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Association Between Device-Detected Sleep-Disordered Breathing and Implantable Defibrillator Therapy in Patients With Heart Failure. JACC Clin Electrophysiol 2022; 8:1249-1256. [DOI: 10.1016/j.jacep.2022.07.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/05/2022] [Accepted: 07/10/2022] [Indexed: 11/22/2022]
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2
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Hu WH, Khoo MCK. Treatment of Cheyne-Stokes Respiration in Heart Failure with Adaptive Servo-Ventilation: An Integrative Model. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:79-103. [PMID: 36217080 DOI: 10.1007/978-3-031-06413-5_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The SERVE-HF (Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure) multicenter trial found a small but significant increase in all-cause and cardiovascular mortality in patients assigned to adaptive servo-ventilation (ASV) versus guideline-based medical treatment. To better understand the physiological underpinnings of this clinical outcome, we employ an integrative computer model to simulate congestive heart failure with Cheyne-Stokes respiration (CHF-CSR) in subjects with a broad spectrum of underlying pathogenetic mechanisms, as well as to determine the in silico changes in cardiopulmonary and autonomic physiology resulting from ASV. Our simulation results demonstrate that while the elimination of CSR through ASV can partially restore cardiorespiratory and autonomic physiology toward normality in the vast majority of CHF phenotypes, the degree of restoration can be highly variable, depending on the combination of CHF mechanisms in play. The group with the lowest left ventricular ejection fraction (LVEF) appears to be most vulnerable to the potentially adverse effects of ASV, but the level of pulmonary capillary wedge pressure (PCWP) plays an important role in determining the nature of these effects.
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3
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Lévy P, Naughton MT, Tamisier R, Cowie MR, Bradley TD. Sleep Apnoea and Heart Failure. Eur Respir J 2021; 59:13993003.01640-2021. [PMID: 34949696 DOI: 10.1183/13993003.01640-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/07/2021] [Indexed: 11/05/2022]
Abstract
Heart Failure (HF) and Sleep-Disordered-Breathing (SDB) are two common conditions that frequently overlap and have been studied extensively in the past three decades. Obstructive Sleep Apnea (OSA) may result in myocardial damage, due to intermittent hypoxia increased sympathetic activity and transmural pressures, low-grade vascular inflammation and oxidative stress. On the other hand, central sleep apnoea and Cheyne-Stokes respiration (CSA-CSR) occurs in HF, irrespective of ejection fraction either reduced (HFrEF), preserved (HFpEF) or mildly reduced (HFmrEF). The pathophysiology of CSA-CSR relies on several mechanisms leading to hyperventilation, breathing cessation and periodic breathing. Pharyngeal collapse may result at least in part from fluid accumulation in the neck, owing to daytime fluid retention and overnight rostral fluid shift from the legs. Although both OSA and CSA-CSR occur in HF, the symptoms are less suggestive than in typical (non-HF related) OSA. Overnight monitoring is mandatory for a proper diagnosis, with accurate measurement and scoring of central and obstructive events, since the management will be different depending on whether the sleep apnea in HF is predominantly OSA or CSA-CSR. SDB in HF are associated with worse prognosis, including higher mortality than in patients with HF but without SDB. However, there is currently no evidence that treating SDB improves clinically important outcomes in patients with HF, such as cardiovascular morbidity and mortality.
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Affiliation(s)
- Patrick Lévy
- Univ Grenoble Alpes, Inserm, HP2 laboratory, Grenoble, France .,CHU Grenoble Alpes, Physiology, EFCR, Grenoble, France.,All authors contributed equally to the manuscript
| | - Matt T Naughton
- Alfred Hospital, Department of Respiratory Medicine and Monash University, Melbourne, Australia.,All authors contributed equally to the manuscript
| | - Renaud Tamisier
- Univ Grenoble Alpes, Inserm, HP2 laboratory, Grenoble, France.,CHU Grenoble Alpes, Physiology, EFCR, Grenoble, France.,All authors contributed equally to the manuscript
| | - Martin R Cowie
- Royal Brompton Hospital and Faculty of Lifesciences & Medicine, King"s College London, London, UK.,All authors contributed equally to the manuscript
| | - T Douglas Bradley
- Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Centre for Sleep Medicine and Circadian Biology of the University of Toronto and Department of Medicine of the University Health Network Toronto General Hospital, Canada.,All authors contributed equally to the manuscript
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4
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Ventrikuläre Arrhythmien bei obstruktiver und zentraler Schlafapnoe. SOMNOLOGIE 2021. [DOI: 10.1007/s11818-021-00319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Zusammenfassung
Hintergrund
Ventrikuläre Arrhythmien treten mit einer hohen Prävalenz auf und sind mit einer hohen Morbidität und Mortalität assoziiert. Sowohl die obstruktive (OSA) als auch die zentrale (ZSA) Schlafapnoe können auf Grund ihrer Pathophysiologie zu vermehrten ventrikulären Arrhythmien beitragen.
