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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
TREATING RESPIRATORY DISEASE
Minerva Pneumologica 2013 June-September;52(2-3):111-22
Management of sleep disordered breathing in heart failure
Randerath J. W.
Institute of Pneumology at the University Witten/Herdecke, Clinic for Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
Approximately 50% of patients with chronic heart failure suffer from sleep related breathing disorders (SRBD), both obstructive and central apneas and hypopneas. Cheyne-Stokes respiration (CSR) is defined by a periodic pattern of waxing and waning of the tidal volume and breathing effort. The pathophysiology includes hypersensitivity of the peripheral chemoreceptors and respiratory control centers in the brain stem and a chronic hyperventilatory state. Stimulation of vagal afferent nerves in the lungs, fluid shift from the lower body compartments, metabolic changes, increased arousability may contribute to the vicious circle. The mortality of heart failure patients with CSR is increased. However, optimal treatment is still under discussion. CPAP and oxygen supply both reduce respiratory disturbances by about 50% while there is only limited evidence on the use of bilevel therapy. Adapted servoventilation is superior to all other treatment options in terms of improvement of respiratory disturbances and cardiac parameters. However, data on long-term survival are missing yet. Therefore, a short-term trial of CPAP is reasonable, but should be replaced by ASV, if it fails to sufficiently improve respiration.