Effects of nasal high flow on sympathovagal balance, sleep, and sleep-related breathing in patients with precapillary pu
- PDF / 885,227 Bytes
- 13 Pages / 595.276 x 790.866 pts Page_size
- 55 Downloads / 187 Views
SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Effects of nasal high flow on sympathovagal balance, sleep, and sleep-related breathing in patients with precapillary pulmonary hypertension Jens Spiesshoefer 1,2 & Britta Bannwitz 1 & Michael Mohr 3 & Simon Herkenrath 4 & Winfried Randerath 4 & Paolo Sciarrone 5 & Christian Thiedemann 1 & Hartmut Schneider 6 & Andrew T. Braun 7 & Michele Emdin 2,5 & Claudio Passino 2,5 & Michael Dreher 8 & Matthias Boentert 1,9 & Alberto Giannoni 2,5 Received: 17 March 2020 / Revised: 9 July 2020 / Accepted: 1 August 2020 # The Author(s) 2020
Abstract Background In precapillary pulmonary hypertension (PH), nasal high flow therapy (NHF) may favorably alter sympathovagal balance (SVB) and sleep-related breathing through washout of anatomical dead space and alleviation of obstructive sleep apnea (OSA) due to generation of positive airway pressure. Objectives To investigate the effects of NHF on SVB, sleep, and OSA in patients with PH, and compare them with those of positive airway pressure therapy (PAP). Methods Twelve patients with PH (Nice class I or IV) and confirmed OSA underwent full polysomnography, and noninvasive monitoring of SVB parameters (spectral analysis of heart rate, diastolic blood pressure variability). Study nights were randomly split into four 2-h segments with no treatment, PAP, NHF 20 L/min, or NHF 50 L/min. In-depth SVB analysis was conducted on 10-min epochs during daytime and stable N2 sleep at nighttime. Results At daytime and compared with no treatment, NHF20 and NHF50 were associated with a flow-dependent increase in peripheral oxygen saturation but a shift in SVB towards increased sympathetic drive. At nighttime, NHF20 was associated with increased parasympathetic drive and improvements in sleep efficiency, but did not alter OSA severity. NHF50 was poorly tolerated. PAP therapy improved OSA but had heterogenous effects on SVB and neutral effects on sleep outcomes. Hemodynamic effects were neutral for all interventions.
First authors, Jens Spiesshoefer and Britta Bannwitz, contributed equally to this work. Senior authors, Matthias Boentert and Alberto Giannoni, contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11325-020-02159-1) contains supplementary material, which is available to authorized users. * Jens Spiesshoefer [email protected]
5
Cardiology and Cardiovascular Medicine Division, Fondazione Toscana Gabriele Monasterio, National Research Council, CNR-Regione Toscana, Pisa, Italy
1
Department of Neurology with Institute for Translational Neurology, University of Muenster, Muenster, Germany
6
Sleep Disorders Center, Bayview Hospital, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
2
Institute of Life Sciences, Scuola Superiore Sant’Anna, Piazza Martiri della Libertà, 33, 56127 Pisa, PI, Italy
7
Division of Allergy, Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
8
Department
Data Loading...
