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Sun X, Wang Y, Wu C, Gao Y. Association Between Central Sleep Apnea and Left Atrial Enlargement in Snoring Patients with Preserved Ejection Fraction. Nat Sci Sleep 2025; 17:447-460. [PMID: 40103651 PMCID: PMC11913979 DOI: 10.2147/nss.s500562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2024] [Accepted: 03/03/2025] [Indexed: 03/20/2025] Open
Abstract
Background Central sleep apnea (CSA) significantly impacts cardiovascular health, linking it to left atrial enlargement, atrial fibrillation, and impaired cardiac function in heart failure patients with reduced ejection fraction (EF). However, the relationship between CSA and left atrial size in individuals with preserved EF remains underexplored. Objective This study aims to examine the relationship between left atrial size and CSA in snoring patients with preserved EF. Methods An observational study was conducted involving 341 consecutive snoring patients from a cardiology department who underwent overnight polysomnography (PSG) and echocardiography. Patients with EF below 50%, pulmonary diseases or neuromuscular disorders were excluded. CSA was defined as a central apnea-hypopnea index (CAHI) of five or more events per hour. Inverse probability of treatment weighting (IPTW) and logistic regression models were employed to evaluate the relationship between CSA and left atrial size. Results Among the 341 patients, 33 (9.68%) were diagnosed with CSA, with a higher prevalence in males (10.0%) than females (8.91%). Left atrial enlargement (LAE) was observed in 172 patients (50.44%), predominantly in females (71.29%). CSA patients demonstrated significantly higher apnea-hypopnea index (AHI) (49.2/h vs 26.75/h, p < 0.01) and oxygen desaturation index (ODI) (44.9 vs 22.85, p < 0.01), alongside more sleep time with oxygen saturation < 90% (6.6% vs 2.35%, p = 0.01). Echocardiographic evaluations revealed that CSA patients had a greater left atrial anterior-posterior diameter(LAD-ap 42.73 ± 13.01 mm vs 38.15 ± 4.58 mm, p < 0.01) and a higher frequency of LAE (69.7% vs 48.38%, p = 0.02). Males with CSA had a significantly increased risk of LAE (OR: 4.54; 95% CI: 1.45-14.2) after IPTW adjustment, with significant associations persisting among those with risk factors such as smoking and dyslipidemia. Conclusion This study highlights a significant association between CSA and left atrial enlargement in males with preserved EF, suggesting that CSA may contribute to atrial remodeling even without reduced ejection fraction.
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Affiliation(s)
- Xinghe Sun
- Department of Cardiology, Peking University International Hospital, Beijing, People's Republic of China
| | - Yang Wang
- Department of Cardiology, Peking University International Hospital, Beijing, People's Republic of China
| | - Chaoqun Wu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Yinghui Gao
- Department of Sleep Medicine, Peking University International Hospital, Beijing, People's Republic of China
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2
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Javaheri S, Badr MS. Central sleep apnea: pathophysiologic classification. Sleep 2023; 46:zsac113. [PMID: 35551411 PMCID: PMC9995798 DOI: 10.1093/sleep/zsac113] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 05/05/2022] [Indexed: 11/14/2022] Open
Abstract
Central sleep apnea is not a single disorder; it can present as an isolated disorder or as a part of other clinical syndromes. In some conditions, such as heart failure, central apneic events are due to transient inhibition of ventilatory motor output during sleep, owing to the overlapping influences of sleep and hypocapnia. Specifically, the sleep state is associated with removal of wakefulness drive to breathe; thus, rendering ventilatory motor output dependent on the metabolic ventilatory control system, principally PaCO2. Accordingly, central apnea occurs when PaCO2 is reduced below the "apneic threshold". Our understanding of the pathophysiology of central sleep apnea has evolved appreciably over the past decade; accordingly, in disorders such as heart failure, central apnea is viewed as a form of breathing instability, manifesting as recurrent cycles of apnea/hypopnea, alternating with hyperpnea. In other words, ventilatory control operates as a negative-feedback closed-loop system to maintain homeostasis of blood gas tensions within a relatively narrow physiologic range, principally PaCO2. Therefore, many authors have adopted the engineering concept of "loop gain" (LG) as a measure of ventilatory instability and susceptibility to central apnea. Increased LG promotes breathing instabilities in a number of medical disorders. In some other conditions, such as with use of opioids, central apnea occurs due to inhibition of rhythm generation within the brainstem. This review will address the pathogenesis, pathophysiologic classification, and the multitude of clinical conditions that are associated with central apnea, and highlight areas of uncertainty.
