The role of high-frequency jet ventilation in the treatment of Cheyne–Stokes respiration in patients with chronic heart failure

BackgroundCheyne–Stokes respiration with central sleep apnea (CSR-CSA) is common in patients with severe cardiac failure. Various modes of positive airway pressure have been suggested as treatments.The authors hypothesized that high frequency jet ventilation (HFJV) can improve central sleep apnea in patients with chronic heart failure.MethodsEleven subjects with stable, optimally treated chronic heart failure and Cheyne–Stokes respiration were tested untreated and on four treatment nights in random order: nasal oxygen (4 L/min), continuous positive airway pressure (CPAP) (mean 9.3 cm H2O), bilevel positive airway pressure (BiPAP)(mean 12.0/5.3 cm H2O), or HFJV(60∼80 breaths per minute) during polysomnography (EMBLA, Flaga, Reykjavik, Iceland).ResultsThe apnea–hypopnea index (AHI) declined from 30.9 ± 8.3/h in untreated night to 23.6 ± 6.6/h oxygen night and 18.5 ± 5.0/h CPAP, 14.3 ± 3.9/h BiPAP, and 20.1 ± 4.1/h HFJV (all P < 0.001 versus control). There was no significant difference between the AHI of HFJV and that of CPAP (P = 0.541). Arousal index decreased from 31.4 ± 13.2/h untreated to 25.0 ± 7.1/h oxygen and 13.6 ± 4.7/h CPAP, to 13.7 ± 4.9/h BiPAP and 14.4 ± 4.7/h HFJV. HFJV had the similar effect to the other therapeutic groups in arousal index (P > 0.05). There were large increases in slow-wave and rapid eye movement (REM) sleep with HFJV. All subjects preferred HFJV to CPAP.ConclusionsOne night of therapy with HFJV improved nocturnal breathing pattern and sleep quality in patients with Cheyne–Stokes respiration in chronic heart failure. HFJV therapy for sleep and breathing were the same as those during a nasal CPAP night. A long-term study of the effect of HFJV on cardiovascular function is needed.