1
|
Idalino SCC, Canever JB, Cândido LM, Wagner KJP, de Souza Moreira B, Danielewicz AL, de Avelar NCP. Association between sleep problems and multimorbidity patterns in older adults. BMC Public Health 2023; 23:978. [PMID: 37237275 DOI: 10.1186/s12889-023-15965-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 05/23/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Sleep problems are frequent in older adults and are associated with chronic diseases. However, the association with multimorbidity patterns is still unknown. Considering the negative impacts that multimorbidity patterns can have on older adults' life, knowledge of this association can help in the screening and early identification of older adults with sleep problems. The objective was to verify the association between sleep problems and multimorbidity patterns in older Brazilian adults. METHODS This was a cross-sectional study conducted with data from 22,728 community-dwelling older adults from the 2019 National Health Survey. The exposure variable was self-reported sleep problems (yes/no). The study outcomes were: multimorbidity patterns, analyzed by self-report of the coexistence of two or more chronic diseases with similar clinical characteristics: (1) cardiopulmonary; (2) vascular-metabolic; (3) musculoskeletal; (4) coexisting patterns. RESULTS Older adults with sleep problems had 1.34 (95%CI: 1.21; 1.48), 1.62 (95%CI: 1.15; 2.28), 1.64 (95%CI: 1.39; 1.93), and 1.88 (95%CI: 1.52; 2.33) greater odds of presenting vascular-metabolic, cardiopulmonary, musculoskeletal, and coexisting patterns, respectively. CONCLUSIONS These results suggest that public health programs aimed at preventing sleep problems in older adults are essential to reduce possible adverse health outcomes, including multimorbidity patterns and their negative consequences for older adults' health.
Collapse
Affiliation(s)
- Stefany Cristina Claudino Idalino
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil
| | - Jaquelini Betta Canever
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil
- Post-Graduate Program in Neuroscience, Federal University of Santa Catarina (UFSC), Florianópolis, Santa Catarina, Brazil
| | - Letícia Martins Cândido
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil
| | - Katia Jakovljevic Pudla Wagner
- Federal University of Santa Catarina (UFSC), Campus Curitibanos, Rod. Ulysses Gaboardi, 300, Curitibanos, 89520-000, Santa Catarina, Brazil
| | - Bruno de Souza Moreira
- Center for Studies in Public Health and Aging, Federal University of Minas Gerais (UFMG), Av. Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Ana Lúcia Danielewicz
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil
| | - Núbia Carelli Pereira de Avelar
- Laboratory of Aging, Resources and Rheumatology, Department of Health Sciences, Federal University of Santa Catarina (UFSC), Campus Araranguá, Rod. Governador Jorge Lacerda, Urussanguinha, Araranguá, 3201, 88906-072, Santa Catarina, Brazil.
| |
Collapse
|
2
|
Han SJ, Xu QQ, Pan H, Liu WJ, Dai QQ, Lin HY, Cui HR, You LZ, Wu YZ, Wei XH, Shang HC. Network pharmacology and molecular docking prediction, combined with experimental validation to explore the potential mechanism of Qishen Yiqi pills against HF-related cognitive dysfunction. JOURNAL OF ETHNOPHARMACOLOGY 2023; 314:116570. [PMID: 37187360 DOI: 10.1016/j.jep.2023.116570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/18/2023] [Accepted: 05/01/2023] [Indexed: 05/17/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Qishen Yiqi Pills (QSYQ) is a classical herbal formula for treating heart failure (HF) and has potential efficacy in improving cognitive function. The latter is one of the most common complications in patients with HF. However, there is no study on treating HF-related cognitive dysfunction by QSYQ. AIMS OF THE STUDY The study aims to investigate the effect and mechanism of QSYQ on treating post-HF cognitive dysfunction based on network pharmacology and experimental validation. MATERIALS AND METHODS Network pharmacology analysis and molecular docking was used to explore endogenous targets of QSYQ in treating cognitive impairment. Ligation of the anterior descending branch of the left coronary artery and sleep deprivation (SD) were used to induce HF-related cognitive dysfunction in rats. The efficacy and potential signal targets of QSYQ were then verified by functional evaluation, pathological staining, and molecular biology experiments. RESULTS 384 common targets were identified by intersecting QSYQ 'compound targets' and 'cognitive dysfunction' disease targets. KEGG analysis showed these targets were enriched to the cAMP signal, and four marks responsible for regulating the cAMP signal were successfully docked with core compounds of QSYQ. Animal experiments demonstrated that QSYQ significantly ameliorated cardiac function and cognitive function in rats suffering from HF and SD, inhibited the reduction of cAMP and BDNF content, reversed the upregulation of PDE4 and downregulation of CREB, suppressed the loss of neurons, and restored the expression of synaptic protein PSD95 in the hippocampus. CONCLUSION This study clarified that QSYQ could improve HF-related cognitive dysfunction by modulating cAMP-CREB-BDNF signals. It provides a rich basis for the potential mechanism of QSYQ in the treatment of heart failure with cognitive dysfunction.
