediately reduced association with consolidation increase proportion both slow wave REM sleep.5–8 One can therefore conclude causes arousal sleep, this, turn, reduces amounts sleep. In patients heart failure (HF) coexisting Cheyne-Stokes respiration central apnea (CSA), often follow apneas hypopneas.2,9,10 However, contrast these occur breaths after termination, suggesting such cases, they not contribute Arousals, whether occurring during apnea-hyperpnea cycle or not, provoke abrupt increases ventilation decreases PCO2. If PCO2 falls below threshold apnea, ensues.11,12 Among CSA, either without HF, ventilation, PCO2, mainly provoked arousals, precede more than 90% episodes repetitive apneas.11,12 Moreover, previous studies, it has been shown CPAP only partially suppresses CSA hypopneas/h (apnea-hypopnea index AHI) approximately 30% 70% HF.13–21 Perhaps was because did eliminate one stimulus respiratory cycle: arousal-mediated hyperpneas. Therefore, may causation CSA. If a consequence should diminish if attenuated treatment. If, on cause of, incidental then suppression HF have little no effect structure. There controversy point: some articles reported interventions suppress increased sleep,13–15 whereas others not.16–21 all were small (n ≤ 24), short duration (1 day 1 month), simply structure, but discussing significance improved. Our objective, therefore, determine much larger, longer-term randomized trial, attenuation improves To end, we analyzed structure at baseline follow-up enrolled clinical trial treat (Canadian Continuous Positive Airway Pressure Patients Central Sleep Apnea Heart Failure [CANPAP]).