Ziel
Dieser Artikel soll die komplexen Zusammenhänge und Erkenntnisse jüngster Forschungen bezüglich schlafbezogenen Atmungsstörungen (SBAS) und ventrikulärer Arrhythmien und deren Therapiemöglichkeiten beleuchten.
Material und Methoden
Es erfolgte eine Literaturrecherche basierend auf prospektiven, retrospektiven, klinischen und experimentellen Studien sowie Reviews, Metaanalysen und aktuellen Leitlinien, die seit 2014 in der Medline-Datenbank gelistet wurden.
Ergebnisse
Es besteht ein bidirektionaler Zusammenhang zwischen der SBAS und ventrikulären Arrhythmien. Intermittierende Hypoxie, oxidativer Stress, wiederkehrende Arousals, intrathorakale Druckschwankungen und kardiales Remodeling tragen im Rahmen der SBAS zu einer erhöhten ventrikulären Arrhythmieneigung bei. Der Schweregrad der OSA, gemessen mittels Apnoe-Hypopnoe-Index, ist mit der Prävalenz ventrikulärer Arrhythmien assoziiert. Ähnliche Ergebnisse liegen für Patienten mit ZSA und Herzinsuffizienz vor. Studien zu ventrikulären Arrhythmien bei ZSA-Patienten ohne Herzinsuffizienz fehlen. Eine Positivdrucktherapie (PAP) bei OSA- oder ZSA-Patienten führte in verschiedenen Studien zu einer reduzierten Anzahl an ventrikulären Arrhythmien. Dieser Zusammenhang konnte jedoch nicht in allen Studien bestätigt werden. Ventrikuläre Arrhythmien treten bei der OSA gehäuft nachts auf, bei der ZSA gleichmäßig über den Tag verteilt.
Diskussion
Bisherige Studien weisen einen Zusammenhang zwischen der OSA bzw. der ZSA und ventrikulären Arrhythmien trotz unterschiedlicher Pathophysiologie nach. Hinsichtlich des Effektes der PAP auf ventrikuläre Arrhythmien bei Patienten mit OSA und ZSA sind weitere Studien erforderlich.
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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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Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:608-624. [PMID: 34353537 DOI: 10.1016/j.jacc.2021.05.048] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/11/2021] [Indexed: 12/23/2022]
Abstract
Sleep disordered breathing causes repetitive episodes of nocturnal hypoxemia, sympathetic nervous activation, and cortical arousal, often associated with excessive daytime sleepiness. Sleep disordered breathing is common in people with, or at risk of, cardiovascular (CV) disease including those who are obese or have hypertension, coronary disease, heart failure, or atrial fibrillation. Current therapy of obstructive sleep apnea includes weight loss (if obese), exercise, and positive airway pressure (PAP) therapy. This improves daytime sleepiness. Obstructive sleep apnea is associated with increased CV risk, but treatment with PAP in randomized trials has not been shown to improve CV outcome. Central sleep apnea (CSA) is not usually associated with daytime sleepiness in heart failure or atrial fibrillation and is a marker of increased CV risk, but PAP has been shown to be harmful in 1 randomized trial. The benefits of better phenotyping, targeting of higher-risk patients, and a more personalized approach to therapy are being explored in ongoing trials.
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Sanchez AM, Germany R, Lozier MR, Schweitzer MD, Kosseifi S, Anand R. Central sleep apnea and atrial fibrillation: A review on pathophysiological mechanisms and therapeutic implications. IJC HEART & VASCULATURE 2020; 30:100527. [PMID: 33102683 PMCID: PMC7573647 DOI: 10.1016/j.ijcha.2020.100527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 01/06/2023]
Abstract
Precipitating factors and chronic diseases associated with atrial fibrillation (AF) are detailed in the literature. Emerging evidence over the last several decades suggests a potential causal relationship between central sleep apnea (CSA) and AF. Mechanisms including apnea-induced hypoxia with intermittent arousal, fluctuating levels of carbon dioxide, enhanced sympathetic/neurohormonal activation and oxidative stress causing inflammation have been implicated as etiologic causes of AF within this subpopulation. CSA affects the efficacy of pharmacologic and catheter-based antiarrhythmic treatments, which is why treating CSA prior to these interventions may lead to lower rates of AF. Subsequently, a reduction in the AF burden with transvenous phrenic nerve stimulation (TPNS) has become a topic of interest. The present review describes the relationship between these conditions, pathophysiologic mechanisms implicating the role of CSA in development of AF, and emerging therapeutic interventions.
