Hypotensive effects of positive airway pressure ventilation in heart failure patients with sleep-disordered breathing.

Introduction: Obstructive sleep apnoea (OSA) as well as central sleep apnoea (CSA) are highly prevalent in heart failure (HF) patients. Positive airway pressure (PAP) therapy is usually intended to treat OSA and CSA. The aim of the present study was to investigate immediate hemodynamic effects of PAP therapy in these patients.

Materials And Methods: In 61 consecutive HF patients (NYHA ≥ II, EF ≤ 45%) with moderate to severe OSA or CSA (AHI ≥ 15/h) blood pressure (BP) and heart rate (HR) response to PAP therapy initiation was investigated during mask fitting with patients being awake and in supine position. While applying an endexspiratory pressure of 5.8 ± 0.9 cm H(2)O, there was a significant decrease in systolic (-8.9 ± 12.1 mmHg, p < 0.001) and diastolic BP (-5.1 ± 9.2 mmHg, p < 0.001) without a change in HR (p = n.s.).

Results: At least a transient drop in mean arterial pressure ≤70 mmHg was seen in 10% of these patients. Logistic regression analysis revealed a significant impact of baseline BP on potential BP drops: lower baseline BP was associated with BP drops.

Conclusion: PAP therapy may cause unexpected hypotension especially in patients with low baseline BP as seen in HF patients treated according to current guidelines. Whether these hypotensive effects sustain, cause any harm to the patients and/or is responsible for non-acceptance or non-adherence of PAP therapy needs to be determined.