(Associate Editor: Amanda Piper).
Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure
Version of Record online: 23 DEC 2013
© 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology
Volume 19, Issue 1, pages 47–52, January 2014
How to Cite
Schroll, S., Sériès, F., Lewis, K., Benjamin, A., Escourrou, P., Luigart, R., Pfeifer, M. and Arzt, M. (2014), Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure. Respirology, 19: 47–52. doi: 10.1111/resp.12193
Conflict of interest statement: M.A. has previously received lecture fees from Astra Zeneca, Covidien, Philips Home Healthcare Solutions (Murrysville, PA, USA) and Resmed (Martinsried, Germany), and received grant support from Philips Home Healthcare Solutions. He is also the holder of an endowed professorship from the Free State of Bavaria at the University of Regensburg, donated by Philips Home Healthcare Solutions and Resmed. K.L. has received grant support from Pzier Inc., and lecture fees and reimbursement for attending conferences from Pfizer, Astra Zeneca and Glaxo-Smith Kline.
- Issue online: 23 DEC 2013
- Version of Record online: 23 DEC 2013
- Accepted manuscript online: 19 SEP 2013 08:47PM EST
- Manuscript Accepted: 1 AUG 2013
- Manuscript Received: 23 JUL 2013
- Manuscript Revised: 23 JUL 2013
- Manuscript Revised: 18 JUL 2013
- Manuscript Revised: 8 JUL 2013
- Manuscript Revised: 7 JUL 2013
- blood pressure;
- heart failure;
- heart rate;
- positive airway pressure;
- sleep apnoea
Background and objective
Continuous 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.
During daytime, we applied incremental CPAP (4–10 cmH2O) in 37 stable patients with CHF and SDB. BP and HR were assessed after each 1 cmH2O CPAP increase in 5-min intervals in the entire sample, and CO was assessed at one centre (n = 11).
Neither mean BP, HR nor CO changed significantly with incremental CPAP (at 0 and 10 cmH2O: 85 ± 2 and 84 ± 2 mm Hg, P = 1.0, 63 ± 1 to 61 ± 2 b.p.m., P = 0.88 and 2.03 ± 0.5 and 2.35 ± 0.8 L/min/m2, 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 >15 mm Hg) without clinical signs occurred.
These results contribute to the evidence that CPAP does not cause haemodynamic compromise in the vast majority of normotensive CHF patients with SDB.