Symptomatic Congestive Heart Failure Clinical Trial
Successful treatment of pulmonary edema was first published in 1938 by A. L. Barach. Since
then, this has been the accepted method of treating acute respiratory failure due to left
heart failure and edema.
The question was raised if pressure supported ventilation during sleep is used to eliminate
sleep apneas, would it be useful also for improving congestive heart failure (CHF). Recent
studies assessed the role of continuous positive airway pressure (CPAP) in patients with
advanced CHF and found the treatment useful. A possible explanation for these results is
that central sleep apnea frequently coexists with severe CHF and is not treated or
suppressed by CPAP.
The frequency of central sleep apnea increases with the severity of CHF and can be found in
more than 30% of patients.
A few recent studies showed the usefulness of bilevel positive airway pressure (BIPAP) or
adaptive servo-ventilation (ASV). ASV led to improvement in ejection fraction as well as in
6 min walking distance testing, and was associated with decreased BNP levels. In another
study, bilevel PAP increased LVEF by 7.9%.
The limitations of these studies are the small number of patients and that they were
conducted on inpatients only. These factors make it difficult to include BIPAP in the
guidelines for chronic heart failure therapy.
Recently, two outpatient modalities have been introduced to diagnose sleep disordering
breathing (SDB). However, no study has directly compared the results of both studies in
patients with CHF. Moreover, no studies have assessed improvement in CHF after BIPAP
treatment.
In addition, the investigators plan to assess the endothelial function in this population
before and after BIPAP treatment with the EndoPAT, a noninvasive technology
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Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment