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Autoset CS vs Oxygen in CHF and CSA-CSR

OXYGEN VERSUS ADAPTIVE PRESSURE SUPPORT SERVO-VENTILATION (AUTOSET CS) IN PATIENTS WITH CENTRAL SLEEP APNOEA- CHEYNE STOKES RESPIRATION (CSA-CSR) AND CONGESTIVE HEART FAILURE (CHF)

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Angela Campbell, Katherine Ferrier, Alister Neill
WellSleep, Department of Medicine, Wellington School of Medicine and Health Sciences, Wellington New Zealand

There is a debate regarding the need for and optimum treatment of CSA-CSR in patients with CHF. Aim: To compare Autoset-CS and overnight oxygen therapy utilising a crossover study design. Methods: Ten stable outpatients with CSA-CSR and CHF (LVEF < 45%) were randomised to either 8 weeks oxygen 2l/min via nasal prongs or 8 weeks Autoset-CS, separated by a 3 week washout. At baseline and at completion of each arm, we compared polysomnography, shuttle walk distance, symptoms, urine catecholamines, plasma NT-BNP and bi-planar echocardiography. Results: Ten subjects were recruited (mean age 64±10 years, LVEF 28±10.5%, AHI 63±30/hr). Seven completed the protocol (one died, one refused Autoset-CS and one was withdrawn after CCU admission). Mean AHI on oxygen therapy, 19.4±14.6/hr, Autoset-CS, 5.0 ±5.9/hr (p=0.03). CSA-CSR was prevented (AHI of < 10/hr) in 4/9 using oxygen (44%), 6/8 using Autoset-CS (75%) and 6/7 with either therapy (86%). Autoset-CS compliance averaged 4.7±2.3 hrs/night (range 1.2 - 7.1 hr/night). LVEF did not change with either therapy (Oxygen arm 28.7% vs baseline 28.7% p = 0.97, Autoset-CS arm 31.4% vs baseline 33.5% p = 0.23). NTBNP, urinary catecholamines, shuttle walk distance and symptoms were unchanged.

Conclusion: Over eight weeks Autoset-CS reduced polysomnographic indices of CSA-CSR more than oxygen therapy. Neither intervention improved prognostic indices of heart failure, symptoms or exercise capacity. A larger study would better address any potential long-term benefits.

Supported by funding: ResMed Ltd

Key words: Congestive heart failure, Central sleep apnoea-Cheyne Stokes respiration, oxygen therapy, adaptive servo-ventilation

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