1
|
Elgammal N, Zaher TI, Elkomy H, Abdelmoaty AA, Abdallah M, Emara MH. How frequent is sleep-disordered breathing among Egyptian cirrhotic adults? Clin Exp Hepatol 2020; 6:150-157. [PMID: 32728633 PMCID: PMC7380477 DOI: 10.5114/ceh.2020.95940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/19/2020] [Indexed: 02/07/2023] Open
Abstract
AIM OF THE STUDY Liver cirrhosis is an irreversible destructive liver disease that is associated with a wide range of complications. Among the recognized comorbidities of liver cirrhosis are sleep-disordered breathing (SDB), which is being more and more often described among cirrhotics. This study aimed to detect the prevalence of SDB among Egyptian post-viral cirrhotic adults. MATERIAL AND METHODS This study enrolled 48 post-viral cirrhotic patients and 16 apparently healthy control subjects. All patients and controls were evaluated by thorough history taking, full clinical examination, laboratory investigations, the Epworth Sleepiness Scale questionnaire, the Berlin Questionnaire and polysomnography. RESULTS Patients and controls were comparable as regards baseline demographics. Patients with liver cirrhosis had higher frequency of SDB compared to controls (56.2% vs. 12.5%, p = 0.002). The most frequently encountered SBD patterns among cirrhotics were obstructive sleep apnea and apnea hypopnea index. Moreover, SDB was more severe among cirrhotics (25% were mild, 16.6% were moderate and 14.6% were severe obstructive sleep apnea - OSA) compared to the healthy controls (all were mild). CONCLUSIONS It seems that post-viral cirrhotic patients had a wide range of SDB with variable degrees of severity compared to the healthy controls.
Collapse
Affiliation(s)
- Nahla Elgammal
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tarik I Zaher
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hoida Elkomy
- Chest Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | | | - Mohamed Abdallah
- Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelshiekh University, Kafr Elshikh, Egypt
- Address for correspondence Dr. Mohamed H Emara, Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelshiekh University, Kafr Elshikh, 33516, Egypt, e-mail:
| |
Collapse
|
2
|
Alexa A, Mansukhani MP, Gali B, Deljou A, Sprung J, Weingarten TN. Primary central sleep apnea and anesthesia: a retrospective case series. Can J Anaesth 2018; 65:884-892. [DOI: 10.1007/s12630-018-1144-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 12/13/2022] Open
|
3
|
Enezi A, Al-Jahdali F, Ahmed A, Shirbini N, Harbi A, Salim B, Ali Y, Abdulrahman A, Khan M, Khaleid A, Hamdan AJ. Symptoms of Daytime Sleepiness and Sleep Apnea in Liver Cirrhosis Patients. Ann Hepatol 2018; 16:591-598. [PMID: 28611264 DOI: 10.5604/01.3001.0010.0304] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
UNLABELLED Background/propose. Sleep disturbance and excessive daytime sleepiness (EDS) have been reported in patients with hepatic cirrhosis with no hepatic encephalopathy (HE). The objective of this study was to evaluate daytime sleepiness and risk of obstructive sleep apnea (OSA) among liver cirrhosis patients. MATERIAL AND METHODS A cross-sectional study was conducted at King Abdulaziz Medical City (KAMC)-Riyadh over a period of six months, using a structured questionnaire that investigated: 1) Sleep patterns and daytime sleepiness using the Epworth Sleeping Scale (ESS), and 2) The risk for sleep apnea using the Berlin Questionnaire (BQ). We enrolled patients with a confirmed diagnosis of liver cirrhosis who were being followed at the hepatology and pre-liver transplant clinics. RESULTS We enrolled 200 patients with liver cirrhosis, 57.5% of whom were male. The mean age was 60 (± SD 12.2). The reported prevalence of EDS, OSA, and both EDS and OSA were 29.5%, 42.9%, and 13.6%, respectively. The prevalence of EDS was higher in patients with Hepatitis-C and patients with DM, who experienced short sleep duration. We did not find any association between the severity of liver disease and EDS or OSA as measured by Child-Pugh scores (CPS). CONCLUSIONS The risk of OSA and EDS is high among liver cirrhosis patients. Those patients with cirrhosis secondary to Hepatitis C are at higher risk of EDS and OSA. Both EDS and OSA affect patients designated as CPS Class A more frequently than patients designated as CPS Class B.
