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Jiang H, Ping Z, Li S, Zhu J. Recurrence of CCHS-associated PHOX2B Poly-Alanine expansion variant due to paternal mosaicism. Gene 2024; 911:148358. [PMID: 38467313 DOI: 10.1016/j.gene.2024.148358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Paired-like Homeobox 2B (PHOX2B) is considered the causative gene of Congenital Central Hypoventilation Syndrome (CCHS), a dominant genetic disorder characterized by impaired central respiratory control and subsequent hypoventilation during sleep. METHODS Herein, we present a family with recurrent severe CCHS. The potential causative genetic variant was confirmed through Whole-Exome Sequencing (WES), Sanger sequencing, and droplet digital PCR (ddPCR). Furthermore, prenatal diagnosis was performed on the proband's mother at 20 weeks of her fourth pregnancy upon request. RESULTS The proband and her brother were both carriers of the PHOX2B polyalanine expansion variant: c.744_758dupCGCGGCAGCGGCGGCGGCGGC. Sanger sequencing revealed that the proband's father had a small variant peak in the gene position, implying potential somatic mosaicism. In addition, ddPCR results showed that the proband's father had germline mosaicism, with a mosaicism proportion of 14.3%. Notably, the detect p.(Ala241[26]) variant was not detected in the fetus. CONCLUSIONS These findings have important implications for improving genetic counseling of CCHS families as they suggest that even parents without CCHS symptoms may have somatic chimerism, necessitating careful genetic counseling and consideration of prenatal testing for subsequent pregnancies.
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Affiliation(s)
- Huling Jiang
- Department of Prenatal Diagnosis Center, Maternity and Child Health Care Affiliated Hospital, Jiaxing University, Jiaxing 314000, China
| | - Zepeng Ping
- Department of Prenatal Diagnosis Center, Maternity and Child Health Care Affiliated Hospital, Jiaxing University, Jiaxing 314000, China
| | - Suping Li
- Department of Prenatal Diagnosis Center, Maternity and Child Health Care Affiliated Hospital, Jiaxing University, Jiaxing 314000, China.
| | - Jianjun Zhu
- Department of Prenatal Diagnosis Center, Maternity and Child Health Care Affiliated Hospital, Jiaxing University, Jiaxing 314000, China.
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Qu XR, Han T, Li YM, Zhang XL. A 38-Year-Old Woman With REM Predominant Central Sleep Apnea After Bulbar Infarction. Chest 2024; 165:e101-e106. [PMID: 38599753 DOI: 10.1016/j.chest.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/27/2023] [Accepted: 12/07/2023] [Indexed: 04/12/2024] Open
Abstract
CASE PRESENTATION A 38-year-old previously healthy woman was referred to our sleep center for recurrent witnessed breathing arrest during sleep. She had been brought to the ED 3 months earlier because of sudden onset of dizziness with nausea and vomiting, numbness and weakness of the left limb, less clear speech, double vision, dysphagia, and choking cough while drinking water. Brain MRI showed an acute cerebral infarction in the left medulla oblongata (Fig 1). High-resolution MRI showed vertebral artery dissection (Fig 2). Antiplatelet aggregation, lipid reduction, plaque stabilization, and trophic nerve treatments were administered, and the left limb strength, speech, and swallowing function improved. She complained of poor sleep and difficulties with memory.
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Affiliation(s)
- Xin Ru Qu
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Teng Han
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Yi Ming Li
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Xiao Lei Zhang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; National Clinical Research Center for Respiratory Diseases, Beijing, China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China; Peking University Health Science Center, Beijing, China; Capital Medical University, Beijing, China.