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Affiliation(s)
- Shahrokh Javaheri
- Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, OH, USA
- Division of Pulmonary Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, USA
- Division of Cardiology, Department of Medicine, Ohio State University, Columbus, OH, USA
| | - M Safwan Badr
- Department of Internal Medicine, Liborio Tranchida, MD, Endowed Professor of Medicine, Wayne State University School of Medicine, University Health Center, Detroit, MI, USA
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3
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Paulus MG, Liedtke T, Hamerle M, Schach C, Maier LS, Stadler S, Birner C, Debl K, Arzt M, Unsöld B, Meindl C. Impact of transcatheter edge-to-edge mitral valve repair on central sleep apnoea. Clin Res Cardiol 2022; 112:594-604. [PMID: 36507943 PMCID: PMC10160214 DOI: 10.1007/s00392-022-02139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022]
Abstract
Abstract
Aims
Sleep-disordered breathing (SDB) and its subtype central sleep apnoea (CSA) are highly prevalent in patients with heart failure and associated with worse prognosis. Whereas pharmacological therapy of heart failure has been shown to ameliorate CSA, results from previous studies on the effect of mitral regurgitation therapy on SDB are contradicting. The aim of this study was to assess the impact of transcatheter edge-to-edge mitral valve repair (TEER) on prevalence and severity of CSA.
Methods and results
We enrolled 47 patients undergoing TEER for symptomatic mitral regurgitation in a prospective study. Secondary mitral regurgitation and left ventricular ejection fraction < 50% were present in 79% and 68% of patients, respectively. Respiratory polygraphy was performed before TEER in a compensated condition and four weeks after the procedure. 34 patients completed the follow-up. At baseline, 19 (56%) patients showed moderate-to-severe SDB, of whom 13 (68%) were classified as CSA. Both apnoea-hypopnoea index and percentage of recorded time spent in Cheyne-Stokes respiration strongly decreased from baseline to follow-up (median [IQR] 16 [7–30] vs. 7 [4–15] /h, p = 0.007; 6 [0–34] vs. 0 [0–8] %, p = 0.008). Median relative reduction of central apnoea index was 75% (p = 0.023), while obstructive apnoea index did not change significantly. Increase in stroke volume after TEER and high systolic pulmonary artery pressure at baseline predicted a > 50% reduction of both Apnoea-hypopnoea index and Cheyne-Stokes respiration.
Conclusion
TEER is associated with a significant short-term reduction of CSA and Cheyne-Stokes respiration in high-risk patients, strengthening its value as an effective treatment option for advanced heart failure.
Graphical abstract
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Affiliation(s)
- Michael G Paulus
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Tobias Liedtke
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Hamerle
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christian Schach
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Stefan Stadler
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christoph Birner
- Department of Internal Medicine I, Klinikum St. Marien, Amberg, Germany
| | - Kurt Debl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Bernhard Unsöld
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christine Meindl
- Department of Internal Medicine II, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
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4
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Prevalence of sleep-disordered breathing in patients with mitral regurgitation and the effect of mitral valve repair. Sleep Breath 2022; 27:599-610. [DOI: 10.1007/s11325-022-02667-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
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5
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Kahn D, Baele P, Pasquet A, Liistro G. Cheyne-Stokes respiration and cardiovascular oscillations ending abruptly when deploying transfemoral aortic valve. J Appl Physiol (1985) 2020; 128:345-349. [PMID: 31873067 DOI: 10.1152/japplphysiol.00193.2019] [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: 11/22/2022] Open
Abstract
A 86-yr-old man was referred for transfemoral aortic valve implantation. Transthoracic echocardiography revealed a severe stenosis (mean gradient: 58 mmHg, aortic valve area: 0.4 cm2), and after multidisciplinary discussion, the risk of surgery was judged too high (logistic Euroscore: 51%), and the patient was proposed for a transfemoral aortic valve implantation (TAVI). On arrival in the operating room, the patient, fully conscious, was noted to have Cheyne-Stokes breathing (CSB), which persisted after 40% oxygen administration. TAVI procedure was successful, and the CSB pattern was interrupted within 8 s. To the best of our knowledge, this report is the first to show an acute disappearance of CSB, occurring only seconds after TAVI and restoration of a normal hemodynamic situation. To explain such rapid changes in breathing pattern, we hypothesize a role played by the acute release of pulmonary hypertension and pulmonary volume overload.NEW & NOTEWORTHY Acute disappearance of Cheyne-Stokes breathing after transfemoral aortic valve implantation suggests a reflex pathway originating from the fall in pulmonary vessels congestion.