Collapse
Affiliation(s)
- Song-Jie Han
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Qian-Qian Xu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Hai'e Pan
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Wen-Jing Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Qian-Qian Dai
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Hong-Yuan Lin
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - He-Rong Cui
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Liang-Zhen You
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Yu-Zhuo Wu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China
| | - Xiao-Hong Wei
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
| | - Hong-Cai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, 100700, China.
| |
Collapse
|
3
|
Piccirillo F, Crispino SP, Buzzelli L, Segreti A, Incalzi RA, Grigioni F. A State-of-the-Art Review on Sleep Apnea Syndrome and Heart Failure. Am J Cardiol 2023; 195:57-69. [PMID: 37011555 DOI: 10.1016/j.amjcard.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/19/2023] [Accepted: 02/25/2023] [Indexed: 04/05/2023]
Abstract
Heart failure (HF) affects many patients worldwide every year. It represents a leading cause of hospitalization and still, today, mortality remains high, albeit the progress in treatment strategies. Several factors contribute to the development and progression of HF. Among these, sleep apnea syndrome represents a common but still underestimated factor because its prevalence is substantially higher in patients with HF than in the general population and is related to a worse prognosis. This review summarizes the current knowledge about sleep apnea syndrome coexisting with HF in terms of morbidity and mortality to provide actual and future perspectives about the diagnosis, evaluation, and treatment of this association.
Collapse
Affiliation(s)
- Francesco Piccirillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy.
| | - Simone Pasquale Crispino
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Lorenzo Buzzelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Andrea Segreti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Raffaele Antonelli Incalzi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Geriatrics, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| | - Francesco Grigioni
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128 Roma, Italy; Research Unit of Cardiovascular Sciences, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128 Roma, Italy
| |
Collapse
|
4
|
Marques I, Ramos RL, Mendonça D, Teixeira L. One-year mortality after hospitalization for acute heart failure: Predicting factors (PRECIC study subanalysis). Rev Port Cardiol 2023:S0870-2551(23)00121-X. [PMID: 36893846 DOI: 10.1016/j.repc.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/07/2022] [Accepted: 07/14/2022] [Indexed: 03/09/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES One-year mortality after hospitalization for heart failure (HF) is high. This study aims to identify predictive factors of one-year mortality. METHODS This is a retrospective, single-center and observational study. All patients hospitalized for acute HF for one-year were enrolled. RESULTS A total of 429 patients were enrolled, mean age of 79 years. The in-hospital and one-year all-cause mortality rates were 7.9% and 34.3%, respectively. In the univariable analysis, the factors significantly associated with higher one-year mortality risk were: age ≥80 years (odds ratio (OR)=2.05, 95% confidence interval (CI) 1.35-3.11, p=0.001); active cancer (OR=2.93, 95% CI 1.36-6.32, p=0.008); dementia (OR=2.84, 95% CI 1.81-4.47, p<0.001); functional dependency (OR=2.63, 95% CI 1.65-4.19, p<0.001); atrial fibrillation (OR=1.86, 95% CI 1.24-2.80, p=0.004); higher creatinine (OR=2.03, 95% CI 1.29-3.21, p=0.002), urea (OR=2.92, 95% CI 1.95-4.36, p<0.001) and red cell distribution width (RDW; 4thQ OR=5.59, 95% CI 3.03-10.32, p=0.001); and lower hematocrit (OR=0.94, 95% CI 0.91-0.97, p<0.001), hemoglobin (OR=0.83, 95% CI 0.75-0.92, p<0.001) and platelet distribution width (PDW; OR=0.89, 95% CI 0.82-0.97, p=0.005). In the multivariable analysis, the independent predictors of higher one-year mortality risk were: age ≥80 years (OR=2.05, 95% CI 1.21-3.48); active cancer (OR=2.70, 95% CI 1.03-7.01); dementia (OR=2.69, 95% CI 1.53-4.74); higher urea (OR=2.97, 95% CI 1.84-4.80) and RDW (4thQ OR=5.24, 95% CI 2.55-10.76); and lower PDW (OR=0.88, 95% CI 0.80-0.97). CONCLUSIONS Active cancer, dementia, and high values for urea and RDW at admission are predictors of one-year mortality in patients hospitalized for HF. These variables are readily available at admission and can support the clinical management of HF patients.