Collapse
Affiliation(s)
- Abdullah Enezi
- College of Medicine. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Fares Al-Jahdali
- College of Medicine. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Anwar Ahmed
- College of Public Health and Health Informatics. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nahid Shirbini
- Department of Medicine, Pulmonary Division, and Sleep Disorders Center. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Harbi
- Department of Medicine, Pulmonary Division, and Sleep Disorders Center. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Baharoon Salim
- Department of Medicine, Pulmonary Division, and Sleep Disorders Center. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yosra Ali
- College of Public Health and Health Informatics. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Aljumah Abdulrahman
- Departments of Hepatobiliary Surgery and Liver Transplantation. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mohd Khan
- College of Medicine. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdullah Khaleid
- Departments of Hepatobiliary Surgery and Liver Transplantation. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Al-Jahdali Hamdan
- Department of Medicine, Pulmonary Division, and Sleep Disorders Center. King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| |
Collapse
|
4
|
Sleep in ambulatory patients with stable cirrhosis of the liver. Sleep Med 2018; 41:15-19. [DOI: 10.1016/j.sleep.2017.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 02/07/2023]
|
5
|
Randerath W, Javaheri S. Sleep-Disordered Breathing in Patients with Heart Failure. CURRENT SLEEP MEDICINE REPORTS 2016. [DOI: 10.1007/s40675-016-0047-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
6
|
|
7
|
Abstract
Neurophysiologically, central apnea is due to a temporary failure in the pontomedullary pacemaker generating breathing rhythm. As a polysomnographic finding, central apneas occur in many pathophysiological conditions. Depending on the cause or mechanism, central apneas may not be clinically significant, for example, those that occur normally at sleep onset. In contrast, central apneas occur in a number of disorders and result in pathophysiological consequences. Central apneas occur commonly in high-altitude sojourn, disrupt sleep, and cause desaturation. Central sleep apnea also occurs in number of disorders across all age groups and both genders. Common causes of central sleep apnea in adults are congestive heart failure and chronic use of opioids to treat pain. Under such circumstances, diagnosis and treatment of central sleep apnea may improve quality of life, morbidity, and perhaps mortality. The mechanisms of central sleep apnea have been best studied in congestive heart failure and hypoxic conditions when there is increased CO2 sensitivity below eupnea resulting in lowering eupneic PCO2 below apneic threshold causing cessation of breathing until the PCO2 rises above the apneic threshold when breathing resumes. In many other disorders, the mechanism of central sleep apnea (CSA) remains to be investigated.
Collapse
Affiliation(s)
- S Javaheri
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
| | | |
Collapse
|
8
|
Passino C, Giannoni A, Mannucci F, Prontera C, Filipponi F, Carrai P, Emdin M, Catapano G. Abnormal hyperventilation in patients with hepatic cirrhosis: Role of enhanced chemosensitivity to carbon dioxide. Int J Cardiol 2012; 154:22-6. [DOI: 10.1016/j.ijcard.2010.08.066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 08/11/2010] [Accepted: 08/19/2010] [Indexed: 11/28/2022]
|
9
|
Carnevale C, Georges M, Rabec C, Tamisier R, Levy P, Pépin JL. Effectiveness of Adaptive Servo Ventilation in the treatment of hypocapnic central sleep apnea of various etiologies. Sleep Med 2011; 12:952-8. [PMID: 22030207 DOI: 10.1016/j.sleep.2011.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 07/04/2011] [Accepted: 07/06/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND Central sleep apnea (CSA) occurs in clinical situations that induce hypocapnia and respiratory instability during sleep. This is true, not only in heart failure patients, but also in patients suffering from neurological diseases and idiopathic CSA. Adaptive Servo Ventilation (ASV) is frequently prescribed in France for the treatment of CSA, but only a few studies have evaluated ASV treatment with regards to long term effectiveness and compliance. METHODS Retrospective chart review in two French centers of the outcome of 74 CSA patients treated by ASV with a mean follow up on ASV of 36±18 months. RESULTS Thirty-three of the 74 patients suffered from CSA related to heart failure (HF), whereas the 41 others exhibited CSA mainly associated with neurological disorders or idiopathic CSA. Mean ASV compliance was 5.2±2.6 and 5.9±2.9h per night in cardiac failure and non-cardiac failure patients, respectively. All patients significantly improved their apnea+hypopnea index (from 47.4±19.8 to 6.9±9.3/h [p<0.001]) and mean nocturnal SaO(2) (from 92.1±2.6% to 93.6±3.2% [p<0.001]). The Epworth sleepiness scale score was reduced from 10.2±5.2 to 6.5±3.9 (p<0.01) in compliant patients but not in non-compliant patients (less than 3h per night). Moreover, compliant cardiac failure patients demonstrated a significant improvement in their NYHA score [p<0.05]. Lastly, ASV significantly reduced chronic hyperventilation as assessed by blood gases. CONCLUSION Our findings suggest that ASV is well tolerated and effective for most patients with hypocapnic central sleep apnea and chronic hyperventilation.