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Arzt M, Munt O, Pépin JL, Heinzer R, Kübeck R, von Hehn U, Ehrsam-Tosi D, Benjafield AV, Woehrle H. Effects of Adaptive Servo-Ventilation on Quality of Life: The READ-ASV Registry. Ann Am Thorac Soc 2024; 21:651-657. [PMID: 38241012 DOI: 10.1513/annalsats.202310-908oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/18/2024] [Indexed: 04/04/2024] Open
Abstract
Rationale: Adaptive servo-ventilation (ASV) effectively treats sleep-disordered breathing, including central sleep apnea (CSA) and coexisting obstructive sleep apnea (OSA).Objectives: The prospective, multicenter European READ-ASV (Registry on the Treatment of Central and Complex Sleep-Disordered Breathing with Adaptive Servo-Ventilation) registry investigated the effects of first-time ASV therapy on disease-specific quality of life (QoL).Methods: The registry enrolled adults with CSA with or without OSA who had ASV therapy prescribed between September 2017 and March 2021. The primary endpoint was change in disease-specific QoL (Functional Outcomes of Sleep Questionnaire [FOSQ]) score between baseline and 12-month follow-up. Sleepiness determined using the Epworth Sleepiness Scale (ESS) score was a key secondary outcome. For subgroup analysis, participants were classified as symptomatic (FOSQ score < 17.9 and/or ESS score > 10) or asymptomatic (FOSQ score ⩾ 17.9 and/or ESS score ⩽ 10).Results: A total of 801 individuals (age, 67 ± 12 yr; 14% female; body mass index, 31 ± 5 kg/m2; apnea-hypopnea index, 48 ± 22/h) were enrolled; analyses include those with paired baseline and follow-up data. After 12 ± 3 months on ASV, median (interquartile range) FOSQ score had increased significantly from baseline (+0.8 [-0.2 to 2.2]; P < 0.001; n = 499). This was due to a significantly increased FOSQ score in symptomatic participants (+1.69 [0.38 to 3.05]), with little change in asymptomatic individuals (+0.11 [-0.39 to 0.54]). The median ESS score also improved significantly from baseline during ASV (-2.0 [-5.0 to 0.0]; P < 0.001).Conclusions: ASV treatment of CSA with or without coexisting OSA was associated with improvements in disease-specific QoL and daytime sleepiness, especially in individuals with sleep-disordered breathing symptoms before therapy initiation. These improvements in patient-reported outcomes support the use of ASV in this population.
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Affiliation(s)
- Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | | | - Jean-Louis Pépin
- University Grenoble Alpes, Laboratoire HP2, U1300 Inserm, CHU Grenoble Alpes, Grenoble, France
| | - Raphael Heinzer
- Centre d'Investigation et de Recherche sur le Sommeil, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Barreto I, Fernandes Pedro I, Alves D, Pereira ML, Moreira S. Congenital Central Hypoventilation Syndrome: The Singularity of A Successful Case. ACTA MEDICA PORT 2024; 37:310-311. [PMID: 38631052 DOI: 10.20344/amp.20748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Inês Barreto
- * Co-first author. Pulmonology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Inês Fernandes Pedro
- * Co-first authors. Pulmonology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Daniel Alves
- Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
| | - Maria Luísa Pereira
- Faculdade de Medicina. Universidade de Lisboa. Lisbon; Pediatrics Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon. Portugal
| | - Susana Moreira
- Pulmonology Department. Centro Hospitalar Universitário Lisboa Norte. Lisbon; Faculdade de Medicina. Universidade de Lisboa. Lisbon. Portugal
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Carrara M, Aubertin G, Khirani S, Massenavette B, Bierme P, Griffon L, Ioan I, Schweitzer C, Binoche A, Lampin ME, Mordacq C, Rubinsztajn R, Debeilleix S, Galode F, Bui S, Hullo E, Becourt A, Lubrano M, Moreau J, Renoux MC, Matecki S, Stremler N, Baravalle-Einaudi M, Mazenq J, Sigur E, Labouret G, Genevois AL, Heyman R, Pomedio M, Masson A, Hangard P, Menetrey C, Le Clainche L, Bokov P, Dudoignon B, Fleurence E, Bergounioux J, Mbieleu B, Breining A, Giovannin-Chami L, Fina A, Ollivier M, Gachelin E, Perisson C, Pervillé A, Barzic A, Cros P, Jokic M, Labbé G, Diaz V, Coutier L, Fauroux B, Taytard J. Pediatric long-term noninvasive respiratory support in children with central nervous system disorders. Pediatr Pulmonol 2024; 59:642-651. [PMID: 38088209 DOI: 10.1002/ppul.26796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 10/31/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024]