Collapse
Affiliation(s)
- Irene Marques
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal; Unidade Multidisciplinar de Investigação Biomédica, ICBAS - Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal.
| | - Raquel Lopes Ramos
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto (CHUPorto), Porto, Portugal
| | - Denisa Mendonça
- ITR-Laboratory for Integrative and Translational Research in Population Health, Porto, Portugal; Department of Population Studies, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Laetitia Teixeira
- Department of Population Studies, Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal; Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Instituto de Ciências Biomédicas de Abel Salazar, Universidade do Porto, Porto, Portugal
| |
Collapse
|
5
|
Zhu Y, Chen X, Guo L, Wang L, Chen N, Xiao Y, Wang E. Acute sleep deprivation increases inflammation and aggravates heart failure after myocardial infarction. J Sleep Res 2022; 31:e13679. [PMID: 35785454 PMCID: PMC9786274 DOI: 10.1111/jsr.13679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/30/2022]
Abstract
Sleep disorders have been observed among patients with heart failure. The aim of this study was to investigate whether acute sleep deprivation (SD) aggravates left heart function. Male C57B/L6 mice were assigned to four experimental groups. Ligation of the left anterior descending branch (LAD) caused myocardial infarction (MI) in mice in the LAD group and the LAD+SD group, while mice in the sham and sham+SD groups underwent the same surgery without ligation. Echocardiography was performed before and 8 weeks after ligation of the LAD to evaluate the left ventricular internal diameter at diastole (LVIDd), left ventricular internal diameter at systole (LVIDs), ejection fraction (EF), and fractional shortening (FS). Seven days of sleep deprivation induced using the modified single platform method resulted in a lower EF and FS and a higher LVIDd and LVIDs, as well as increased expression of the IL-1β, IL-18, and IL-10 mRNAs in the left ventricular tissue of MI mice. ELISA also indicated higher levels of IL-1β and IL-10 in the LAD+SD group. It was concluded that acute sleep deprivation induced cardiovascular alterations in cardiac structure and function in HF mice, accompanied by increased levels of inflammatory cytokines.
Collapse
Affiliation(s)
- Yumin Zhu
- Department of Anesthesiologythe Affiliated Suzhou Hospital of Nanjing Medical UniversitySuzhouChina
| | - Xian Chen
- The First Affiliated Hospital of Suzhou UniversitySuzhouChina
| | - Lizhe Guo
- Department of AnesthesiologyXiangya Hospital Central South UniversityChangshaChina
| | - Lu Wang
- Department of AnesthesiologyXiangya Hospital Central South UniversityChangshaChina
| | - Na Chen
- Department of AnesthesiologyXiangya Hospital Central South UniversityChangshaChina
| | - Yujie Xiao
- Department of AnesthesiologyXiangya Hospital Central South UniversityChangshaChina
| | - E. Wang
- Department of AnesthesiologyXiangya Hospital Central South UniversityChangshaChina,National Clinical Research Center for Geriatric Disorders (Xiangya Hospital)ChangshaChina
| |
Collapse
|
6
|
Kondratavičienė L, Tamulėnaitė E, Vasylė E, Januškevičius A, Ereminienė E, Malakauskas K, Žemaitis M, Miliauskas S. Changes in Left Heart Geometry, Function, and Blood Serum Biomarkers in Patients with Obstructive Sleep Apnea after Treatment with Continuous Positive Airway Pressure. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111511. [PMID: 36363468 PMCID: PMC9698941 DOI: 10.3390/medicina58111511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
Background: Cardiovascular remodeling is essential in patients with obstructive sleep apnea (OSA), and continuous positive airway pressure (CPAP) therapy could improve these processes. Two-dimensional (2D) speckle-tracking (ST) echocardiography is a useful method for subclinical biventricular dysfunction diagnosis and thus might help as an earlier treatment for OSA patients. It is still not clear which blood serum biomarkers could be used to assess CPAP treatment efficacy. Objectives: To evaluate left heart geometry, function, deformation parameters, and blood serum biomarker (galectin-3, sST2, endothelin-1) levels in patients with OSA, as well as to assess changes after short-term CPAP treatment. Materials and Methods: Thirty-four patients diagnosed with moderate or severe OSA, as well as thirteen patients as a control group, were included in the study. All the subjects were obese (body mass index (BMI) > 30 kg/m2). Transthoracic 2D ST echocardiography was performed before and after 3 months of treatment with CPAP; for the control group, at baseline only. Peripheral blood samples for the testing of biomarkers were collected at the time of study enrolment before the initiation of CPAP therapy and after 3 months of CPAP treatment (blood samples were taken just for OSA group patients). Results: The left ventricle (LV) end-diastolic diameter and volume, as well as LV ejection fraction (EF), did not differ between groups, but an increased LV end-systolic volume and a reduced LV global longitudinal strain (GLS) were found in the OSA group patients (p = 0.015 and p = 0.035, respectively). Indexed by height, higher LV MMi in OSA patients (p = 0.007) and a higher prevalence of LV diastolic dysfunction (p = 0.023) were found in this group of patients. Although left atrium (LA) volume did not differ between groups, OSA group patients had significantly lower LA reservoir strain (p < 0.001). Conventional RV longitudinal and global function parameters (S′, fractional area change (FAC)) did not differ between groups; however, RV GLS was reduced in OSA patients (p = 0.026). OSA patients had a significantly higher right atrium (RA) diameter and mean pulmonary artery pressure (PAP) (p < 0.05). Galectin-3 and sST2 concentrations significantly decreased after 3 months of CPAP treatment. Conclusions: OSA is associated with the left heart remodeling process—increased LV myocardial mass index, LV diastolic dysfunction, reduced LV and RV longitudinal strain, and reduced LA reservoir function. A short-term, 3-months CPAP treatment improves LV global longitudinal strain and LA reservoir function and positively affects blood serum biomarkers. This new indexing system for LV myocardial mass by height helps to identify myocardial structural changes in obese patients with OSA.