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Affiliation(s)
- Alexandra M. Sanchez
- University of Miami at Holy Cross Hospital, Internal Medicine Residency Program, Ft Lauderdale, FL, USA
| | - Robin Germany
- Division of Cardiovascular Disease, University of Oklahoma, Respicardia Inc, Oklahoma City, OK, USA
| | - Matthew R. Lozier
- University of Miami at Holy Cross Hospital, Internal Medicine Residency Program, Ft Lauderdale, FL, USA
| | - Michael D. Schweitzer
- University of Miami at Holy Cross Hospital, Internal Medicine Residency Program, Ft Lauderdale, FL, USA
| | - Semaan Kosseifi
- Pulmonary, Critical Care and Sleep Medicine, Holy Cross Hospital, Fort Lauderdale, FL, USA
| | - Rishi Anand
- Cardiology, Jim Moran Heart and Vascular Research Institute, Holy Cross Hospital, Fort Lauderdale, FL, USA
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8
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Abstract
Synchronization of molecular, metabolic, and cardiovascular circadian oscillations is fundamental to human health. Sleep-disordered breathing, which disrupts such temporal congruence, elicits hemodynamic, autonomic, chemical, and inflammatory disturbances with acute and long-term consequences for heart, brain, and circulatory and metabolic function. Sleep apnea afflicts a substantial proportion of adult men and women but is more prevalent in those with established cardiovascular diseases and especially fluid-retaining states. Despite the experimental, epidemiological, observational, and interventional evidence assembled in support of these concepts, this substantial body of work has had relatively modest pragmatic impact, thus far, on the discipline of cardiology. Contemporary estimates of cardiovascular risk still are derived typically from data acquired during wakefulness. The impact of sleep-related breathing disorders rarely is entered into such calculations or integrated into diagnostic disease-specific algorithms or therapeutic recommendations. Reasons for this include absence of apnea-related symptoms in most with cardiovascular disease, impediments to efficient diagnosis at the population level, debate as to target, suboptimal therapies, difficulties mounting large randomized trials of sleep-specific interventions, and the challenging results of those few prospective cardiovascular outcome trials that have been completed and reported. The objectives of this review are to delineate the bidirectional interrelationship between sleep-disordered breathing and cardiovascular disease, consider the findings and implications of observational and randomized trials of treatment, frame the current state of clinical equipoise, identify principal current controversies and potential paths to their resolution, and anticipate future directions.
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Affiliation(s)
- John S Floras
- From the University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto, Ontario, Canada.
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9
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Cheyne-Stokes-Atmung. SOMNOLOGIE 2018. [DOI: 10.1007/s11818-017-0142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Abstract
PURPOSE OF REVIEW The bidirectional relationships that have been demonstrated between heart failure (HF) and central sleep apnea (CSA) demand further exploration with respect to the implications that each condition has for the other. This review discusses the body of literature that has accumulated on these relationships and how CSA and its potential treatment may affect outcomes in patients with CSA. RECENT FINDINGS Obstructive sleep apnea (OSA) can exacerbate hypertension, type 2 diabetes, obesity, and atherosclerosis, which are known predicates of HF. Conversely, patients with HF more frequently exhibit OSA partly due to respiratory control system instability. These same mechanisms are responsible for the frequent association of HF with CSA with or without a Hunter-Cheyne-Stokes breathing (HCSB) pattern. Just as is the case with OSA, patients with HF complicated by CSA exhibit more severe cardiac dysfunction leading to increased mortality; the increase in severity of HF can in turn worsen the degree of sleep disordered breathing (SDB). Thus, a bidirectional relationship exists between HF and both phenotypes of SDB; moreover, an individual patient may exhibit a combination of these phenotypes. Both types of SDB remain significantly underdiagnosed in patients with HF and hence undertreated. Appropriate screening for, and treatment of, OSA is clearly a significant factor in the comprehensive management of HF, while the relevance of CSA remains controversial. Given the unexpected results of the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure trial, it is now of paramount importance that additional analysis of these data be expeditiously reported. It is also critical that ongoing and proposed prospective studies of this issue proceed without delay.