Abstract
RATIONALE The use of long-term noninvasive respiratory support is increasing in children along with an extension of indications, in particular in children with central nervous system (CNS) disorders. OBJECTIVE The aim of this study was to describe the characteristics of children with CNS disorders treated with long-term noninvasive respiratory support in France. METHODS Data were collected from 27 French pediatric university centers through an anonymous questionnaire filled for every child treated with noninvasive ventilatory support ≥3 months on 1st June 2019. MAIN RESULTS The data of 182 patients (55% boys, median age: 10.2 [5.4;14.8] years old [range: 0.3-25]) were collected: 35 (19%) patients had nontumoral spinal cord injury, 22 (12%) CNS tumors, 63 (35%) multiple disabilities, 26 (14%) central alveolar hypoventilation and 36 (20%) other CNS disorders. Seventy five percent of the patients were treated with noninvasive ventilation (NIV) and 25% with continuous positive airway pressure (CPAP). The main investigations performed before CPAP/NIV initiation were nocturnal gas exchange recordings, alone or coupled with poly(somno)graphy (in 29% and 34% of the patients, respectively). CPAP/NIV was started in an acute setting in 10% of the patients. Median adherence was 8 [6;10] hours/night, with 12% of patients using treatment <4 h/day. Nasal mask was the most common interface (70%). Airway clearance techniques were used by 31% of patients. CONCLUSION CPAP/NIV may be a therapeutic option in children with CNS disorders. Future studies should assess treatment efficacy and patient reported outcome measures.
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Affiliation(s)
- Marion Carrara
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
| | - Guillaume Aubertin
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
- Sorbonne Université, INSERM UMR-S 938, Centre de Recherche Saint-Antoine (CRSA), Paris, France
- Centre de pneumologie de l'enfant, Ramsay Générale de Santé, Paris, France
| | - Sonia Khirani
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
- ASV Santé, Gennevilliers, France
| | - Bruno Massenavette
- Pediatric Intensive Care Unit, Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Bron, France
| | - Priscille Bierme
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, Bron, France
| | - Lucie Griffon
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
| | - Iulia Ioan
- Department of Pediatric, University Children's Hospital, CHRU Nancy; Université de Lorraine, DevAH, Nancy, France
| | - Cyril Schweitzer
- Department of Pediatric, University Children's Hospital, CHRU Nancy; Université de Lorraine, DevAH, Nancy, France
| | - Alexandra Binoche
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Marie-Emilie Lampin
- Pediatric Intensive Care Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Clémence Mordacq
- Pediatic Pulmonology and Allergology Unit, Hôpital Jeanne de Flandre, CHU Lille, Lille, France
| | - Robert Rubinsztajn
- Department of Pediatric orthopedic surgery, Hôpital Necker-Enfants malades, Paris, France
| | | | - François Galode
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Stéphanie Bui
- Pediatric Pulmonology Unit, Hôpital Pellegrin-Enfants, Bordeaux, France
| | - Eglantine Hullo
- Pediatric Pulmonology Unit, Hôpital Couple-Enfant, CHU Grenoble, Grenoble, France
| | - Arnaud Becourt
- Pediatric Pulmonology Department, CHU Amiens Picardie, Amiens, France
| | - Marc Lubrano
- Respiratory Diseases, Allergy and CF Unit, Department of Pediatric, University Hospital Charles Nicolle, Rouen, France
| | - Johan Moreau
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
- Physiology and Experimental Biology of Heart and Muscles Laboratory-PHYMEDEXP, UMR CNRS 9214, INSERM U1046, University of Montpellier, Montpellier, France
| | - Marie-Catherine Renoux
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
| | - Stefan Matecki
- Department of Pediatric Cardiology and Pulmonology, Montpellier University Hospital, Montpellier, France
- Functional Exploration Laboratory, University Hospital, Montpellier, France
| | - Nathalie Stremler
- Pediatric Ventilation Unit, Department of Pediatric, AP-HM, Hôpital La Timone, Marseille, France
| | | | - Julie Mazenq
- Pediatric Ventilation Unit, Department of Pediatric, AP-HM, Hôpital La Timone, Marseille, France
| | - Elodie Sigur
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Géraldine Labouret
