Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing

Oldenburg O, Bartsch S, Bitter T, Schmalgemeier H, Fischbach T, Westerheide N, Horstkotte D (2012)
Sleep And Breathing 16(3): 753-757.

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Abstract
Obstructive sleep apnoea (OSA) as well as central sleep apnoea (CSA) are highly prevalent in heart failure (HF) patients. Positive airway pressure (PAP) therapy is usually intended to treat OSA and CSA. The aim of the present study was to investigate immediate hemodynamic effects of PAP therapy in these patients. In 61 consecutive HF patients (NYHA a parts per thousand yenaEuro parts per thousand II, EF a parts per thousand currency signaEuro parts per thousand 45%) with moderate to severe OSA or CSA (AHI a parts per thousand yenaEuro parts per thousand 15/h) blood pressure (BP) and heart rate (HR) response to PAP therapy initiation was investigated during mask fitting with patients being awake and in supine position. While applying an endexspiratory pressure of 5.8 +/- 0.9 cm H2O, there was a significant decrease in systolic (-8.9 +/- 12.1 mmHg, p < 0.001) and diastolic BP (-5.1 +/- 9.2 mmHg, p < 0.001) without a change in HR (p = n.s.). At least a transient drop in mean arterial pressure a parts per thousand currency sign70 mmHg was seen in 10% of these patients. Logistic regression analysis revealed a significant impact of baseline BP on potential BP drops: lower baseline BP was associated with BP drops. PAP therapy may cause unexpected hypotension especially in patients with low baseline BP as seen in HF patients treated according to current guidelines. Whether these hypotensive effects sustain, cause any harm to the patients and/or is responsible for non-acceptance or non-adherence of PAP therapy needs to be determined.
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Oldenburg O, Bartsch S, Bitter T, et al. Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing. Sleep And Breathing. 2012;16(3):753-757.
Oldenburg, O., Bartsch, S., Bitter, T., Schmalgemeier, H., Fischbach, T., Westerheide, N., & Horstkotte, D. (2012). Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing. Sleep And Breathing, 16(3), 753-757.
Oldenburg, O., Bartsch, S., Bitter, T., Schmalgemeier, H., Fischbach, T., Westerheide, N., and Horstkotte, D. (2012). Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing. Sleep And Breathing 16, 753-757.
Oldenburg, O., et al., 2012. Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing. Sleep And Breathing, 16(3), p 753-757.
O. Oldenburg, et al., “Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing”, Sleep And Breathing, vol. 16, 2012, pp. 753-757.
Oldenburg, O., Bartsch, S., Bitter, T., Schmalgemeier, H., Fischbach, T., Westerheide, N., Horstkotte, D.: Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing. Sleep And Breathing. 16, 753-757 (2012).
Oldenburg, Olaf, Bartsch, Stephan, Bitter, Thomas, Schmalgemeier, Heidi, Fischbach, Thomas, Westerheide, Nina, and Horstkotte, Dieter. “Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing”. Sleep And Breathing 16.3 (2012): 753-757.
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5 Citations in Europe PMC

Data provided by Europe PubMed Central.

Acute haemodynamic effects of continuous positive airway pressure in awake patients with heart failure.
Schroll S, Series F, Lewis K, Benjamin A, Escourrou P, Luigart R, Pfeifer M, Arzt M., Respirology 19(1), 2014
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