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11
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Kwon Y, Koene RJ, Kwon O, Kealhofer JV, Adabag S, Duval S. Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol 2017; 10:e004609. [PMID: 28213507 DOI: 10.1161/circep.116.004609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is recommended to prevent sudden cardiac death in some of these patients. Sleep-disordered breathing (SDB) is highly prevalent in this population and may impact arrhythmogenicity. We performed a systematic review and meta-analysis of prospective studies that assessed the impact of SDB on ICD therapy. METHODS AND RESULTS Relevant prospective studies were identified in the Ovid MEDLINE, EMBASE, and Google Scholar databases. Weighted risk ratios of the association between SDB and appropriate ICD therapies were estimated using random effects meta-analysis. Nine prospective cohort studies (n=1274) were included in this analysis. SDB was present in 52% of the participants. SDB was associated with a 55% higher risk of appropriate ICD therapies (45% versus 28%; risk ratio, 1.55; 95% confidence interval, 1.32-1.83). In a subgroup analysis based on the subtypes of SDB, the risk was higher in both central (risk ratio, 1.50; 95% confidence interval, 1.11-2.02) and obstructive (risk ratio, 1.43; 95% confidence interval, 1.01-2.03) sleep apnea. CONCLUSIONS SDB is associated with an increased risk of appropriate ICD therapy in patients with heart failure and reduced ejection fraction.
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Affiliation(s)
- Younghoon Kwon
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
| | - Ryan J Koene
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Osung Kwon
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Jessica V Kealhofer
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Selcuk Adabag
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Sue Duval
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
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12
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Farrell PC, Richards G. Recognition and treatment of sleep-disordered breathing: an important component of chronic disease management. J Transl Med 2017; 15:114. [PMID: 28545542 PMCID: PMC5445298 DOI: 10.1186/s12967-017-1211-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/13/2017] [Indexed: 12/14/2022] Open
Abstract
Sleep-disordered breathing (SDB) is a highly prevalent condition, and is associated with many debilitating chronic diseases. The role of untreated obstructive sleep apnea (OSA) in arterial hypertension has been recognized in international guidelines. Treatment with continuous positive airway pressure (CPAP) is associated with clinically-relevant reductions in blood pressure. In heart failure (HF), SDB is associated with worse prognosis and increased mortality. Major HF guidelines recommend that patients should be treated for sleep apnea to improve their HF status. Severe OSA increases the risk of arrhythmias, including atrial fibrillation, influences risk management in stroke, and is highly prevalent in patients with type 2 diabetes. Effective treatment with CPAP improves the success of antiarrhythmic interventions, improves outcomes in stroke and reduces hyperglycemia in diabetes. Patients with coronary artery disease also have a high prevalence of SDB, which is independently associated with worse outcomes. The role of CPAP for secondary cardiovascular prevention remains to be determined. Data from large, well-conducted clinical trials have shown that noninvasive ventilation, targeted to markedly reduce hypercapnia, significantly improves survival and reduces readmission in stable hypercapnic chronic obstructive pulmonary disease. The association of SDB with chronic diseases contributes to the high healthcare costs incurred by SDB patients. SDB also has an important negative impact on quality of life, which is reversed by CPAP treatment. The high prevalence of SDB, and its association with diseases that cause significant morbidity and mortality, suggest that the diagnosis and management of SDB is an important therapeutic goal. First, adherent CPAP treatment significantly improves the quality of life of all patients with SDB; second, it eliminates the negative impact of untreated SDB on any associated chronic diseases; and third, it significantly reduces the increased costs of all hospital and medical services directly associated with untreated SDB. In short, the recognition and treatment of SDB is vital for the continued health and wellbeing of individual patients with SDB.
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Affiliation(s)
- Peter C. Farrell
- ResMed Science Center, c/o ResMed, 9001 Spectrum Center Blvd., San Diego, CA 92123 USA
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13
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Abstract
Sleep-disordered breathing (SDB) occurs in approximately 50% of patients with reduced left ventricular ejection fraction receiving contemporary heart failure (HF) therapies. Obstructive (OSA) and central sleep apneas (CSA) interrupt breathing by different mechanisms but impose qualitatively similar autonomic, chemical, mechanical, and inflammatory burdens on the heart and circulation. Because contemporary evidence-based drug and device HF therapies have little or no mitigating effect on the acute or long-term consequences of such stimuli, there is a sound mechanistic rationale for targeting SDB to reduce cardiovascular event rates and prolong life. However, the promise of observational studies and randomized trials of small size and duration describing a beneficial effect of treating SDB in HF via positive airway pressure was not realized in 2 recent randomized outcome-driven trials: SAVE, which evaluated the cardiovascular effect of treating OSA in a cohort without HF, and SERVE-HF, which reported the results of a strategy of random allocation of minute-ventilation-triggered adaptive servo-ventilation (ASV) for HF patients with CSA. Whether effective treatment of either OSA or CSA improves the HF trajectory by reducing cardiovascular morbidity or mortality has yet to be definitively established. ADVENT-HF, designed to determine the effect of treating both CSA and non-sleepy OSA HF patients with a peak-airflow triggered ASV algorithm, could resolve this present clinical equipoise concerning the treatment of SDB.