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Anne-Laure Genevois
- Pediatric Pulmonology and Allergology Unit, Hôpital des Enfants, Toulouse, France
| | - Rachel Heyman
- Pediatric Unit, Department of Physical Medicine and Rehabilitation, Hôpital Pontchaillou, Rennes, France
| | - Michael Pomedio
- Pediatric Intensive Care Unit, American Memorial Hospital, CHU Reims, Reims, France
| | - Alexandra Masson
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Pauline Hangard
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Céline Menetrey
- Pediatric Unit, Hôpital de la Mère et de l'Enfant, Limoges, France
| | - Laurence Le Clainche
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
| | - Plamen Bokov
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
- Université Paris Cité, INSERM NeuroDiderot, Paris, France
| | - Benjamin Dudoignon
- Pediatric Noninvasive Ventilation Unit, AP-HP, Hôpital Robert Debré, Paris, France
| | | | - Jean Bergounioux
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | - Blaise Mbieleu
- Pediatric Intensive Care Unit, AP-HP, Hôpital Raymond Poincaré, Garches, France
| | | | - Lisa Giovannin-Chami
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | - Agnes Fina
- Department of Pediatric Pulmonology and Allergology, Hôpitaux pédiatriques de Nice CHU-Lenval, Nice, France
| | | | - Elsa Gachelin
- Department of Pediatric, CHU Félix Guyon, Saint Denis, La Réunion, France
| | - Caroline Perisson
- Department of Pediatric, CHU Sud Réunion, Saint Pierre, La Réunion, France
| | - Anne Pervillé
- Department of Pédiatrics, Hôpital d'Enfants-ASFA, Saint Denis, La Réunion, France
| | | | | | - Mickaël Jokic
- Pediatric Intensive Care Unit, CHU de Caen Normandie, Caen, France
| | - Guillaume Labbé
- Pediatric Pulmonology and Allergology Unit, CHU d'Estaing, Clermont-Ferrand, France
| | - Véronique Diaz
- Department of Respiratory Physiology, CHU Poitiers, Poitiers, France
| | - Laurianne Coutier
- Pediatric Pulmonology and Allergology Unit, Hospices Civils de Lyon, Bron, France
| | - Brigitte Fauroux
- Pediatric Noninvasive Ventilation and Sleep Unit, AP-HP, Hôpital Necker-Enfants malades, Paris, France
- Université Paris Cité, VIFASOM, Paris, France
| | - Jessica Taytard
- Department of Pediatric Pulmonology, AP-HP, Hôpital Armand Trousseau, Paris, France
- INSERM UMR-S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique", Sorbonne Université, Paris, France, Paris, France
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Dieter M, Kevin P, Tobias V, Andreas H, Lorenz N, Kathrin K, Nikolaus K, Juergen B, Jan R, Adrian D. Polysomnographic findings in the ultra-rare McLeod syndrome: further documentation of sleep apnea as a possible feature. J Clin Sleep Med 2024; 20:339-344. [PMID: 37811906 PMCID: PMC11019222 DOI: 10.5664/jcsm.10854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/10/2023]
Abstract
STUDY OBJECTIVES McLeod syndrome is a very rare multisystemic neurodegenerative disease linked to mutations in the XK gene. It has cardiac, neurologic, and neuromuscular manifestations and shares similarities with Huntington's disease. The aim of this study was to evaluate sleep patterns of patients affected by McLeod syndrome. METHODS This retrospective case series of four males who underwent diagnostic polysomnography (mean age 53.8 ± 2.5 years) includes self-reported and objective evaluation of sleep using the Epworth Sleepiness Scale, genetic tests, documentation of clinical course and features, and laboratory-based full-night attended video-polysomnography. RESULTS In three out of four patients, an Epworth Sleepiness Scale score ≥ 7 was evident. The average apnea-hypopnea index was 45.0 ± 19.0, with predominantly obstructive phenotype in three patients and predominant central events (central sleep apnea syndrome) in one patient. A significantly increased periodic limb movement index during sleep was observed in all patients. All patients tolerated continuous positive airway pressure or pressure controlled therapy. CONCLUSIONS Polysomnography of all patients confirmed sleep apnea syndrome as a feature of McLeod syndrome. Three patients were diagnosed with obstructive sleep apnea and one with central sleep apnea syndrome. In addition, periodic limb movement index was increased in all patients. CITATION Dieter M, Kevin P, Tobias V, et al. Polysomnographic findings in the ultra-rare McLeod syndrome: further documentation of sleep apnea as a possible feature. J Clin Sleep Med. 2024;20(3):339-344.