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Affiliation(s)
- David Kahn
- Department of Anaesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Philippe Baele
- Department of Anaesthesiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Agnès Pasquet
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Giuseppe Liistro
- Pôle de Pneumologie, ORL et Dermatologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.,Service de Pneumologie, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Central Sleep Apnea with Cheyne-Stokes Breathing in Heart Failure – From Research to Clinical Practice and Beyond. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1067:327-351. [DOI: 10.1007/5584_2018_146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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7
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Abstract
Central sleep apnea and Cheyne-Stokes respiration are commonly observed breathing patterns during sleep in patients with congestive heart failure. Common risk factors are male gender, older age, presence of atrial fibrillation, and daytime hypocapnia. Proposed mechanisms include augmented peripheral and central chemoreceptor sensitivity, which increase ventilator instability during both wakefulness and sleep; diminished cerebrovascular reactivity and increased circulation time, which impair the normal buffering of Paco2 and hydrogen ions and delay the detection of changes in Paco2 during sleep; and rostral fluid shifts that predispose to hypocapnia.
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8
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Gessner V, Bitter T, Horstkotte D, Oldenburg O, Fox H. Impact of sleep-disordered breathing in patients with acute myocardial infarction: a retrospective analysis. J Sleep Res 2017; 26:657-664. [PMID: 28488317 DOI: 10.1111/jsr.12540] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/16/2017] [Indexed: 11/29/2022]
Abstract
Sleep-disordered breathing (SDB) is associated with an increased risk of cardiovascular events. Previous studies showed that severe SDB has a negative impact on myocardial salvage and progression of left ventricular dysfunction after acute myocardial infarction (AMI). This study investigated the frequency of SDB and the effects of SDB on left ventricular function after AMI. This retrospective study enrolled all patients with AMI who had undergone cardiorespiratory polygraphy for SDB diagnosis. The apnea-hypopnea index was used as a standard metric of SDB severity. SDB was classified as mild (apnea-hypopnea index >5 to <15 per h), moderate (≥15 to <30 per h) or severe (apnea-hypopnea index ≥30 per h). According to the majority of events, SDB was classified as predominant obstructive sleep apnea, central sleep apnea or mixed sleep apnea (mixed SDB). A total of 223 patients with AMI (112 with ST elevation and 111 without ST elevation; 63.2 ± 11.2 years, 82% male, left ventricular ejection fraction 49 ± 12%) were enrolled. SDB was present in 85.6%, and was moderate-to-severe in 63.2%; 40.8% had obstructive sleep apnea, 41.7% had central sleep apnea and 3.1% had mixed SDB. Left ventricular ejection fraction was lower in patients with AMI with severe SDB (45 ± 14%) versus those without SDB (57 ± 7%; P < 0.005). In addition, lower left ventricular ejection fraction (≤45%) was associated with increased frequency (apnea-hypopnea index ≥5 per h in 96%) and severity (apnea-hypopnea index ≥30 per h in 48%) of SDB in general and a higher percentage of central sleep apnea (57%) in particular. SDB is highly frequent in patients with AMI. SDB severity appeared to be linked to impaired left ventricular function, especially in patients with central sleep apnea.
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Affiliation(s)
- Verena Gessner
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Thomas Bitter
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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9
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Sleep Apnea and Left Atrial Phasic Function in Heart Failure With Reduced Ejection Fraction. Can J Cardiol 2016; 32:1402-1410. [DOI: 10.1016/j.cjca.2016.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/05/2016] [Accepted: 02/09/2016] [Indexed: 01/07/2023] Open
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10
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Orr JE, Malhotra A, Sands SA. Pathogenesis of central and complex sleep apnoea. Respirology 2016; 22:43-52. [PMID: 27797160 DOI: 10.1111/resp.12927] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/22/2016] [Accepted: 10/03/2016] [Indexed: 12/01/2022]
Abstract
Central sleep apnoea (CSA) - the temporary absence or diminution of ventilatory effort during sleep - is seen in a variety of forms including periodic breathing in infancy and healthy adults at altitude and Cheyne-Stokes respiration in heart failure. In most circumstances, the cyclic absence of effort is paradoxically a consequence of hypersensitive ventilatory chemoreflex responses to oppose changes in airflow, that is elevated loop gain, leading to overshoot/undershoot ventilatory oscillations. Considerable evidence illustrates overlap between CSA and obstructive sleep apnoea (OSA), including elevated loop gain in patients with OSA and the presence of pharyngeal narrowing during central apnoeas. Indeed, treatment of OSA, whether via continuous positive airway pressure (CPAP), tracheostomy or oral appliances, can reveal CSA, an occurrence referred to as complex sleep apnoea. Factors influencing loop gain include increased chemosensitivity (increased controller gain), reduced damping of blood gas levels (increased plant gain) and increased lung to chemoreceptor circulatory delay. Sleep-wake transitions and pharyngeal dilator muscle responses effectively raise the controller gain and therefore also contribute to total loop gain and overall instability. In some circumstances, for example apnoea of infancy and central congenital hypoventilation syndrome, central apnoeas are the consequence of ventilatory depression and defective ventilatory responses, that is low loop gain. The efficacy of available treatments for CSA can be explained in terms of their effects on loop gain, for example CPAP improves lung volume (plant gain), stimulants reduce the alveolar-inspired PCO2 difference and supplemental oxygen lowers chemosensitivity. Understanding the magnitude of loop gain and the mechanisms contributing to instability may facilitate personalized interventions for CSA.