Collapse
Affiliation(s)
- Claudio Carnevale
- INSERM U1042, Laboratoire HP2, Université Joseph Fourier, Faculté de Médecine, 38700 Grenoble, France
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
Central apnea is caused by temporary failure in the pontomedullary pacemaker generating breathing rhythm, which results in the loss of ventilatory effort, and if it lasts 10 seconds or more it is defined as central apnea. This article reviews current knowledge on central sleep apnea.
Collapse
Affiliation(s)
- S Javaheri
- Department of Medicine, University of Cincinnati College of Medicine, 4780 Socialville Fosters Road, Mason, OH 45040, USA.
| |
Collapse
|
11
|
Carlson MD, Hilsabeck RC, Barakat F, Perry W. Role of Sleep Disturbance in Chronic Hepatitis C Infection. ACTA ACUST UNITED AC 2010; 9:25-29. [PMID: 20208985 PMCID: PMC2829649 DOI: 10.1007/s11901-010-0030-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Chronic infection with the hepatitis C virus (CHC) is associated with physical and mental symptoms including fatigue and depression that adversely affect quality of life. A related complaint, sleep disturbance, has received little attention in the literature, with the exception of sleep changes noted in cirrhosis and end-stage liver disease. We present an overview of studies indicating sleep problems in patients with CHC, with about 60% to 65% of individuals reporting such complaints. Evidence suggests that impairments in sleep quality exist independent of antiviral therapy with interferon-α and prior to advanced stages of liver disease. Further investigation of sleep disturbance in CHC patients with a mild stage of liver disease may provide important information on disease course as well as allow additional opportunities for patient support.
Collapse
Affiliation(s)
- Meghan D. Carlson
- University of California, San Diego, 210 Dickinson Street, CTF-A Room 109, San Diego, CA 92103-8423 USA
| | - Robin C. Hilsabeck
- University of California, San Diego, 210 Dickinson Street, CTF-A Room 109, San Diego, CA 92103-8423 USA
| | - Fatma Barakat
- University of California, San Diego, 210 Dickinson Street, CTF-A Room 109, San Diego, CA 92103-8423 USA
| | - William Perry
- University of California, San Diego, 210 Dickinson Street, CTF-A Room 109, San Diego, CA 92103-8423 USA
| |
Collapse
|
12
|
Treatment of sleep disordered breathing in congestive heart failure. Heart Fail Rev 2008; 14:195-203. [PMID: 18618242 DOI: 10.1007/s10741-008-9099-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 06/18/2008] [Indexed: 10/21/2022]
Abstract
In patients with congestive heart failure, sleep disordered breathing occurs commonly and is associated with an increased mortality. In addition to central sleep apnea (Cheyne-Stokes respiration), obstructive sleep apnea is more prevalent in patients with congestive heart failure than in the general population. As a result, a number of treatments have been investigated, with varying results. While many therapies may improve the severity of sleep disordered breathing, only positive pressure ventilation has been shown to improve cardiac function. Newer forms of positive pressure ventilation, such as adaptive servo-ventilation, appear to be even more effective at correcting central sleep apnea. Whether any of these treatments have an effect on transplant-free survival is presently unknown and awaits further study.