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Affiliation(s)
- Munker Dieter
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Peikert Kevin
- Translational Neurodegeneration Section “Albrecht-Kossel,” Department of Neurology, University Medical Center, University of Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen Rostock/Greifswald, Rostock, Germany
- United Neuroscience Campus Lund-Rostock, Rostock Site, Rostock, Germany
| | - Veit Tobias
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Hermann Andreas
- Translational Neurodegeneration Section “Albrecht-Kossel,” Department of Neurology, University Medical Center, University of Rostock, Rostock, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen Rostock/Greifswald, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock, University Medical Center, Rostock, Germany
| | - Nowak Lorenz
- Department of Sleep Medicine, Asklepios Lung Clinic, Gauting, Germany
| | - Kahnert Kathrin
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Kneidinger Nikolaus
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Behr Juergen
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich, Munich, Germany
| | - Remi Jan
- Department of Neurology, University Hospital of LMU Munich, Munich, Germany
| | - Danek Adrian
- Department of Neurology, University Hospital of LMU Munich, Munich, Germany
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Angiolillo DJ, Cao D, Baber U, Mehran R. Reply: Decoding Ticagrelor Dyspnea: Central Apnea Screening Before Drug Discontinuation. JACC Cardiovasc Interv 2024; 17:452-453. [PMID: 38355276 DOI: 10.1016/j.jcin.2023.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/26/2023] [Indexed: 02/16/2024]
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Giannoni A, Passino C, Gentile F, Sciarrone P, Emdin M. Decoding Ticagrelor Dyspnea: Central Apnea Screening Before Drug Discontinuation. JACC Cardiovasc Interv 2024; 17:450-451. [PMID: 38355275 DOI: 10.1016/j.jcin.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 02/16/2024]
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Sevoz-Couche C, Patout M, Charbit B, Similowski T, Straus C. Higher baseline heart rate variability in CCHS patients with progestin-associated recovery of hypercapnic ventilatory response. Respir Res 2024; 25:87. [PMID: 38336689 PMCID: PMC10858557 DOI: 10.1186/s12931-023-02625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/03/2023] [Indexed: 02/12/2024] Open
Abstract
After a fortuitous observation of two cases of chemosensitivity recovery in women with congenital central hypoventilation syndrome (CCHS) who took desogestrel, we aimed to evaluate the ventilatory response to hypercapnia of five CCHS patients with or without treatment consisting of desogestrel (DESO) or levonorgestrel (LEVO). Only two patients became responsive to hypercapnia under treatment, according to their basal vagal heart rate variability. These results suggest that heart rate variability may be promising tool to discriminate patients susceptible to become responsive to hypercapnia under DESO-LEVO treatment.Clinical Trials Identifier NCT01243697.
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Affiliation(s)
- Caroline Sevoz-Couche
- Sorbonne Université, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75013, Paris, France.