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Affiliation(s)
- Jeremy E Orr
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, California, USA
| | - Atul Malhotra
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, La Jolla, California, USA
| | - Scott A Sands
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Allergy Immunology and Respiratory Medicine and Central Clinical School, The Alfred and Monash University, Melbourne, Victoria, Australia
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Abstract
Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation.
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Affiliation(s)
- Scott A Sands
- Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Department of Allergy, Immunology and Respiratory Medicine and Central Clinical School, Alfred Hospital and Monash University, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Robert L Owens
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, 9300 Campus Point Drive, #7381, La Jolla, CA 92037, USA.
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12
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Mulchrone A, Shokoueinejad M, Webster J. A review of preventing central sleep apnea by inspired CO2. Physiol Meas 2016; 37:R36-45. [DOI: 10.1088/0967-3334/37/5/r36] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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13
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Flinta I, Ponikowski P. Relationship between central sleep apnea and Cheyne-Stokes Respiration. Int J Cardiol 2016; 206 Suppl:S8-12. [PMID: 26961739 DOI: 10.1016/j.ijcard.2016.02.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/21/2016] [Indexed: 10/22/2022]
Abstract
Central sleep apnea (CSA) in patients with heart failure (HF) occurs frequently and shows a serious influence on prognosis in this population. The key elements in the pathophysiology of CSA are respiratory instability with chronic hyperventilation, changes of arterial carbon dioxide pressure (pCO2) and elongated circulation time. The main manifestation of CSA in patients with HF is Cheyne-Stokes Respiration (CSR). The initial treatment is the optimization of HF therapy. However, many other options of the therapeutic management have been studied, particularly those based on positive airway pressure methods. In patients with heart failure we often can observe the overlap of CSA and CSR; we will discuss the differences between these forms of breathing disorders during sleep. We will also discuss when CSA and CSR occur independently of each other and the importance of CSR occurring during the daytime in context of CSA during the nighttime.
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Affiliation(s)
- Irena Flinta
- Department of Cardiology, 4th Military Hospital, Wrocław, Poland; Department of Physiology, Medical University, Wrocław, Poland.
| | - Piotr Ponikowski
- Department of Cardiology, 4th Military Hospital, Wrocław, Poland; Clinic of Cardiac Diseases, Department of Heart Diseases, Medical University, Wrocław, Poland
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14
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Pathophysiology of central sleep apneas. Sleep Breath 2016; 20:467-82. [DOI: 10.1007/s11325-015-1290-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 11/10/2015] [Accepted: 11/23/2015] [Indexed: 11/26/2022]
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15
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Franzen D, Gerard N, Bratton DJ, Wons A, Gaisl T, Sievi NA, Clarenbach CF, Kohler M, Krayenbühl PA. Prevalence and Risk Factors of Sleep Disordered Breathing in Fabry disease: A Prospective Cohort Study. Medicine (Baltimore) 2015; 94:e2413. [PMID: 26717401 PMCID: PMC5291642 DOI: 10.1097/md.0000000000002413] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Excessive daytime sleepiness (EDS) is a frequently reported and not well-understood symptom in patients with Fabry disease (FD). Sleep-disordered breathing (SDB) is a possible factor. As deposition of glycosphingolipids in the upper airway muscles is likely, we hypothesized that obstructive sleep apnoea (OSA) is highly prevalent in FD and positively associated with its severity.All patients with FD who are followed in the Fabry cohort of the University Hospital Zurich (n = 62) were asked to participate in this prospective cohort study. Eligible patients were prospectively investigated by assessing their daytime sleepiness using the Epworth Sleepiness Scale (ESS), the severity of FD using the Mainz Severity Score Index (MSSI), and by an ambulatory overnight respiratory polygraphy between November 1, 2013, and January 31, 2015. SDB was defined as an apnea/hypopnea index (AHI) of > 5/h.Fifty-two patients (mean ± SD age 42.8 ± 14.7 years, 33% men, mean ± SD BMI 23.4 ± 3.6 kg/m) with a median (IQR) MSSI of 12 (5-19) were included. Median (IQR) ESS was 6 (2-10) and 7 patients (14%) had an ESS > 10. Thirteen patients (25%) had SDB (78% obstructive sleep apnea, 22% central sleep apnea). In the multivariable analysis, the age was the only statistically significant predictor of SDB (OR 1.11, 95% CI 1.04-1.18, P = 0.001). ESS was associated with depression (P < 0.001) but not AHI nor age.This study shows that SDB, especially obstructive sleep apnea is highly prevalent in patients with Fabry disease. However, EDS in FD seems to be related with depression rather than SDB.ClinicalTrials.gov (identifier: NCT01947634).