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Affiliation(s)
- Nobuhiko Haruki
- Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Tottori University Faculty of Medicine.,The University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto
| | - John S Floras
- The University Health Network and Sinai Health System Division of Cardiology, Department of Medicine, University of Toronto
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14
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Fox H, Bitter T, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients. Sleep Med Clin 2017; 12:229-241. [PMID: 28477777 DOI: 10.1016/j.jsmc.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) treatment remains complex and challenging, with current recommendations aiming at consideration and treatment of comorbidities in patients with HF. Sleep-disordered breathing (SDB) and arrhythmia come into play, as both are associated with quality of life deterioration, and morbidity and mortality increase in patients with HF. Interactions of these diseases are versatile and may appear intransparent in daily practice. Nevertheless, because of their importance for patients' condition and prognosis, SDB and arrhythmia individually, but also through interaction on one another, necessitate attention, following the fact that treatment is requested and desired considering latest research findings and outcomes.
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Affiliation(s)
- Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
| | - Thomas Bitter
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
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15
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Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, Buyse B, De Backer W, Eckert DJ, Grote L, Hagmeyer L, Hedner J, Jennum P, La Rovere MT, Miltz C, McNicholas WT, Montserrat J, Naughton M, Pepin JL, Pevernagie D, Sanner B, Testelmans D, Tonia T, Vrijsen B, Wijkstra P, Levy P. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J 2016; 49:13993003.00959-2016. [DOI: 10.1183/13993003.00959-2016] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 08/25/2016] [Indexed: 02/07/2023]
Abstract
The complexity of central breathing disturbances during sleep has become increasingly obvious. They present as central sleep apnoeas (CSAs) and hypopnoeas, periodic breathing with apnoeas, or irregular breathing in patients with cardiovascular, other internal or neurological disorders, and can emerge under positive airway pressure treatment or opioid use, or at high altitude. As yet, there is insufficient knowledge on the clinical features, pathophysiological background and consecutive algorithms for stepped-care treatment. Most recently, it has been discussed intensively if CSA in heart failure is a “marker” of disease severity or a “mediator” of disease progression, and if and which type of positive airway pressure therapy is indicated. In addition, disturbances of respiratory drive or the translation of central impulses may result in hypoventilation, associated with cerebral or neuromuscular diseases, or severe diseases of lung or thorax. These statements report the results of an European Respiratory Society Task Force addressing actual diagnostic and therapeutic standards. The statements are based on a systematic review of the literature and a systematic two-step decision process. Although the Task Force does not make recommendations, it describes its current practice of treatment of CSA in heart failure and hypoventilation.
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16
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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17
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Anderson RD, Wilson W, Morton J, Aggarwal A. Normalisation of hypoxaemia following successful percutaneous closure of a bidirectional shunting secundum atrial septal defect without pulmonary hypertension in a patient with severe non-ischaemic cardiomyopathy and refractory ventricular tachycardia. Intern Med J 2016; 46:969-72. [PMID: 27553997 DOI: 10.1111/imj.13074] [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: 10/10/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Abstract
Atrial septal defects (ASD) are an uncommon cause of dyspnoea. A high index of suspicion is required, and further investigation should be prompted in patients with unexplained hypoxaemia, particularly those with pulmonary hypertension. Hypoxic ASD without pulmonary hypertension are rare, and only a handful of cases have been published. We present a middle-aged man with progressive dyspnoea with a successfully closed ASD without pulmonary hypertension caused by elevated right ventricular pressures secondary to an idiopathic cardiomyopathy.
