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Archives of cardiovascular diseases
Volume 102, n° 10
pages 711-720 (octobre 2009)
Doi : 10.1016/j.acvd.2009.06.005
Received : 2 July 2008 ;  accepted : 18 June 2009
Sleep apnoea in patients with heart failure: Part II: Therapy
Apnée du sommeil et insuffisance cardiaque : partie II : thérapeutique

Figure 1

Figure 1 : 

Nocturnal O2 supplementation in chronic heart failure and sleep apnoea. Patient with an apnoea-hypopnoea index (AHI: number of apnoeas and hypopnoeas per hour of sleep)=39.2, O2 desaturation index (ODI: number of dips in O2 per hour of sleep)=35.4 and mean nocturnal blood oxygen saturation (SaO2 )=90.7% on baseline nocturnal ventilation polygraphy. 1A and 1B. Baseline recordings, showing mixed and obstructive apnoeas, respectively, with profound dips in O2 . 1C and 1D. Recordings during 3 L/min of nocturnal O2 supplementation; AHI=4.5, ODI=0.3 and mean nocturnal SaO2 =97.9%. 1C. Mixed residual apnoeas with very mild O2 desaturation. The heart rate is stable in this pacemaker recipient, with pacing at a backup rate of 70 bpm. Pacemaker programming was similar during baseline polygraphy. This indicates that the elimination of O2 desaturation during apnoeic events may suppress the autonomic nervous system instability. 1D. Prolonged, residual, abnormal respiratory event with obstructive hypopnoea progressing toward apnoea; note that the dips in O2 remain shallow. ECG: electrocardiogram.

Figure 2

Figure 2 : 

Treatment algorithm for sleep apnoea (SA) in patients with heart failure (HF). SA is considered to be obstructive (OSA), central (CSA) or mixed according to the predominant type of apnoea and hypopnoea. ACEI: angiotensin-converting enzyme inhibitor; CSR: Cheyne-Stokes respiration; CPAP: continuous positive airway pressure; CRT: cardiac resynchronization therapy.

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