| | - Maxime Patout
- Sorbonne Université, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75013, Paris, France
- Département R3S (Respiration, Réanimation, Réadaptation Respiratoire, Sommeil), Service des Pathologies du Sommeil, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France
- Département R3S (Respiration, Réanimation, Réadaptation Respiratoire, Sommeil), Centre de Référence Constitutif Maladies Pulmonaires Rares de l'Adulte Orphalung, Hypoventilations Centrales, Syndrome d'Ondine, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Beny Charbit
- Faculté de Médecine, EA 3801, Université de Reims Champagne Ardenne, 51095, Reims, France
- Anesthesia, Critical Care and Pain Medicine Department, CHU Reims, Hôpital Robert Debré, 51092, Paris, France
| | - Thomas Similowski
- Sorbonne Université, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75013, Paris, France
- Département R3S (Respiration, Réanimation, Réadaptation Respiratoire, Sommeil), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France
| | - Christian Straus
- Sorbonne Université, UPMC Univ Paris 06, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, 75013, Paris, France
- Département R3S (Respiration, Réanimation, Réadaptation Respiratoire, Sommeil), Service d'Explorations Fonctionnelles de la Respiration, de l'Exercice et de la Dyspnée, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Hôpital Pitié-Salpêtrière, 75013, Paris, France
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Polytarchou A, Moudaki A, Van de Perck E, Boudewyns A, Kaditis AG, Verhulst S, Ersu R. An update on diagnosis and management of obstructive sleep apnoea in the first 2 years of life. Eur Respir Rev 2024; 33:230121. [PMID: 38296343 PMCID: PMC10828842 DOI: 10.1183/16000617.0121-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/05/2023] [Indexed: 02/03/2024] Open
Abstract
The aim of this review is to summarise evidence that became available after publication of the 2017 European Respiratory Society statement on the diagnosis and management of obstructive sleep apnoea syndrome (OSAS) in 1- to 23-month-old children. The definition of OSAS in the first 2 years of life should probably differ from that applied in children older than 2 years. An obstructive apnoea-hypopnoea index >5 events·h-1 may be normal in neonates, as obstructive and central sleep apnoeas decline in frequency during infancy in otherwise healthy children and those with symptoms of upper airway obstruction. A combination of dynamic and fixed upper airway obstruction is commonly observed in this age group, and drug-induced sleep endoscopy may be useful in selecting the most appropriate surgical intervention. Adenotonsillectomy can improve nocturnal breathing in infants and young toddlers with OSAS, and isolated adenoidectomy can be efficacious particularly in children under 12 months of age. Laryngomalacia is a common cause of OSAS in young children and supraglottoplasty can provide improvement in children with moderate-to-severe upper airway obstruction. Children who are not candidates for surgery or have persistent OSAS post-operatively can be treated with positive airway pressure (PAP). High-flow nasal cannula may be offered to young children with persistent OSAS following surgery, as a bridge until definitive therapy or if they are PAP intolerant. In conclusion, management of OSAS in the first 2 years of life is unique and requires consideration of comorbidities and clinical presentation along with PSG results for treatment decisions, and a multidisciplinary approach to treatment with medical and otolaryngology teams.
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Affiliation(s)
- Anastasia Polytarchou
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
- These authors contributed equally to this review article and share first authorship
| | - Angeliki Moudaki
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
- These authors contributed equally to this review article and share first authorship
| | - Eli Van de Perck
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine Translational Neurosciences, University of Antwerp, Antwerp, Belgium
- These authors contributed equally to this review article and share first authorship
| | - An Boudewyns
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine Translational Neurosciences, University of Antwerp, Antwerp, Belgium
| | - Athanasios G Kaditis
- Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | - Stijn Verhulst
- Department of Pediatric Pulmonology and Sleep Medicine, Antwerp University Hospital, Antwerp, Belgium
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp, Belgium
| | - Refika Ersu
- Division of Respiratory Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
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11
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Cithiravel N, Xiao L, Shi J, Chiang J, Amin R. Volume assured pressure support mode use for non-invasive ventilation in pediatrics. Pediatr Pulmonol 2024; 59:7-18. [PMID: 37818782 DOI: 10.1002/ppul.26721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
There has been increasing interest in utilizing volume assured pressure support (VAPS) modes of ventilation for children, which historically had only been favored in adult populations. In addition to patients with obesity hypoventilation syndrome, newer pediatric populations for which it has recently been prescribed include congenital central hypoventilation syndrome and children with neuromuscular disease such as Duchenne muscular dystrophy and spinal muscular atrophy. Given its expanding use in pediatrics, greater familiarity with VAPS is essential for pediatric pulmonologists and sleep physicians. This review article will highlight methods of initiation for this mode, specific ventilator settings, discussion of suitable pediatric patient populations, ventilator titrations via formal polysomnograms and detailed ventilator data downloads specific interpretation. Finally, common challenges to be aware of and how to troubleshoot relevant machine alarms will be reviewed.
