Chest
Volume 102, Issue 1, July 1992, Pages 31-35
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The Effect of Short-term Nasal CPAP on Cheyne-Stokes Respiration in Congestive Heart Failure

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We studied male patients (BMI = 27.6 ± 3.4, mean ± SD), mean age 54.1 ± 8.9 years, with stable NYHA class 3-4 congestive heart failure (CHF) (LVEF = 24.3 ± 11.5 percent) and normal daytime arterial blood gas values. These patients underwent three consecutive nights of full polysomnography; adaptation, control, and treatment with nasal CPAP. Each night's study was followed during the day by cognitive testing and multiple sleep latency tests (MSLT). The purpose of the study was to document the effect of nasal CPAP on these variables. The main findings of the study showed no significant differences between control and treatment nights with respect to the amount of Cheyne-Stokes respiration (CSR) observed, the nocturnal oxygenation, or sleep quality. Both subjective and objective measures of sleep quality showed no change from night to night. In addition, the degree of cognitive functioning and daytime sleepiness (as measured by MSLT) showed no significant differences between control and treatment nights. We conclude that short-term treatment with nasal CPAP in patients with CHF does not improve either CSR, nocturnal oxygenation, or sleep quality. Furthermore, most of our patients did not tolerate nasal CPAP therapy. (Chest 1992; 102:31–35)

Section snippets

METHODS

We studied eight male patients who were not morbidly obese using the following inclusion criteria: younger than 65 years of age with a clinical diagnosis of stable severe CHF (NYHA class 3-4) and a measured left ventricular ejection fraction (LVEF) confirming reduced function (<50 percent). There was to be no evidence of neurologic disease, significant primary lung disease as assessed by history, lung function testing, and chest roentgenogram; no historic evidence of primary sleep disorders,

RESULTS

For complete anthropomorphic data see Table 1. Eight patients were studied. Their ages were 54.1 ± 8.9 years (mean ± SD) with a range of 41 to 65 years. One of the patients had a BMI over 30 and for the group mean BMI was 27.6 ±3.4 kg/m2. All the patients had clinical and radiologic evidence of CHF with an LVEF of 24.3 ± 11.5 percent. All patients had a congestive cardiomyopathy (seven were due to ischemic cardiomyopathy, one had an idiopathic cardiomyopathy) and had stable NYHA class 3 or 4

DISCUSSION

Cheyne-Stokes respiration, a complication of CHF,2,18 is also thought to be a poor prognostic indicator.2 It leads to sleep fragmentation and nocturnal O2 desaturation and can cause severe sleep disruption. This study confirms the previous findings of severe subjective and objective insomnia in severe CHF.3,19 It has been shown previously that CSR, sleep quality, and nocturnal SaO2 improve with O2 administration.11 The question we asked in this study was whether short-term NCPAP might also be

ACKNOWLEDGMENT

This work was supported by the Medical Research Council of Canada, the Heart ana Stroke Foundation of Canada, and the Manitoba Health Research Council. We also wish to thank Candace Harper for manuscript preparation.

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    Manuscript received Augnst 19; revision accepted October

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