Collapse
Affiliation(s)
- Laima Kondratavičienė
- Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
- Correspondence:
| | - Eglė Tamulėnaitė
- Department of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Eglė Vasylė
- Laboratory of Pulmonology, Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Andrius Januškevičius
- Laboratory of Pulmonology, Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Eglė Ereminienė
- Department of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Kęstutis Malakauskas
- Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Marius Žemaitis
- Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Skaidrius Miliauskas
- Department of Pulmonology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| |
Collapse
|
7
|
The role of PPARγ in intermittent hypoxia-related human umbilical vein endothelial cell injury. Sleep Breath 2022; 27:1155-1164. [DOI: 10.1007/s11325-022-02696-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/22/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022]
|
8
|
Gerçek M, Gerçek M, Alzein K, Sciacca V, Sohns C, Sommer P, Rudolph V, Fox H. Impact of Sleep-Disordered Breathing Treatment on Ventricular Tachycardia in Patients with Heart Failure. J Clin Med 2022; 11:jcm11154567. [PMID: 35956183 PMCID: PMC9369567 DOI: 10.3390/jcm11154567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/30/2022] [Accepted: 08/03/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Sleep-disordered breathing (SDB) is a highly common comorbidity in patients with heart failure (HF), and a known risk factor for ventricular tachycardia (VT) development. However, little is known about the impact of SDB treatment on VT burden in HF patients to date. Therefore, this study investigated VT burden, as well as implantable cardioverter-defibrillator (ICD) therapies in HF patients with SDB treatment, in comparison to untreated SDB HF patients. Methods: This retrospective study analyzed VT burden, rate of antitachycardia pacing (ATP), and the number of shocks delivered in a propensity score-matched patient cohort of patients with SDB treatment or control. Patients had moderate or severe SDB (n = 73 per each group; standardized mean difference of 0.08) and were followed for a minimum of one year. In addition, survival over 4 years was assessed. Results: Mean patient age was 67.67 ± 10.78 and 67.2 ± 10.10, respectively, with 15.06% and 10.95% of the patients, respectively, being female. Regarding SDB subtypes in the control and SDB treatment group, central sleep apnea was present in 42.46% and 41.09% of the patients, respectively, and obstructive sleep apnea was present in 26.02% and 31.50% of the patients, respectively. Mixed type sleep disorder was present in 31.50% and 27.40% of cases. Among the SDB treatment group, a significantly lower number of VTs (28.8% vs. 68.5%; p = 0.01), ATP (21.9% vs. 50.7%; p = 0.02), as well as a lower shock rate (5.5% vs. 31.5%; p < 0.01), was observed compared to the control group. Furthermore, the VT burden was significantly lower in the SDB treatment group when compared to the time prior to SDB treatment (p = 0.02). Event-free survival was significantly higher in the SDB treatment group (Log-rank p < 0.01). Conclusion: SDB treatment in HF patients with ICD leads to significant improvements in VT burden, ATP and shock therapy, and may even affect survival. Thus, HF patients should be generously screened for SDB and treated appropriately.
Collapse
Affiliation(s)
- Muhammed Gerçek
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
- Correspondence: ; Tel.: +49-5731-97-1258
| | - Mustafa Gerçek
- Clinic for Cardiovascular Surgery, Herzzentrum Duisburg, 47137 Duisburg, Germany
| | - Kanjo Alzein
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Clinic for Electrophysiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Philipp Sommer
- Clinic for Electrophysiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
- Heart Failure Department, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
- Heart Failure Department, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| | - Henrik Fox
- Heart Failure Department, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
- Clinic for Thoracic and Cardiovascular Surgery, Herz-und Diabeteszentrum NRW, Ruhr-Universität Bochum, 32545 Bad Oeynhausen, Germany
| |
Collapse
|
9
|
Gharzeddine R, McCarthy MM, Yu G, Dickson VV. Associations of insomnia symptoms with sociodemographic, clinical, and lifestyle factors in persons with HF: Health and retirement study. Res Nurs Health 2022; 45:364-379. [DOI: 10.1002/nur.22211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/10/2022] [Accepted: 01/13/2022] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Gary Yu
- Rory Meyers College of Nursing New York University New York City New York USA
| | - Victoria V. Dickson
- Rory Meyers College of Nursing New York University New York City New York USA
| |
Collapse
|
10
|
Formiga F, Martínez-Velilla N. [Heart failure and insomnia: A bidirectional relationship]. Rev Esp Geriatr Gerontol 2022; 57:61-62. [PMID: 35190192 DOI: 10.1016/j.regg.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 12/27/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Francesc Formiga
- Sección de Geriatría, Servicio de Medicina Interna, Hospital Universitari Bellvitge. IDIBELL, L'Hospitalet de Llobregat, Barcelona, España.