Collapse
|
13
|
Palma DT, Philips GM, Arguedas MR, Harding SM, Fallon MB. Oxygen desaturation during sleep in hepatopulmonary syndrome. Hepatology 2008; 47:1257-63. [PMID: 18311748 DOI: 10.1002/hep.22143] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
UNLABELLED Sleep alters respiratory mechanics and gas exchange, which can adversely affect arterial oxygenation. Whether sleep affects oxygenation in hepatopulmonary syndrome is unknown. The aim of this study was to assess oxygen desaturation during sleep in hepatopulmonary syndrome. Twenty adults with cirrhosis including 10 controls and 10 patients with hepatopulmonary syndrome underwent home pulse-oximetry during sleep. Subjects at high risk for obstructive sleep apnea were excluded through the Berlin questionnaire. Subjects who spent more than 10% of total sleep time with arterial oxygen saturation < 90% were classified as sleep-time oxygen desaturators. Sleep-time desaturation was correlated with clinical variables. The results showed that 7 of 10 hepatopulmonary syndrome subjects and none of the 10 controls had sleep-time oxygen desaturation. The median percentage of total sleep time with arterial oxygen saturation < 90% was significantly higher in hepatopulmonary syndrome subjects than in controls (medians 25% versus 0%, P = 0.005). Hepatopulmonary syndrome subjects had significantly lower wake-time arterial oxygen saturation level (median, 97% versus 95%; P = 0.003) and mean sleep-time arterial oxygen saturation level (median, 96% versus 91%; P = 0.0008) than did the controls. Sleep-time desaturation directly correlated with alveolar-arterial oxygen gradient (P = 0.0007) and inversely correlated with wake-time arterial oxygen tension (P = 0.0007) and oxygen saturation (P < 0.0001). CONCLUSION Oxygen desaturation occurred during sleep in 70% of hepatopulmonary syndrome subjects, the degree of which correlated with the severity of hepatopulmonary syndrome. Marked hypoxemia during sleep may occur in hepatopulmonary syndrome patients who, according to wake-time oxygen values, have only mild to moderate hypoxemia.
Collapse
Affiliation(s)
- David T Palma
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | | | | | | | | |
Collapse
|
14
|
Javaheri S, Dempsey J. Mechanisms of Sleep Apnea and Periodic Breathing in Systolic Heart Failure. Sleep Med Clin 2007. [DOI: 10.1016/j.jsmc.2007.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
15
|
Affiliation(s)
- David T Palma
- University of Alabama at Birmingham Liver Center, MCLM 290, 1918, University Boulevard, Birmingham, AL 35294, USA
| | | |
Collapse
|
16
|
Javaheri S. Long-term Efficacy of Acetazolamide on Cheyne-Stokes Respiration in Congestive Heart Failure. Am J Respir Crit Care Med 2006. [DOI: 10.1164/ajrccm.174.4.479a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
17
|
Horner RL, Bradley TD. Update in Sleep and Control of Ventilation 2005. Am J Respir Crit Care Med 2006; 173:827-32. [PMID: 16601128 DOI: 10.1164/rccm.2601005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Richard L Horner
- Department of Medicine and Physiology, University of Toronto, Sleep Research Laboratory of the Toronto Rehabilitation Institute, Toronto General Hospital of the University Health Network, Toronto, ON, Canada M5S 1A8.
| | | |
Collapse
|
18
|
Pépin JL, Chouri-Pontarollo N, Tamisier R, Lévy P. Cheyne–Stokes respiration with central sleep apnoea in chronic heart failure: Proposals for a diagnostic and therapeutic strategy. Sleep Med Rev 2006; 10:33-47. [PMID: 16376589 DOI: 10.1016/j.smrv.2005.10.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Central sleep apnoea (CSA) is highly prevalent in the evolutionary course of chronic heart failure. Such a ventilatory pattern during sleep is independently associated with poor prognosis in people with congestive heart failure. Chronic hyperventilation and daytime hypocapnia are the main mechanisms underlying the frequent association between CSA and cardiac failure. Simplified diagnostic strategies allowing easier recognition of CSA among people with severe heart failure are obviously needed but remain to be validated. Treatment of CSA is essentially aimed at improving cardiac function. When CSA persists, after appropriate adjustment of medication and resynchronisation therapy when indicated, specific ventilatory support during sleep should be considered. Continuous positive airway pressure (CPAP), oxygen, adaptive Servo-ventilation (ASV) and non-invasive ventilation have been proposed. Large randomised trials demonstrating survival and time free from heart transplantation are lacking.
