Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure

作者：Schroll Stephan; Series Frederic; Lewis Keir; Benjamin Amit; Escourrou Pierre; Luigart Ruth; Pfeifer Michael; Arzt Michael^*

来源：Respirology, 2014, 19(1): 47-52.

DOI：10.1111/resp.12193

• blood pressure
• heart failure
• heart rate
• positive airway pressure
• sleep apnoea

Background and objectiveContinuous positive airway pressure (CPAP) has been used to treat patients with chronic heart failure (CHF) and sleep-disordered breathing (SDB). CPAP treatment in severe CHF with concomitant SDB and atrial fibrillation has been linked to impairment of cardiac output (CO) as a potential cause for adverse outcome. The aim of the present study was to test whether incremental CPAP application in awake CHF patients with SDB, with and without atrial fibrillation, induces acute alterations of blood pressure (BP), heart rate (HR) and CO.
MethodsDuring daytime, we applied incremental CPAP (4-10cmH(2)O) in 37 stable patients with CHF and SDB. BP and HR were assessed after each 1cmH(2)O CPAP increase in 5-min intervals in the entire sample, and CO was assessed at one centre (n=11).
ResultsNeither mean BP, HR nor CO changed significantly with incremental CPAP (at 0 and 10cmH(2)O: 852 and 842mmHg, P=1.0, 631 to 61 +/- 2b.p.m., P=0.88 and 2.03 +/- 0.5 and 2.35 +/- 0.8L/min/m(2), P=0.92, respectively). No significant differences in maximum BP drop or HR drop between patients with sinus rhythm and atrial fibrillation were found. In 1 of 37 patients, a prespecified event of haemodynamic compromise (drop of mean BP >15mmHg) without clinical signs occurred.
ConclusionsThese results contribute to the evidence that CPAP does not cause haemodynamic compromise in the vast majority of normotensive CHF patients with SDB.
CPAP treatment in severe congestive heart failure (CHF) with concomitant SDB has been causally linked to CO impairment. We show that CPAP does not acutely change haemodynamic measures in most CHF patients with SDB, indicating that CPAP does not cause haemodynamic compromise in the vast majority of normotensive CHF patients with SDB. See Editorial, page 1

• 出版日期2014-1