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Affiliation(s)
- R D Anderson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - W Wilson
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - J Morton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - A Aggarwal
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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18
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Effects of adaptive servo-ventilation on ventricular arrhythmias in patients with stable congestive heart failure and sleep-disordered breathing. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0072-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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19
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Effekte einer adaptiven Servoventilation auf Herzrhythmusstörungen bei Patienten mit chronischer Herzinsuffizienz und schlafbezogenen Atmungsstörungen. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0059-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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20
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Bekfani T, Abraham WT. Current and future developments in the field of central sleep apnoea. Europace 2016; 18:1123-34. [DOI: 10.1093/europace/euv435] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 11/23/2015] [Indexed: 12/22/2022] Open
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21
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Aurora RN, Bista SR, Casey KR, Chowdhuri S, Kristo DA, Mallea JM, Ramar K, Rowley JA, Zak RS, Heald JL. Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses". J Clin Sleep Med 2016; 12:757-61. [PMID: 27092695 DOI: 10.5664/jcsm.5812] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 01/15/2023]
Abstract
ABSTRACT An update of the 2012 systematic review and meta-analyses were performed and a modified-GRADE approach was used to update the recommendation for the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnea syndrome (CSAS) related to congestive heart failure (CHF). Meta-analyses demonstrated an improvement in LVEF and a normalization of AHI in all patients. Analyses also demonstrated an increased risk of cardiac mortality in patients with an LVEF of ≤ 45% and moderate or severe CSA predominant sleep-disordered breathing. These data support a Standard level recommendation against the use of ASV to treat CHF-associated CSAS in patients with an LVEF of ≤ 45% and moderate or severe CSAS, and an Option level recommendation for the use of ASV in the treatment CHF-associated CSAS in patients with an LVEF > 45% or mild CHF-related CSAS. The application of these recommendations is limited to the target patient populations; the ultimate judgment regarding propriety of any specific care must be made by the clinician.
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Affiliation(s)
- R Nisha Aurora
- Johns Hopkins University, School of Medicine, Baltimore, MD
| | | | - Kenneth R Casey
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
| | | | - Jorge M Mallea
- Mayo Clinic Florida, Transplant Center, Jacksonville, FL
| | | | - James A Rowley
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Rochelle S Zak
- Sleep Disorders Center, University of California, San Francisco, San Francisco CA
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22
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Yang H, Sawyer AM. The effect of adaptive servo ventilation (ASV) on objective and subjective outcomes in Cheyne-Stokes respiration (CSR) with central sleep apnea (CSA) in heart failure (HF): A systematic review. Heart Lung 2016; 45:199-211. [DOI: 10.1016/j.hrtlng.2016.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/26/2023]
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23
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Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies. Clin Res Cardiol 2016; 105:563-70. [PMID: 26872963 DOI: 10.1007/s00392-016-0970-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 02/01/2016] [Indexed: 12/27/2022]
Abstract
Sleep disordered breathing (SDB) (obstructive sleep apnea, central sleep apnea/Cheyne-Stokes respiration or the combination of both) is highly prevalent in patients with a wide variety of cardiovascular diseases including hypertension, arrhythmia, coronary artery disease, myocardial infarction and stroke (reviewed previously in the September issue of this journal). Its close association with outcomes in chronic heart failure with reduced ejection fraction (HF-REF) suggests that it may be a potential treatment target. Herein, we provide an update on SDB and its treatment in HF-REF.
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Pearse SG, Cowie MR, Sharma R, Vazir A. Sleep-disordered Breathing in Heart Failure. Eur Cardiol 2015; 10:89-94. [PMID: 30310432 PMCID: PMC6159414 DOI: 10.15420/ecr.2015.10.2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 11/03/2015] [Indexed: 11/04/2022] Open
Abstract
Sleep-disordered breathing affects over half of patients with heart failure (HF) and is associated with a poor prognosis. It is an under-diagnosed condition and may be a missed therapeutic target. Obstructive sleep apnoea is caused by collapse of the pharynx, exacerbated by rostral fluid shift during sleep. The consequent negative intrathoracic pressure, hypoxaemia, sympathetic nervous system activation and arousals have deleterious cardiovascular effects. Treatment with continuous positive airway pressure may confer symptomatic and prognostic benefit in this group. In central sleep apnoea, the abnormality is with regulation of breathing in the brainstem, often causing a waxing-waning Cheyne Stokes respiration pattern. Non-invasive ventilation has not been shown to improve prognosis in these patients and the recently published SERVE-HF trial found increased mortality in those treated with adaptive servoventilation. The management of sleep-disordered breathing in patients with HF is evolving rapidly with significant implications for clinicians involved in their care.
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Affiliation(s)
- Simon G Pearse
- Royal Brompton and Harefield NHS Trust and Imperial College London, London, United Kingdom
| | - Martin R Cowie
- Royal Brompton and Harefield NHS Trust and Imperial College London, London, United Kingdom
| | - Rakesh Sharma
- Royal Brompton and Harefield NHS Trust and Imperial College London, London, United Kingdom
| | - Ali Vazir
- Royal Brompton and Harefield NHS Trust and Imperial College London, London, United Kingdom
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25
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Mehra R, Gottlieb DJ. A Paradigm Shift in the Treatment of Central Sleep Apnea in Heart Failure. Chest 2015; 148:848-851. [DOI: 10.1378/chest.15-1536] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Bitter T, Fox H, Gaddam S, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Cardiac Arrhythmias. Can J Cardiol 2015; 31:928-34. [PMID: 26037822 DOI: 10.1016/j.cjca.2015.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 02/07/2023] Open
Abstract
Over the past few years sleep-disordered breathing has been identified as an important factor in arrhythmogenesis and a potential target of therapy to prevent cardiac arrhythmias in selected patients. In this review we highlight the role of obstructive sleep apnea and Cheyne-Stokes respiration in the pathophysiology of arrhythmias, address their clinical effect in supraventricular and ventricular tachyarrhythmias, and in conduction disturbances, and address the role of current treatment options for sleep-disordered breathing in the primary and secondary prevention of arrhythmic events.