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Affiliation(s)
- Daniel Franzen
- From the Division of Pulmonology, University Hospital Zurich, Raemistrasse, Zurich (DF, NG, DJB, AW, TG, NAS, CFC, MK); and Department of Internal Medicine, Regional Hospital Linth, Gasterstrasse, Uznach, Switzerland (PAK)
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16
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Correale M, Brunetti ND, Forte L, Passero T, Monaco I, Ferraretti A, Totaro A, Carpagnano GE, Foschino Barbaro MP, Di Biase M, Lacedonia D. Tissue Doppler Imaging predicts central sleep apnea in patients with chronic heart failure: data from the Daunia Registry. Eur J Clin Invest 2015; 45:1153-60. [PMID: 26365893 DOI: 10.1111/eci.12520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 08/16/2015] [Indexed: 01/18/2023]
Abstract
BACKGROUND Tissue Doppler imaging (TDI) is used to improve risk stratification in patients with chronic heart failure (CHF). So far, few studies have used this method to investigate the characteristics of subjects with CHF and Cheyne-Stokes breathing (CSB). The aim of this study was therefore to evaluate whether TDI assessment may predict the presence of CSB in patients with CHF. MATERIALS AND METHODS A total of 41 consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent echocardiography assessment and nocturnal polygraphy to evaluate the presence of sleep apnea and CSB. Conventional echocardiography and TDI parameters were calculated. We have also quantified by TDI a combined index (EAS index) of diastolic and systolic performance: E'/(A' × S'). RESULTS Subjects with evidence of CSB (N = 8) were characterized by lower values of A' (5·03 ± 2·64 vs. 7·88 ± 2·64 cm/s, P < 0·01). A' and EAS index values were related to Cheyne-Stokes episode rates (r = -0·49 and 0·52, P < 0·05 and <0·01 respectively), EAS index values also with the number of episodes of central apnea (r = 0·39, P < 0·05). A' values predicted the presence of CSB at poly-somnography examination with an OR 0·62 (95% CI 0·40-0·96, P < 0·05) even after correction for age and gender. CONCLUSIONS Tissue Doppler imaging values (A') are associated with the presence of sleep apnea at nocturnal polygraphy.
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Affiliation(s)
| | | | - Lucia Forte
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Tommaso Passero
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Ilenia Monaco
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Armando Ferraretti
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Totaro
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Matteo Di Biase
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Donato Lacedonia
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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17
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Abstract
Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation.
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Affiliation(s)
- Scott A Sands
- Division of Sleep Medicine, Brigham and Women's Hospital and Harvard Medical School, 221 Longwood Avenue, Boston, MA 02115, USA; Department of Allergy, Immunology and Respiratory Medicine and Central Clinical School, Alfred Hospital and Monash University, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Robert L Owens
- Division of Pulmonary and Critical Care Medicine, University of California San Diego, 9300 Campus Point Drive, #7381, La Jolla, CA 92037, USA.
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Bardia A, Montealegre-Gallegos M, Mahmood F, Owais K, Pal A, Matyal R. Left atrial size: an underappreciated perioperative cardiac risk factor. J Cardiothorac Vasc Anesth 2014; 28:1624-32. [PMID: 25307502 DOI: 10.1053/j.jvca.2014.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Amit Bardia
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Mario Montealegre-Gallegos
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Hospital México C.C.S.S., Universidad de Costa Rica, San José, Costa Rica
| | - Feroze Mahmood
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
| | - Khurram Owais
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Anam Pal
- Department of Surgery, Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Robina Matyal
- Departments of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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