Comparison of CPAP With SOMNOventCR in Patients With Underlying Heart Disease, Combined OSA and CSR
NCT ID: NCT00811668
Last Updated: 2023-12-21
Study Results
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Basic Information
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COMPLETED
NA
40 participants
INTERVENTIONAL
2008-05-31
2009-10-31
Brief Summary
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In a lot of these patients it is neither a purely obstructive sleep-apnea syndrome nor a complete Cheyne-Stokes-respiration but a combination of both sleep related respiratory disturbances.
Previous studies showed an improvement of the central respiratory disorder, for example Cheyne-Stokes-respiration, under continuous positive pressure breathing (CPAP) and an improvement of the left ventricular pump function. (Naughton 1995, Tkacova 1997).
However, the recently published CanPAP study could not prove any improvement in the mortality among CPAP therapy patients in comparison to the optimal medical treatment, although under this therapy, the number of breathing disturbances, the oxygen saturation at night and the ejection fraction of the left ventricle showed a significant improvement.(Bradley 2005)
Earlier studies proved the adaptive servo ventilation to be an effective therapy for patients with central sleep-apnea and Cheyne-Stokes-respiration respectively. (Teschler 2001) Teschler's study showed that the adaptive servo ventilation therapy with a reduction of central sleep apnea down to 10/hours succeeded. With the SOMNOvent CR a new therapy-algorithm has been developed for the adaptive servo ventilation in patients with obstructive sleep apnea and Cheyne-Stokes-respiration with underlying heart disease. In the first validation study this therapy was very effective and presented only few adverse effects in the patients. (Galetke 2007)
The goal of the study was to compare this new therapeutic option (SOMNOvent CR) with the established method of continuous positive airway pressure (CPAP) in patients with combination of obstructive sleep-apnea syndrome and Cheyne-Stokes-respiration with underlying heart disease.
Detailed Description
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We divided the patients in two groups:
Group 1: started with CPAP and continued with SOMNOvent CR Group 2: began with SOMNOvent CR and ended with CPAP
First of all a CPAP-titration was applied to both fixed groups during the second night. During the third night they received either the CPAP- pressure (first group) or the adaptive servo ventilation (second group. The patients were discharged from the hospital continuing with the procedure of the third night.
After four weeks a new admission for the sleep laboratory was necessary and, during the first night, a control investigation with the procedure of the last four weeks. The procedure changed during the next night, so that the patients of the first group now slept with the SOMNOventCR-device and the patients of the second group with the CPAP-device.
After a wash-out-period of a week and a four-week treatment with the last procedure a final in-hospital polysomnography was performed in which adaptive servo ventilation was applied to the first group and fixed CPAP to the second group.
After the study ended, the patients received the therapy procedure which was the most effective and which was better tolerated.
The following analyses were carried out in addition to the polysomnographic measurements:
Admission 1: Berlin questionnaire, European sleep questionnaire, echocardiography, 6 minute walking test, patients questionnaire.
Admission 2: ESS, Berlin questionnaire, echocardiography, 6 minute walking test, patients´ questionnaire.
After the wash-out-period: ESS, Berlin questionnaire, patients questionnaire.
Admission 4: ESS, Berlin questionnaire, echocardiography, 6 minute walking test, patients questionnaire.
Conditions
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Keywords
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Study Design
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RANDOMIZED
CROSSOVER
TREATMENT
SINGLE
Study Groups
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CPAP before SOMNOVentCR
started with CPAP and continued with SOMNOvent CR
CPAP before SOMNOVentCR
4 weeks CPAP treatment, 1 week wash out period, 4 weeks SOMNOventCR treatment
SOMNOVentCR before CPAP
began with SOMNOvent CR and ended with CPAP
SOMNOventCR before CPAP
4 weeks SOMNOventCR treatment, 1 week wash out period, 4 weeks CPAP treatment
Interventions
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CPAP before SOMNOVentCR
4 weeks CPAP treatment, 1 week wash out period, 4 weeks SOMNOventCR treatment
SOMNOventCR before CPAP
4 weeks SOMNOventCR treatment, 1 week wash out period, 4 weeks CPAP treatment
Eligibility Criteria
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Inclusion Criteria
* Diagnosis of arterial hypertension or a coronary heart disease or a dilative cardiomyopathy
* Combined sleep-apnea-syndrome with a total value of AHI\>15 per hour and a rate up to 20% of central events or periodic breathing.
Exclusion Criteria
* Myocardial infarction or unstable angina pectoris or cardiac surgery within the last three months.
* Apnea-hypopnea-index \< 15 per hour.
* Obstructive breathing disturbances up to 80%.
* Pregnancy.
* Absence of declaration of consent.
* Malign diseases.
* Serious (Severe) chronic oxygen-requiring pulmonary illness.
* Age under 18 years.
18 Years
ALL
No
Sponsors
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Wissenschaftliches Institut Bethanien e.V
OTHER
Responsible Party
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Principal Investigators
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Wolfgang Galetke, PD Dr.
Role: STUDY_CHAIR
Winfried J. Randerath, Prof. Dr.
Role: STUDY_DIRECTOR
References
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Bradley TD, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, Belenkie I, Pfeifer M, Fleetham J, Hanly P, Smilovitch M, Tomlinson G, Floras JS; CANPAP Investigators. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2005 Nov 10;353(19):2025-33. doi: 10.1056/NEJMoa051001.
Naughton MT, Liu PP, Bernard DC, Goldstein RS, Bradley TD. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure. Am J Respir Crit Care Med. 1995 Jan;151(1):92-7. doi: 10.1164/ajrccm.151.1.7812579.
Teschler H, Dohring J, Wang YM, Berthon-Jones M. Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med. 2001 Aug 15;164(4):614-9. doi: 10.1164/ajrccm.164.4.9908114.
Tkacova R, Hall MJ, Liu PP, Fitzgerald FS, Bradley TD. Left ventricular volume in patients with heart failure and Cheyne-Stokes respiration during sleep. Am J Respir Crit Care Med. 1997 Nov;156(5):1549-55. doi: 10.1164/ajrccm.156.5.9612101.
Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, Roselle GA. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998 Jun 2;97(21):2154-9. doi: 10.1161/01.cir.97.21.2154.
Other Identifiers
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WI_VentCR_13/2008
Identifier Type: -
Identifier Source: org_study_id