Einflüsse der nasalen Ventilationstherapie bei Patienten mit schlafbezogenen Atmungsstörungen und Herzinsuffizienz auf die kardiale Funktion (LAHN) - eine Pilotstudie

Die chronische Herzinsuffizienz gehört zu den häufigsten internistischen Krankheiten und trägt aufgrund ihrer hohen Prävalenz entscheidend zur Mortalität und Morbidität der Gesellschaft bei. Herzinsuffiziente Patienten sind gehäuft von schlafbezogenen Atmungsstörungen, in erster Linie von zentralen...

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Bibliographic Details
Main Author: Wagner, Jessica
Contributors: Alter, Peter (Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2014
Online Access:PDF Full Text
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Chronic heart failure is one of the most common diseases. Because of its high prevalence it contributes substantially to morbidity and mortality in Western countries. Patients with chronic heart failure frequently exhibit sleep disordered breathing (SDB), predominantly central sleep apnoea (CSA). Sleep disordered breathing seems to be a crucial determinant leading to disease progression and worse prognosis. In accordance to previous findings the extent of the left ventricular wall stress is of crucial pathophysiologic importance for chronic heart failure and its prognosis. Continuous positive airway pressure ventilation (CPAP) is expected to increase the intrathoracic and oesophageal pressure and reduce left ventricular wall stress with favorable prognostic consequences. The present study evaluates the efficacy of continuous positive airway pressure ventilation on left ventricular function, the left ventricular volume and left ventricular wall stress of patients with chronic heart failure and predominantly central sleep apnoea. Furthermore, we examined if there is a beneficial effect on the prognosis. Cardiac magnetic resonance (CMR) imaging was used to assess cardiac function, left ventricular wall stress was determined using a thick-walled sphere model. We examined 6 patients with chronic heart failure characterized by a left ventricular ejection fraction ≤ 45% and an apnoea/ hypopnoea index ≥ 15 with a central amount of about 50 %. After 1:1 randomisation the control group (n = 3) received standard medical therapy solely, the treatment arm (n = 3) obtained additional nasal ventilation therapy (nCPAP). After 3 months of follow-up we assessed similar cardiac and polysomnographic parameters as at time of enrolment. 13 The present LAHN (low ejection fraction, apnoea/ hypopnoea and nasal ventilation) study showed that CPAP therapy leads to a significant improvement of left ventricular ejection fraction (p = 0,0383) as well as a reduction of the apnoea/ hypopnoea index (p = 0,021). It shows an obvious tendency to reduction of increased systolic wall stress in the treatment arm. In addition to reduced enddiastolic volume a not significant improvement of the endsystolic volume was found in the treatment arm (ns), too. Similarly, a trend of improved central sleep apnoea was found shown in the treatment group (ns). In summary it was shown that nasal ventilation therapy (CPAP) has beneficial effects on cardiac function and preexisting sleep disordered breathing in patients with chronic heart. Based on these data nasal ventilation therapy should be envisaged as future therapeutic target in addition to standard heart failure treatment. Due to the small number of patients in the present study, further larger prospective studies are required before CPAP therapy can be recommended routinely in these patients.