| | - Nicolás Martínez-Velilla
- Servicio de Geriatría, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), Instituto de Investigación Sanitaria de Navarra (IdiSNa), Pamplona, España
| |
Collapse
|
11
|
Ahmed A, Anand AN, Shah I, Yakah W, Freedman SD, Thomas R, Sheth SG. Prospective evaluation of sleep disturbances in chronic pancreatitis and its impact on quality of life: a pilot study. Sleep Breath 2022; 26:1683-1691. [PMID: 34981297 DOI: 10.1007/s11325-021-02541-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/13/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022]
|
12
|
Predictive Biomarkers for Postmyocardial Infarction Heart Failure Using Machine Learning: A Secondary Analysis of a Cohort Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:2903543. [PMID: 34938340 PMCID: PMC8687817 DOI: 10.1155/2021/2903543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/17/2021] [Indexed: 12/13/2022]
Abstract
Background There are few biomarkers with an excellent predictive value for postacute myocardial infarction (MI) patients who developed heart failure (HF). This study aimed to screen candidate biomarkers to predict post-MI HF. Methods This is a secondary analysis of a single-center cohort study including nine post-MI HF patients and eight post-MI patients who remained HF-free over a 6-month follow-up. Transcriptional profiling was analyzed using the whole blood samples collected at admission, discharge, and 1-month follow-up. We screened differentially expressed genes and identified key modules using weighted gene coexpression network analysis. We confirmed the candidate biomarkers using the developed external datasets on post-MI HF. The receiver operating characteristic curves were created to evaluate the predictive value of these candidate biomarkers. Results A total of 6,778, 1,136, and 1,974 genes (dataset 1) were differently expressed at admission, discharge, and 1-month follow-up, respectively. The white and royal blue modules were most significantly correlated with post-MI HF (dataset 2). After overlapping dataset 1, dataset 2, and external datasets (dataset 3), we identified five candidate biomarkers, including FCGR2A, GSDMB, MIR330, MED1, and SQSTM1. When GSDMB and SQSTM1 were combined, the area under the curve achieved 1.00, 0.85, and 0.89 in admission, discharge, and 1-month follow-up, respectively. Conclusions This study demonstrates that FCGR2A, GSDMB, MIR330, MED1, and SQSTM1 are the candidate predictive biomarker genes for post-MI HF, and the combination of GSDMB and SQSTM1 has a high predictive value.
Collapse
|
13
|
Sleep-disordered breathing patterns in hospitalized patients with acute heart failure across the entire spectrum of ejection fraction. Sleep Breath 2021; 26:1281-1286. [PMID: 34671911 DOI: 10.1007/s11325-021-02511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/08/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is prevalent in heart failure (HF). Yet, scarce data exist on sleep-patterns in acute HF and differences in specific subgroups. Our goal was to assess SDB prevalence in hospitalized patients with decompensated HF across the entire spectrum of left ventricle ejection fraction (LVEF). METHODS Single-center retrospective study enrolling patients admitted for acute HF between 2013 and 2018. All patients were screened for SDB with an ApneaLink™ Plus device before discharge while euvolemic and receiving oral therapy. Those with a sleep study time < 3 h were excluded. HF with reduced, moderately reduced, and preserved LVEF (HFrEF, HFmrEF, and HFpEF) was defined by a LVEF < 40%, 40-49%, and ≥ 50%, respectively. SDB was defined by an apnea-hypopnea index (AHI) ≥ 5/h. RESULTS Overall, 221 patients were included (mean age 75 ± 11 years). Seventy-two (33%) had HFrEF, 26 (11%) HFmrEF, and 123 (56%) HFpEF. In total, 176 (80%) met the criteria for mild SDB, while 59% and 38% had an AHI ≥ 15/h or ≥ 30/h, respectively. SDB prevalence was high and similar between HFrEF, HFmrEF, and HFpEF. Yet, SDB was often more severe in HFrEF when compared to HFpEF. HFmrEF had intermediate characteristics, with an AHI closer to HFrEF. CONCLUSION In a cohort of patients admitted for acute HF, SDB was highly prevalent in all subgroups, including HFmrEF. The pervasiveness and severity of SDB was particularly noted in HFrEF. These findings suggest that routine SDB screening may be warranted following acute HF.