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Affiliation(s)
- Thomas Bitter
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Henrik Fox
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - SaiPrassad Gaddam
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
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27
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Heart Failure and Sleep Apnea. Can J Cardiol 2015; 31:898-908. [PMID: 26112300 DOI: 10.1016/j.cjca.2015.04.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/23/2015] [Accepted: 04/12/2015] [Indexed: 12/18/2022] Open
Abstract
Obstructive and central sleep apnea are far more common in heart failure patients than in the general population and their presence might contribute to the progression of heart failure by exposing the heart to intermittent hypoxia, increased preload and afterload, sympathetic nervous system activation, and vascular endothelial dysfunction. There is now substantial evidence that supports a role for fluid overload and nocturnal rostral fluid shift from the legs as unifying mechanisms in the pathogenesis of obstructive and central sleep apnea in heart failure patients, such that the predominant type of sleep apnea is related to the relative distribution of fluid from the leg to the neck and chest. Despite advances in therapies for heart failure, mortality rates remain high. Accordingly, the identification and treatment of sleep apnea in patients with heart failure might offer a novel therapeutic target to modulate this increased risk. In heart failure patients with obstructive or central sleep apnea, continuous positive airway pressure has been shown to improve cardiovascular function in short-term trials but this has not translated to improved mortality or reduced hospital admissions in long-term randomized trials. Other forms of positive airway pressure such as adaptive servoventilation have shown promising results in terms of attenuation of sleep apnea and improvement in cardiovascular function in short-term trials. Large scale, randomized trials are required to determine whether treating sleep apnea with various interventions can reduce morbidity and mortality.
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28
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Linz D, Woehrle H, Bitter T, Fox H, Cowie MR, Böhm M, Oldenburg O. The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol 2015; 104:705-18. [DOI: 10.1007/s00392-015-0859-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/15/2015] [Indexed: 01/22/2023]
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Oldenburg O, Arzt M, Bitter T, Bonnemeier H, Edelmann F, Fietze I, Podszus T, Schäfer T, Schöbel C, Skobel E, Skowasch D, Penzel T, Nienaber C. Positionspapier „Schlafmedizin in der Kardiologie“. KARDIOLOGE 2015. [DOI: 10.1007/s12181-015-0654-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Omran H, Bitter T, Fox H, Horstkotte D, Oldenburg O. [Association of sleep-disordered breathing and malignant arrhythmias in patients with ischemic and dilated cardiomyopathy]. Herzschrittmacherther Elektrophysiol 2015; 26:27-31. [PMID: 25733315 DOI: 10.1007/s00399-015-0354-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
Sleep-disordered breathing (SDB) has so far been a neglected comorbidity in patients with cardiac arrhythmias. Recently however, several studies have revealed a correlation between SDB and malignant ventricular arrhythmias. This review article is intended to provide the reader with an update on the pathophysiological association between SDB and ventricular arrhythmias, available clinical data, and therapeutic options.
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MESH Headings
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/therapy
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/therapy
- Comorbidity
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Humans
- Incidence
- Prevalence
- Risk Assessment/methods
- Risk Factors
- Sleep Apnea Syndromes/diagnosis
- Sleep Apnea Syndromes/mortality
- Sleep Apnea Syndromes/therapy
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Affiliation(s)
- Hazem Omran
- Klinik für Kardiologie, Herz- und Diabeteszentrum NRW Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Deutschland
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Abstract
The intersecting relationships of sleep disordered breathing (SDB), arrhythmogenic risk and chronic heart failure (HF) are complex and most likely multi-directional and synergistic. Autonomic dysfunction is a common pathophysiological feature of each of these entities. Intermittent hypoxia, hypercapnia, mechanical cardiac influences due to upper airway obstruction and rostral fluid shifts are SDB-specific mechanisms which may trigger, perpetuate and exacerbate HF and arrhythmogenesis. Specific pathophysiological mechanisms will vary according to the predominance of central as compared to obstructive sleep apnea. The risk of cardiac arrhythmias and HF attributable to SDB may be considerable given the high prevalence of SDB and its likely physiologic burden. The current review focuses on the data, which have accrued elucidating the specific contributory mechanisms of SDB in cardiac arrhythmias and HF, highlighting the clinical relevance and effects of standard SDB treatment on these outcomes, and describing the role of novel therapeutics.
