Treatment of central sleep apnoea in congestive heart failure with nasal ventilation.

Cheyne-Stokes respiration (CSR) is common in patients with congestive heart failure (CHF). This characteristic crescendo-decrescendo pattern of breathing is often seen during sleep in patients with CHF and is a form of central sleep apnoea. Disordered nocturnal breathing leads to oxygen desaturation, poor sleep quality, and altered sleep architecture. These features may lead to complaints of daytime somnolence, fatigue, insomnia, and many of the symptoms typical of sleep disordered breathing. It has been proposed that CSR during sleep in patients with heart failure is an indicator of a poor prognosis. 5 The likely adverse eVects of CSR on daytime performance and myocardial function have resulted in the introduction and evaluation of a range of treatments aimed at reducing CSR. These include low flow oxygen, theophylline, and nasal continuous positive airways pressure (nCPAP). In one controlled study nCPAP was shown to improve both sleep quality and daytime myocardial function. Other groups have found nCPAP to be ineVective in controlling CSR. Nocturnal nasal intermittent positive pressure ventilation (nIPPV) is the accepted treatment for patients with chronic respiratory failure due to hypoventilation during sleep. 13 We hypothesised that nIPPV may also eVectively treat central sleep apnoea in heart failure by controlling ventilation and carbon dioxide in patients whose disordered breathing has been linked to fluctuating carbon dioxide levels, relative hyperventilation, and hypocapnia. 15 Nasal IPPV was administered in an attempt to mechanically ventilate the patient through the apnoeic portion of the Cheyne-Stokes cycle, thereby preventing fluctuations in carbon dioxide levels and consequently abolishing CSR. This study describes the use of nocturnal nIPPV in a group of patients with heart failure and Cheyne-Stokes respiration during sleep. The eVects of this therapy on respiratory disturbance and sleep quality following an in-hospital acclimatisation period are reported. We also report our experience with long term domiciliary therapy and its eVects on daytime left ventricular function in patients who remained compliant with treatment.