Collapse
|
14
|
Pelaia C, Armentaro G, Miceli S, Perticone M, Toscani AF, Condoleo V, Spinali M, Cassano V, Maio R, Caroleo B, Lombardo N, Arturi F, Perticone F, Sciacqua A. Association Between Sleep Apnea and Valvular Heart Diseases. Front Med (Lausanne) 2021; 8:667522. [PMID: 34434938 PMCID: PMC8380810 DOI: 10.3389/fmed.2021.667522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 07/15/2021] [Indexed: 01/20/2023] Open
Abstract
Background: Although sleep respiratory disorders are known as a relevant source of cardiovascular risk, there is a substantial lack of trials aimed to evaluate the eventual occurrence of associations between sleep apnea (SA) and valvular heart diseases (VHD). Methods: We recruited 411 patients referring to our sleep disorder unit, among which 371 had SA. Ninety-three subjects with SA also suffered from VHD. Physical examination, echocardiography, nocturnal cardio-respiratory monitoring, and laboratory tests were performed in each patient. Patient subgroups were comparatively evaluated through cross-sectional analysis. Results: A statistically significant increase in the prevalence of VHD was detected in relation to high apnea hypopnea index (AHI) values (p = 0.011). Obstructive sleep apnea occurrence was higher in SA patients without VHD (p < 0.0001). Conversely, central and mixed sleep apneas were more frequent among SA patients with VHD (p = 0.0003 and p = 0.002, respectively). We observed a direct correlation between AHI and BMI values (p < 0.0001), as well as between AHI and serum uric acid levels (p < 0.0001), high sensitivity C-reactive protein (p < 0.0001), and indexed left ventricular end-diastolic volume (p < 0.015), respectively. BMI and VHD resulted to be the main predictors of AHI values (p < 0.0001). Conclusions: Our study suggests that a significant association can occur between SA and VHD. It is clinically relevant that when compared to SA patients without VHD, higher frequencies of central and mixed apneas were found in subjects with SA and VHD. Moreover, after elevated BMI, VHD represented the second predictor of AHI values.
Collapse
Affiliation(s)
- Corrado Pelaia
- Department of Health Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | | | - Valentino Condoleo
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Martina Spinali
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Velia Cassano
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Raffaele Maio
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Benedetto Caroleo
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Nicola Lombardo
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Franco Arturi
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences; University Magna Græcia of Catanzaro, Catanzaro, Italy
| |
Collapse
|
15
|
Cheng JY. Risk of sudden unexpected death in people with epilepsy and obstructive sleep apnea. Epilepsy Res 2021; 176:106729. [PMID: 34352639 DOI: 10.1016/j.eplepsyres.2021.106729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022]
Abstract
This study aimed to determine whether severity of newly diagnosed obstructive sleep apnea (OSA) in people with epilepsy is associated with elevated sudden unexpected death in epilepsy (SUDEP) risk as calculated by the revised SUDEP-7 Inventory (rSUDEP-7). To this aim, a retrospective cross-sectional study was conducted at a single academic center. Adults ≥18 years of age with epilepsy and newly diagnosed OSA were retrospectively identified via electronic health records. Analysis was performed for subjects with confirmed epilepsy, OSA, and complete diagnostic PSG and rSUDEP-7 data. OSA severity was categorized as mild, moderate or severe. Logistic regression analysis was used to determine the association between OSA severity and rSUDEP-7 scores, adjusting for significantly different baseline characteristics. Of 86 subjects, OSA severity was classified as mild 38(44.2 %), moderate 25(29.1 %), and severe 23(26.7 %). Multivariate logistic regression demonstrated that severe OSA was significantly associated with rSUDEP-7 ≥ 5 after adjusting for congestive heart failure and diabetes (OR:4.08,p = 0.046,CI:1.04-16.28), but was attenuated when male gender was added to the model (OR:3.91,p = 0.067,CI:0.91-16.77). In conclusion, severe OSA is associated with elevated SUDEP risk. As a treatable disorder, OSA may thus represent a modifiable SUDEP risk factor. However, future confirmatory studies involving the prospective, longitudinal evaluation of SUDEP from broader populations are required.
Collapse
Affiliation(s)
- Jocelyn Y Cheng
- Neurology, Eisai Inc., 100 Tice Blvd, Woodcliff Lake, NJ, 07677, USA.
| |
Collapse
|
16
|
Abstract
Exercise intolerance represents a typical feature of heart failure with preserved ejection fraction (HFpEF), and is associated with a poor quality of life, frequent hospitalizations, and increased all-cause mortality. The cardiopulmonary exercise test is the best method to quantify exercise intolerance, and allows detection of the main mechanism responsible for the exercise limitation, influencing treatment and prognosis. Exercise training programs improve exercise tolerance in HFpEF. However, studies are needed to identify appropriate type and duration. This article discusses the pathophysiology of exercise limitation in HFpEF, describes methods of determining exercise tolerance class, and evaluates prognostic implications and potential therapeutic strategies.
