انقطاع النفس المركزي أثناء النوم مع تنفس شاين-ستوكس في قصور القلب مع انخفاض الكسر القذفي عندما لم يُحقق تحسين قصور القلب حلاً لانقطاع النفس المركزي

References

CSA, often with concurrent CSB (a form of periodic breathing with waxing and waning amplitude of flow/tidal volume), can be observed in low cardiac output states including heart failure with reduced ejection fraction (HFrEF), heart failure with preserved ejection fraction (HFpEF; impaired cardiac filling/relaxation) and cardiac arrhythmia.

Nonetheless, after the SERVE-HF (Treatment of Predominant Apnoea by Adaptive Servo Ventilation in Patients With Heart Failure) trial, ASV is no longer recommended in CSA–CSB among heart failure patients with LVEF <45%.

In patients who have had inadequate response to heart failure optimisation, the next line of therapy is continuous positive airway pressure (CPAP) therapy.

Supplemental oxygen can mitigate the severity of hypoxaemia, decrease ventilatory response to CO2 and reduce post-apnoeic ventilatory overshoot.

A subsequent post hoc analysis showed that among subjects of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP) with CSA syndrome that were adequately controlled with CPAP therapy (AHI <15 events per h), the transplant-free survival and LVEF were better than in non-suppressed and control subjects.

DOI: 10.1183/20734735.0235-2023

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