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Abstract
Es hat sich viel getan in der Welt der Schlafmedizin in der Kardiologie, weshalb eine vollwertige Überarbeitung des Positionspapiers „Schlafmedizin in der Kardiologie“ erforderlich wurde. In der aktuellen neuartigen Version finden sich nicht nur alle verfügbaren Studien, Literaturstellen und Updates zu Pathophysiologie, Diagnostik- und Therapieempfehlungen, sondern auch Ausblicke auf neue Entwicklungen und zukünftige Forschungserkenntnisse. Dieses überarbeitete Positionspapier gibt Empfehlungen für Diagnostik und Therapie von Patienten mit kardiovaskulären Erkrankungen mit schlafassoziierten Atmungsstörungen und erteilt darüber hinaus einen fundierten Überblick über verfügbare Therapien und Evidenzen, gibt aber ebenso Ratschläge wie mit Komorbiditäten umzugehen ist. Insbesondere enthält dieses überarbeitete Positionspapier aktualisierte Stellungnahmen zu schlafassoziierten Atmungsstörungen bei Patienten mit koronarer Herzerkrankung, Herzinsuffizienz, arterieller Hypertonie, aber auch für Patienten mit Vorhofflimmern. Darüber hinaus finden sich erstmals Empfehlungen zur Telemedizin als eigenes, neues Kapitel. Dieses Positionspapier bietet Kardiologen sowie Ärzten in der Behandlung von kardiovaskulären Patienten die Möglichkeit einer evidenzbasierten Behandlung der wachsend bedeutsamen und mit zunehmender Aufmerksamkeit behafteten Komorbidität schlafassoziierter Atmungsstörungen. Und nicht zuletzt besteht mit diesem neuen Positionspapier eine enge Verknüpfung mit dem neuen Curriculum Schlafmedizin der Deutschen Gesellschaft für Kardiologie, weshalb dieses Positionspapier eine Orientierung für die erworbenen Fähigkeiten des Curriculums im Umgang von kardiovaskulären Patienten mit schlafassoziierten Atmungsstörungen darstellt.
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Huang Y, Wang Y, Huang Y, Zhai M, Zhou Q, Zhao X, Tian P, Ji S, Zhang C, Zhang Y, Zhang J. Prognostic value of sleep apnea and nocturnal hypoxemia in patients with decompensated heart failure. Clin Cardiol 2020; 43:329-337. [PMID: 31967668 PMCID: PMC7144483 DOI: 10.1002/clc.23319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 12/01/2019] [Accepted: 12/03/2019] [Indexed: 12/28/2022] Open
Abstract
Background Nocturnal hypoxemia is an important factor underlying the impact of sleep apnea on heart failure. It remains unclear whether nocturnal hypoxemia has a greater prognostic value in acute decompensated heart failure (ADHF) compared with the frequency of sleep apnea. Hypothesis Nocturnal hypoxemia might be better than the frequency of sleep apnea in predicting the outcomes in ADHF. Methods Sleep studies were prospectively performed during an ADHF hospitalization from January 2015 to December 2017. Sleep apnea was defined as the apnea‐hypopnea index (AHI) ≥15/h. The severity of nocturnal hypoxemia was determined by the percentage of time with saturation below 90% (T90%). The endpoint was the first event of all‐cause death, heart transplantation, implantation of left ventricular assist device, unplanned hospitalization for worsening heart failure, acute coronary syndrome, significant arrhythmias, or stroke. Results Of 382 patients, 189 (49.5%) had sleep apnea. The endpoint incidence did not differ between AHI categories (≥15/h vs <15/h: 52.4% vs 44.6%, log rank P = .353), but did between T90% categories (≥3.6% vs <3.6%: 54.5% vs 42.4%, log rank P = .023). Multivariate Cox regression analysis showed that T90% was independently associated with the endpoint (hazard ratio [HR] 1.008, 95% confidence interval [CI] 1.001‐1.016, P = .033), whereas AHI was not; the risk of the endpoint increased by 40.8% in patients with T90% ≥3.6% (HR 1.408, 95%CI 1.030‐1.925, P = .032). Conclusion Nocturnal hypoxemia had a greater prognostic value in ADHF than the frequency of sleep apnea.