Collapse
|
17
|
Wheeler JA, Tutrow KD, Ebenroth ES, Gaston B, Bandyopadhyay A. Heart failure is not a determinant of central sleep apnea in the pediatric population. Pediatr Pulmonol 2021; 56:1092-1102. [PMID: 33434409 PMCID: PMC8035286 DOI: 10.1002/ppul.25242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/20/2020] [Accepted: 12/13/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND/OBJECTIVES Adults with heart failure (HF) have high prevalence of central sleep apnea (CSA). While this has been repeatedly investigated in adults, there is a deficiency of similar research in pediatric populations. The goal of this study was to compare prevalence of CSA in children with and without HF and correlate central apneic events with heart function. METHODS Retrospective analysis of data from children with and without HF was conducted. Eligible children were less than 18 years old with echocardiogram and polysomnogram within 6 months of each other. Children were separated into groups with and without HF based on left ventricular ejection fraction (LVEF). Defining CSA as central apnea-hypopnea index (CAHI) more than 1/hour, the cohort was also classified into children with and without CSA for comparative study. RESULTS A total of 120 children (+HF: 19, -HF: 101) were included. The +HF group was younger, with higher prevalence of trisomy 21, muscular dystrophy, oromotor incoordination, and structural heart disease. The +HF group had lower apnea-hypopnea index (median: 3/hour vs. 8.6/hour) and lower central apnea index (CAI) (median: 0.2/hour vs. 0.55/hour). Prevalence of CSA was similar in both groups (p = .195). LogCAHI was inversely correlated to age (Pearson correlation coefficient: -0.245, p = .022). Children with CSA were younger and had higher prevalence of prematurity (40% vs. 5.3%). There was no significant difference in LVEF between children with and without CSA. After excluding children with prematurity, relationship between CAHI and age was no longer sustained. CONCLUSIONS In contrast to adults, there is no difference in prevalence of CSA in children with and without HF. Unlike in adults, LVEF does not correlate with CAI in children. Overall, it appears that central apneic events may be more a function of age and prematurity rather than of heart function.
Collapse
Affiliation(s)
| | | | - Eric S. Ebenroth
- Indiana University School of Medicine, Division of Pediatric Cardiology
| | - Benjamin Gaston
- Indiana University School of Medicine, Section of Pediatric Pulmonology, Allergy and Sleep Medicine
| | - Anuja Bandyopadhyay
- Indiana University School of Medicine, Section of Pediatric Pulmonology, Allergy and Sleep Medicine
| |
Collapse
|
18
|
Photoplethysmography in Normal and Pathological Sleep. SENSORS 2021; 21:s21092928. [PMID: 33922042 PMCID: PMC8122413 DOI: 10.3390/s21092928] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 01/20/2023]
Abstract
This article presents an overview of the advancements that have been made in the use of photoplethysmography (PPG) for unobtrusive sleep studies. PPG is included in the quickly evolving and very popular landscape of wearables but has specific interesting properties, particularly the ability to capture the modulation of the autonomic nervous system during sleep. Recent advances have been made in PPG signal acquisition and processing, including coupling it with accelerometry in order to construct hypnograms in normal and pathologic sleep and also to detect sleep-disordered breathing (SDB). The limitations of PPG (e.g., oxymetry signal failure, motion artefacts, signal processing) are reviewed as well as technical solutions to overcome these issues. The potential medical applications of PPG are numerous, including home-based detection of SDB (for triage purposes), and long-term monitoring of insomnia, circadian rhythm sleep disorders (to assess treatment effects), and treated SDB (to ensure disease control). New contact sensor combinations to improve future wearables seem promising, particularly tools that allow for the assessment of brain activity. In this way, in-ear EEG combined with PPG and actigraphy could be an interesting focus for future research.