Collapse
|
19
|
Abstract
RATIONALE Acetazolamide is a mild diuretic and a respiratory stimulant. It is used to treat periodic breathing at high altitude. OBJECTIVES To determine the therapeutic efficacy of acetazolamide on central sleep apnea associated with heart failure. METHODS Twelve male patients with stable systolic heart failure whose initial polysomnograms showed more than 15 episodes per hour of apnea and hypopnea participated in the study. The patients were randomized to a double-blind cross-over protocol with acetazolamide or placebo, taken 1 h before bedtime for six nights with 2 wk of washout. MEASUREMENTS Polysomnography, pulmonary function tests, arterial blood gases, and left ventricular ejection fraction were obtained initially along with a sleep questionnaire, history, and physical examination. Baseline measurements were repeated at the end of each arm. MAIN RESULTS There were no significant differences between parameters at baseline and placebo. In comparing placebo with acetazolamide, the hourly number of episodes of central apnea (49 +/- 28 vs. 23 +/- 21 [mean +/- SD]; p = 0.004) and the percentage of total sleep time spent below an arterial oxyhemoglobin saturation of 90% (19 +/- 32 vs. 6 +/- 13%; p = 0.01) decreased significantly. Acetazolamide improved subjective perception of overall sleep quality (p = 0.003), feeling rested on awakening (p = 0.007), daytime fatigue (p = 0.02), and falling asleep unintentionally during daytime (p = 0.002). CONCLUSIONS In patients with heart failure, administration of a single dose of acetazolamide before sleep improves central sleep apnea and related daytime symptoms.
Collapse
Affiliation(s)
- Shahrokh Javaheri
- Pulmonary Section (111F), VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA.
| |
Collapse
|
20
|
Caples SM, Wolk R, Somers VK. Influence of cardiac function and failure on sleep-disordered breathing: evidence for a causative role. J Appl Physiol (1985) 2005; 99:2433-9. [PMID: 16288101 DOI: 10.1152/japplphysiol.00676.2005] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Heart failure is an increasingly common public health problem that is strongly linked to both central and obstructive sleep apnea, collectively referred to as sleep-disordered breathing. Much attention has been given to the deleterious effects of sleep-disordered breathing on the failing heart and potential mechanisms by which treatment of sleep-disordered breathing may result in improved cardiac performance and long-term outcomes. However, there is compelling evidence that cardiac dysfunction may contribute to sleep-disordered breathing. Although there is recognized overlap between pathophysiological mechanisms in central sleep apnea and obstructive sleep apnea, data supporting the role of cardiac function are certain forms of central sleep apnea are well established, whereas investigation into the relationship with obstructive sleep apnea is less mature but continues to evolve. This review will examine experimental and observational data that explore possible pathophysiological mechanisms and potential targets for therapy in heart failure and sleep-disordered breathing.
Collapse
Affiliation(s)
- Sean M Caples
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | | |
Collapse
|
21
|
Abstract
PURPOSE OF REVIEW The recent rapid evolution of our understanding of the mechanisms involved in control of respiration during sleep has yielded new insights to guide our care of difficult-to-treat sleep apnea patients with complex sleep-disordered breathing. This review will describe these recent advances in the literature and suggest a model for their incorporation into clinical practice. RECENT FINDINGS Control of respiration during sleep shows amplified instability relative to that seen during wake in these difficult patients. Baseline (eupneic) carbon dioxide levels as well as the responsiveness of the ventilatory system to changes in carbon dioxide are all-important in this relative instability. Furthermore, the instability seen during sleep varies widely across sleep states. A further refinement of our definition of stable and unstable sleep has been developed that directly informs our understanding of the control of respiration across a night of sleep. SUMMARY Complex sleep-disordered breathing is a distinct form of sleep apnea. It has recognizable characteristics that are present without, and often worsened during, positive airway pressure treatment. Both sleep state stability and the behavior of the respiratory control system contribute to this complexity. It is only with a clear understanding of the factors contributing to complex sleep-disordered breathing that implementation of truly effective clinical therapy can be achieved for this disorder, which to date is poorly controlled.
Collapse
Affiliation(s)
- Geoffrey S Gilmartin
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115, USA
| | | | | |
Collapse
|