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Correspondence
Sleep disorders breathing in chronic heart failure. Is adaptive servoventilation really the answer?
T. Sequeiraa,
Corresponding author
sequeira.telma@gmail.com

Corresponding author.
, L. Bentoa, A.M. Esquinasb
a Pulmonology Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Lisboa, Portugal
b Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Despite much research&#44; Continuous Positive Airway Pressure &#40;CPAP&#41; therapy is still the gold standard in initial treatment for central sleep apneas syndromes &#40;CSAS&#41; related to congestive heart failure &#40;CHF&#41;&#46; Additionally&#44; adaptive servoventilation &#40;ASV&#41; may be an option for these patients&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> CPAP emergent central apnea also known as complex sleep apnea syndrome &#40;CompSAS&#41; has been defined as the development of frequent central apneas or Cheyne&#8211;Stokes respiratory &#40;CSR&#41; pattern after introduction of CPAP therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We read with great interest the results of Correia et al&#46; and consider that some aspects could be analyzed for proper extrapolation practice&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> The present study approaches an important subject in the field of sleep disorder breathing &#40;SDB&#41;&#46; Various data has been published with the objective of defining which treatment is most appropriate for patients with SDB and CHF&#46; However&#44; some comments should be made about the present study&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">First&#44; the readers need a more precise definition when the diagnosis was made in CompSAS&#44; central sleep apnea &#40;CSA&#41; and CSR&#46; In this context&#44; some questions need to be posed&#44; was the diagnosis made during the baseline sleep study and was the baseline sleep study also a split-night sleep study&#63; In relation to patients that were afterwards treated with PAP&#44; should not the second sleep study include CPAP&#47;Auto-CPAP&#47;BPAP titration&#63;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Second&#44; according to Javaheri et al&#46;&#44; CompSAS was transitory and eliminated after 8 weeks of CPAP therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In the study performed by Correia et al&#46; the reader does not know how long the authors waited for CompSAS to disappear with regular CPAP therapy&#44; before performing ASV titration&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Third&#44; as previously stated in the literature&#44; BPAP in the spontaneous mode may intensify central apnea caused by hyperventilation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> in relation to BPAP patients&#44; the authors did not mention if S&#47;T mode was used and which pressures were necessary for optimal treatment&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Fourth&#44; parameters such as left ventricular ejection fraction &#40;LVEF&#41; and treatment compliance have been used to assess ASV vs&#46; CPAP therapy in patients with both CHF and SDB&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In the present study the evaluation of LVEF was a limitation&#44; since only 16 out of 33 patients had a cardiac function evaluation before and after PSG therapy titration and decision&#46; An interesting fact was that in the present study no differences were encountered in terms of cardiovascular &#40;CV&#41; mortality&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Future studies should also focus on long-term effects of persistent CSA in asymptomatic patients&#44; as well as alternative pharmacological interventions for patients with CSAS and HF&#46;</p></span>"
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ISSN: 21735115
Original language: English
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