عندما لا يكون CPAP قد نجح: انقطاع التنفس المركزي مع تنفس شاين-ستوكس في قصور القلب مع انخفاض الكسر القذفي

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%.
• Transvenous phrenic nerve stimulator (TPNS) offers an alternative method to regulate breathing and stabilise CO2 levels while bypassing the surgical risk seen in intrathoracic stimulator implantation.
• Currently, TPNS is considered an option for symptomatic CSA in patients who fail or do not tolerate CPAP therapy.
• Nocturnal oxygen therapy (NOT) is also an alternative in HFrEF with CSA, and may be better accepted in patients who cannot tolerate positive airway pressure (PAP) mask interfaces.
• As upper airway obstruction is a triggering factor in generating CSA episodes, other methods to reduce upper airway collapsibility, such as positioning devices or elevating the head of the patient's bed, can also be considered as non-PAP alternatives.
• The post hoc analysis of the CSA subgroup with heart failure from the redemé System Pivotal Trial (CSA with AHI >20 events per h, 1:1 randomisation to stimulation or no stimulation post TPNS implantation) showed improvement in sleep metrics from baseline (55% reduction in AHI after 3 months of therapy) and trends towards improved LVEF and time to first hospitalisation with no increased mortality.