Collapse
|
19
|
Gupta AK, Tomasoni D, Sidhu K, Metra M, Ezekowitz JA. Evidence-Based Management of Acute Heart Failure. Can J Cardiol 2021; 37:621-631. [PMID: 33440229 DOI: 10.1016/j.cjca.2021.01.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/21/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022] Open
Abstract
Acute heart failure (AHF) is a complex, heterogeneous, clinical syndrome with high morbidity and mortality, incurring significant health care costs. Patients transition from home to the emergency department, the hospital, and home again and require decisions surrounding diagnosis, treatment, and prognosis at each step of the way. The purpose of this review is to examine the epidemiology, etiology, and classifications of AHF and specifically focus on practical information relevant to the clinician. We examine the mechanisms of decompensation relevant to clinical presentations-including precipitating factors, neuroendocrine interactions, and inflammation-along with how consideration of these factors may help select therapies for an individual patient. The prevalence and significance of end-organ manifestations such as renal, gastrointestinal, respiratory, and neurologic manifestations are discussed. We also highlight how the development of renal dysfunction relates to the choice of a variety of diuretics that may be useful in specific circumstances and review guideline-directed medical therapy. We discuss the practical use (and pitfalls) of a variety of evidence-based clinical scoring criteria available to risk stratify patients with AHF. Finally, evidence-based management of AHF is discussed, including both pharmacologic and nonpharmacologic therapies, including the lack of evidence for using old and new vasodilators and the recent evidence regarding initiation of newer therapies in hospital. Overall, we suggest that clinicians consider implementing the newer data in AHF and subject existing practice patterns and treatments to the same rigour as new therapies.
Collapse
Affiliation(s)
- Arjun K Gupta
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Kiran Sidhu
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Justin A Ezekowitz
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
| |
Collapse
|
20
|
Dayer M, MacIver DH, Rosen SD. The central nervous system and heart failure. Future Cardiol 2020; 17:363-381. [PMID: 32933321 DOI: 10.2217/fca-2020-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The view that chronic heart failure was exclusively a disease of the heart dominated the cardiovascular literature until relatively recently. However, over the last 40 years it has increasingly come to be seen as a multisystem disease. Aside from changes in the sympathetic and parasympathetic nervous systems and the renin-angiotensin-aldosterone system, adaptations to the lungs, muscles and gastrointestinal tract have been clearly documented. It is clear that the brain and CNS are also affected in patients with heart failure, although this is often under recognized. The purpose of this review is to summarize the changes in the structure and biochemical function of the CNS in patients with chronic heart failure and to discuss their potential importance.
Collapse
Affiliation(s)
- Mark Dayer
- Department of Cardiology, Musgrove Park Hospital, Taunton, TA1 5DA, UK
| | - David H MacIver
- Department of Cardiology, Musgrove Park Hospital, Taunton, TA1 5DA, UK.,Biological Physics Group, School of Physics & Astronomy, University of Manchester, Manchester, M13 9PL, UK
| | - Stuart D Rosen
- Ealing & Royal Brompton Hospitals, Uxbridge Rd, Southall, UB1 3HW, UK.,Imperial College London, South Kensington, London, SW7 2BU, UK
| |
Collapse
|
21
|
Chronic kidney disease and concomitant sleep apnea are associated with increased overall mortality: a meta-analysis. Int Urol Nephrol 2020; 52:2337-2343. [PMID: 32740787 DOI: 10.1007/s11255-020-02583-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/25/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Sleep apnea (SA) is common in advanced chronic kidney disease (CKD) patients. However, the association between CKD with concomitant SA and overall mortality remains inconclusive. METHODS Ovid MEDLINE, EMBASE, and the Cochrane Library were searched for eligible publications, including non-transplant CKD patients aged > 18 years with co-existing SA. CKD is defined by estimated glomerular filtration rate of < 60 mL/min/1.73 m2. RESULTS Seven observational studies (n = 186,686) were included in the meta-analyses. 94.2% had end-stage kidney disease (ESKD) requiring hemodialysis (HD), 5.0% had ESKD requiring peritoneal dialysis (PD), and 0.8% had non-dialysis CKD. The mean age was 76.8 ± 2.2 years. Most patients were male (53.4%) and white (76.8%). Up to 39.3% had diabetes. The mean body mass index was 26.0 ± 0.6 kg/m2. Among patients with advanced CKD and SA, the pooled estimated odds ratios (OR) for overall mortality and cardiovascular events were 2.092 (95% CI, 1.594-2.744) and 1.020 (95% CI, 0.929-1.119), respectively, compared to patients with CKD alone. The OR was 2.145 (95% CI, 1.563-2.944) when studies with polysomnography-diagnosed SA were examined independently. No potential publication bias was detected. There were no significant differences in odds ratios for overall mortality, based on subgroup analyses. CONCLUSION Co-existence between advanced CKD and SA is associated with increased overall mortality, but not cardiovascular (CV) events when compared with CKD alone. The analysis of CV events requires additional studies to confirm our findings. Moreover, clinical interventions aiming to prevent the progression of SA and CKD are encouraged.
Collapse
|
22
|
Affiliation(s)
- Traci T Goodchild
- From the Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center School of Medicine Cardiovascular Center of Excellence, New Orleans
| | - David J Lefer
- From the Department of Pharmacology and Experimental Therapeutics, Louisiana State University Health Sciences Center School of Medicine Cardiovascular Center of Excellence, New Orleans
| |
Collapse
|