Effects of Dynamic Bilevel Positive Airway Pressure Support on Central Sleep Apnea in Men With Heart Failure

Treatment with continuous positive airway pressure (CPAP) improves cardiac function in chronic heart failure (CHF) patients with central sleep apnea (CSA)-Cheyne-Stokes respiration (CSR) by stabilizing ventilation, but frequently central apneas and hypopneas persist. Our objective was to test the hypothesis that flow-targeted dynamic bilevel positive airway pressure (BPAP) support (BiPAP autoSV; Respironics; Murrysville, PA) effectively suppresses CSR-CSA in CHF patients. We studied 14 CHF patients with CSR-CSA (and residual CSA on positive airway pressure therapy) during 3 consecutive nights: (1) diagnostic polysomnography, (2) CPAP (n = 10) or BPAP (n = 4) titration, and (3) dynamic flow-targeted dynamic BPAP support with an expiratory positive airway pressure (EPAP) set to suppress obstructive respiratory events, and an inspiratory positive airway pressure (IPAP) dynamically ranging between 0 and 15 cm H2O above the EPAP. CPAP or BPAP significantly reduced the apnea-hypopnea index (AHI) [mean ± SD, 46 ± 4 events/h to 22 ± 4 events/h; p = 0.001] compared to the first night without treatment. Flow-targeted dynamic BPAP support (mean EPAP, 6.5 ± 1.7 cm H2O; maximal IPAP, 21.9 ± 2.1 cm H2O) further reduced the AHI to 4 ± 1/h of sleep compared to the untreated (p < 0.001) and CPAP or BPAP night (p = 0.002). After the first night of flow-targeted dynamic BPAP support, patients rated on an analog scale (range, 0 to 10) the treatment as comfortable (6.9 ± 0.6), and the sleep quality as improved compared to previous nights (7.4 ± 0.6). Flow-targeted dynamic BPAP support effectively suppresses CSR-CSA in patients with CHF and is well tolerated.