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Affiliation(s)
- Yuhui Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yunhong Wang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Mei Zhai
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Qiong Zhou
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xuemei Zhao
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Pengchao Tian
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Shiming Ji
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Chen Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Matsumoto H, Kasai T, Suda S, Yatsu S, Shitara J, Murata A, Kato T, Hiki M, Yanagisawa N, Fujibayashi K, Nojiri S, Nishizaki Y, Shinohara M, Daida H. Randomized controlled trial of an oral appliance (SomnoDent) for sleep-disordered breathing and cardiac function in patients with heart failure. Clin Cardiol 2018; 41:1009-1012. [PMID: 30014565 PMCID: PMC6490037 DOI: 10.1002/clc.23028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/10/2018] [Accepted: 07/12/2018] [Indexed: 12/28/2022] Open
Abstract
In patients with heart failure (HF), sleep-disordered breathing (SDB) is a common comorbidity and a risk factor for poor clinical outcomes. SDB can be ameliorated by continuous positive airway pressure; however, inadequate adherence remains a major cause of treatment failure. On the other hand, the efficacy of oral appliance (OA) has been proved in orthodontics and otolaryngology, although the efficacy of OA in patients with HF remains to be elucidated. This trial aims to determine the efficacy of OA for SDB in patients with HF. Patients with HF undergoing optimal medical therapy who were diagnosed as having SDB (apnea-hypopnea index [AHI] ≥ 10 and percentage of central AHI per total AHI ≤ 70%) by using polysomnography (PSG) will be enrolled in the present study. Either patients with HF with reduced ejection fraction (left ventricular ejection fraction [LVEF] ≤ 50%) or HF with preserved ejection fraction (history of hospitalization because of acute decompensated HF) or plasma B-type natriuretic peptide (BNP) level ≥ 100 pg/mL will be included. Each patient will be randomly assigned into active OA or sham OA. PSG, laboratory, and echocardiographic data will be obtained after 3 months of intervention. The main outcome measures are AHI, plasma BNP, and E/e' determined with echocardiography. Furthermore, overnight urinary catecholamine, 6-min walk distance, Epworth sleepiness scale, and health-related quality of life will be assessed simultaneously. This trial started on April 1, 2017, and the projected end date is March 31, 2019. This study was registered in the University Hospital Medical Information Network (UMIN000025731).
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Affiliation(s)
- Hiroki Matsumoto
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
- Cardiovascular Respiratory Sleep MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Takatoshi Kasai
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
- Cardiovascular Respiratory Sleep MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Shoko Suda
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
- Cardiovascular Respiratory Sleep MedicineJuntendo University Graduate School of MedicineTokyoJapan
| | - Shoichiro Yatsu
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Jun Shitara
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Azusa Murata
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Takao Kato
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Masaru Hiki
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo UniversityTokyoJapan
- Clinical Research and Trial Center, Juntendo University HospitalTokyoJapan
| | - Kazutoshi Fujibayashi
- Medical Technology Innovation Center, Juntendo UniversityTokyoJapan
- Clinical Research and Trial Center, Juntendo University HospitalTokyoJapan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo UniversityTokyoJapan
- Clinical Research and Trial Center, Juntendo University HospitalTokyoJapan
| | - Yuji Nishizaki
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
- Medical Technology Innovation Center, Juntendo UniversityTokyoJapan
- Clinical Research and Trial Center, Juntendo University HospitalTokyoJapan
| | - Mitsuyo Shinohara
- Department of Oral and Maxillofacial SurgeryJuntendo University School of MedicineTokyoJapan
| | - Hiroyuki Daida
- Department of Cardiovascular MedicineJuntendo University School of MedicineTokyoJapan
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