The role of high-frequency jet ventilation in the treatment of Cheyne–Stokes respiration in patients with chronic heart failure

https://doi.org/10.1016/j.ijcard.2005.02.005Get rights and content

Abstract

Background

Cheyne–Stokes respiration with central sleep apnea (CSR-CSA) is common in patients with severe cardiac failure. Various modes of positive airway pressure have been suggested as treatments.The authors hypothesized that high frequency jet ventilation (HFJV) can improve central sleep apnea in patients with chronic heart failure.

Methods

Eleven subjects with stable, optimally treated chronic heart failure and Cheyne–Stokes respiration were tested untreated and on four treatment nights in random order: nasal oxygen (4 L/min), continuous positive airway pressure (CPAP) (mean 9.3 cm H2O), bilevel positive airway pressure (BiPAP)(mean 12.0/5.3 cm H2O), or HFJV(60∼80 breaths per minute) during polysomnography (EMBLA, Flaga, Reykjavik, Iceland).

Results

The apnea–hypopnea index (AHI) declined from 30.9 ± 8.3/h in untreated night to 23.6 ± 6.6/h oxygen night and 18.5 ± 5.0/h CPAP, 14.3 ± 3.9/h BiPAP, and 20.1 ± 4.1/h HFJV (all P < 0.001 versus control). There was no significant difference between the AHI of HFJV and that of CPAP (P = 0.541). Arousal index decreased from 31.4 ± 13.2/h untreated to 25.0 ± 7.1/h oxygen and 13.6 ± 4.7/h CPAP, to 13.7 ± 4.9/h BiPAP and 14.4 ± 4.7/h HFJV. HFJV had the similar effect to the other therapeutic groups in arousal index (P > 0.05). There were large increases in slow-wave and rapid eye movement (REM) sleep with HFJV. All subjects preferred HFJV to CPAP.

Conclusions

One night of therapy with HFJV improved nocturnal breathing pattern and sleep quality in patients with Cheyne–Stokes respiration in chronic heart failure. HFJV therapy for sleep and breathing were the same as those during a nasal CPAP night. A long-term study of the effect of HFJV on cardiovascular function is needed.

Section snippets

Subjects

Successive patients with stable, medically treated chronic congestive heart failure were enrolled in the study at Renmin Hospital of Wuhan University between September, 2003 and May, 2004. All patients were diagnosed by cardiologists in combinations of history, clinical signs, echocardiography, chest X-ray, and in most cases by left heart catheter, and were evaluated to confirm that their conditions were stable and that they were receiving optimal therapy. Informed written consent was obtained

Results

Twenty-three patients with chronic heart failure meeting all inclusion and exclusion criteria were considered for this study. Twelve patients did not complete all studies, of which, six subjects withdrew after the first intervention night (nCPAP or BiPAP) because of the inconvenience of the procedure, four subjects were unable to tolerate the jetting airflow or jetting noise from the HFJV, and the other two cases could not fulfil all requirements of the protocol and withdrew in the middle of

Discussion

Cheyne–Stokes respiration reflects uncompensated instability of the feedback control of ventilation.Current concepts of the pathophysiology of leading to CSR-CSA is a fluctuation of PaCO2 below and above the apneic threshold [1]. CHF causes pulmonary congestion and therefore activates pulmonary J receptors which stimulate ventilation. When PaCO2 is periodically driven below threshold by intervening episodes of hyperventilation, central neural outflow to the respiratory muscles is temporarily

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