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32
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Herrscher TE, Akre H, Overland B, Sandvik L, Westheim AS. Clinical predictors of sleep apnoea in heart failure outpatients. Int J Clin Pract 2014; 68:725-30. [PMID: 24548330 DOI: 10.1111/ijcp.12396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common in heart failure patients. Many of them still remain undiagnosed. The aim of this study was to detect clinical predictors of sleep apnoea which may help to identify patients with SDB at a heart failure clinic. METHODS We performed an in-home sleep study on 115 consecutive patients from our heart failure clinic. Clinical characteristics, blood samples, daytime sleepiness and quality of life were registered. RESULTS Among 115 patients, 52% had moderate to severe SDB. Body Mass Index (BMI) ≥ 30 kg/m² was the only independent predictor of moderate to severe SDB [Odds ratio (OR) = 3.62, 95% Confidence interval (CI) 1.40-9.36, p = 0.008]. Quality of life and level of sleepiness were not significantly associated with SDB. Patients with mild to moderate chronic obstructive pulmonary disease (COPD) were unlikely to have SDB compared with patients without COPD (OR = 0.10, 95% CI 0.02-0.43, p = 0.002). Hypertension was a predictor of having obstructive sleep apnoea (OR = 2.78, 95% CI 1.15-6.75, p = 0.02), while haemoglobin ≥ 15 g/dl was associated with central sleep apnoea (OR = 6.71, 95% CI 1.96-22.99, p = 0.002). CONCLUSION BMI ≥ 30 kg/m(2) is associated with moderate to severe SDB, both obstructive and central sleep apnoea. Thus, BMI may be used as one of the selection criteria for referral of heart failure patients to a sleep specialist.
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Affiliation(s)
- T E Herrscher
- Department of Cardiology, Lovisenberg Diakonale Hospital, Oslo, Norway
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Haack KKV, Marcus NJ, Del Rio R, Zucker IH, Schultz HD. Simvastatin treatment attenuates increased respiratory variability and apnea/hypopnea index in rats with chronic heart failure. Hypertension 2014; 63:1041-9. [PMID: 24516105 DOI: 10.1161/hypertensionaha.113.02535] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cheyne-Stokes respiration and cardiac arrhythmias are associated with increased morbidity and mortality in patients with chronic heart failure (CHF). Enhanced carotid body chemoreflex (CBC) sensitivity is associated with these abnormalities in CHF. Reduced carotid body (CB) nitric oxide and nitric oxide synthase (NOS) levels play an important role in the enhanced CBC. In other disease models, Simvastatin (statin) treatment increases endothelial NOS, in part, by increasing Krüppel-like Factor 2 expression. We hypothesized that statin treatment would ameliorate enhanced CBC sensitivity as well as increased respiratory variability, apnea/hypopnea index, and arrhythmia index, in a rodent model of CHF. Resting breathing pattern, cardiac rhythm, and the ventilatory and CB chemoreceptor afferent responses to hypoxia were assessed in rats with CHF induced by coronary ligation. CHF was associated with enhanced ventilatory and CB afferent responses to hypoxia as well as increased respiratory variability, apnea/hypopnea index, and arrhythmia index. Statin treatment prevented the increases in CBC sensitivity and the concomitant increases in respiratory variability, apnea/hypopnea index, and arrhythmia index. Krüppel-like Factor 2 and endothelial NOS protein were decreased in the CB and nucleus tractus solitarii of CHF animals, and statin treatment increased the expression of these proteins. Our findings demonstrate that the increased CBC sensitivity, respiratory instability, and cardiac arrhythmias observed in CHF are ameliorated by statin treatment and suggest that statins may be an effective treatment for Cheyne-Stokes respiration and arrhythmias in patient populations with high chemoreflex sensitivity.
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Affiliation(s)
- Karla K V Haack
- Department of Cellular and Integrative Physiology, 985850 Nebraska Medical Center, Omaha, NE 68198.
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BHAVE PRASHANT, PASSMAN ROD. Learning To Breathe: Treatment of Sleep Disordered Breathing for ICD Shock Prevention. J Cardiovasc Electrophysiol 2013; 24:1141-3. [DOI: 10.1111/jce.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- PRASHANT BHAVE
- Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute; Chicago Illinois USA
| | - ROD PASSMAN
- Northwestern University Feinberg School of Medicine and the Bluhm Cardiovascular Institute; Chicago Illinois USA
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