علاج انقطاع النفس النومي المركزي مع تنفس شاين-ستوكس في قصور القلب مع كسر القذف المحفوظ

References

DOI: 10.1183/20734735.0235-2023

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.

Optimisation of heart failure therapy should be incorporated in all patients with cardiac dysfunction as it has been shown to improve CSA among other clinical outcomes, such as cardiac function, cardiovascular-related mortality and overall quality of life.

This includes β-blockers to reduce sympathetic nervous activity, angiotensin-converting enzyme-inhibitor to reduce ventricular afterload and blockade of the renin–angiotensin system, diuretics to reduce pulmonary venous congestion and appropriate rate/rhythm control of atrial fibrillation.

Heart failure patients with ventricular conduction delay can also benefit from cardiac resynchronisation therapy, which has improved cardiac function and reduced CSA–CSB severity.

In some cases, this may resolve their CSA without further intervention.

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