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Affiliation(s)
- Nisha Cithiravel
- Department of Respiratory Therapy, The Hospital for Sick Children, Toronto, Canada
| | - Lena Xiao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jenny Shi
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Jackie Chiang
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
- Child Health and Evaluative Services, SickKids Research Institute, Toronto, Canada
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12
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Aboussouan LS, Badr MS, Sankari A. The quest for accurate evaluation and treatment of sleep disordered breathing in spinal cord injury. Sleep 2023; 46:zsad264. [PMID: 37801685 DOI: 10.1093/sleep/zsad264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Indexed: 10/08/2023] Open
Affiliation(s)
- Loutfi S Aboussouan
- Respiratory and Neurological Institutes, Cleveland Clinic, Cleveland, 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
| | - Abdulghani Sankari
- Sleep Research Laboratory, John D. Dingell Veterans Affairs Medical Center, Wayne State University, Detroit, MI, USA
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13
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Huang B, Huang Y, Zhai M, Zhou Q, Ji S, Liu H, Zhuang X, Zhang Y, Zhang J. Association of hypoxic burden metrics with cardiovascular outcomes in heart failure and sleep-disordered breathing. ESC Heart Fail 2023; 10:3504-3514. [PMID: 37724626 PMCID: PMC10682880 DOI: 10.1002/ehf2.14526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/04/2023] [Accepted: 08/30/2023] [Indexed: 09/21/2023] Open
Abstract
AIMS Heart failure (HF) and sleep-disordered breathing (SDB) frequently coexist. We aimed to compare the prognostic value of different nocturnal hypoxic burden metrics in hospitalized HF patients. METHODS AND RESULTS HF patients underwent polygraphy screening for SDB in this prospective cohort. Hypoxic burden metrics assessed using pulse oximetry included time < 90% oxygen saturation (T90), proportion of total recording time < 90% oxygen saturation (TRT90), oxygen desaturation index (ODI), and mean oxygen saturation (meanSO2 ). The prespecified endpoints were the composite of cardiovascular death or admission for worsening HF. This study included 764 hospitalized HF patients, 16.5% and 36.6% of whom had obstructive and central sleep apnoea, respectively. With a median follow-up time of 2.2 years, endpoint events occurred in 410 (53.7%) patients. In univariate and multivariate analyses, T90, TRT90, and meanSO2 were substantially associated with the composite outcome, whereas ODI was not. After multivariate Cox model adjustment, patients with 5.0 ≤ T90 ≤ 52.0 min [hazard ratio (HR) 1.32, 95% confidence interval (CI): 1.02-1.71, P = 0.034] or T90 > 52.0 min (HR 1.56, 95% CI: 1.21-2.02, P = 0.001) had a greater risk of the composite outcome than those with T90 < 5.0 min. The TRT90 and T90 results were similar. Compared with meanSO2 > 95%, meanSO2 < 93% (HR 1.47, 95% CI: 1.16-1.88, P = 0.002) was correlated with adverse outcomes. CONCLUSIONS The hypoxic burden metrics T90, TRT90, and meanSO2 , but not ODI, were independent predictors of cardiovascular death or readmission for worsening HF. Indicators of duration and severity, not just the frequency of nocturnal hypoxaemia, should be valued and considered for intervention to improve outcomes in HF patients.
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Affiliation(s)
- Boping Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
| | - Yan Huang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
| | - Mei Zhai
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
| | - Qiong Zhou
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
| | - Shiming Ji
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
| | - Huihui Liu
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
| | - Xiaofeng Zhuang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC)167 Beilishi RoadBeijing100037China
- Key Laboratory of Clinical Research for Cardiovascular MedicationsNational Health CommitteeBeijingChina
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14
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Buyse B, Kalkanis A, Testelmans D. Catathrenia in severe obstructive sleep apnea: A novel entity never described before. Sleep Med 2023; 112:239-245. [PMID: 37925850 DOI: 10.1016/j.sleep.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
STUDY OBJECTIVES Catathrenia, derived from the Greek κατά (kata) meaning below and θρηνώ (threnia) to lament, is characterized by expiratory groaning episodes during sleep. In a case series of nine patients with severe obstructive sleep apnea, we observed a peculiar groaning entity that has not been described before. METHODS We described and illustrated the cases with polysomnographic tracings and additional audio recordings. RESULTS All patients were men, obese (body mass index 39 ± 6 kg/m2) with an apnea-hypopnea index ranging from 47 to 125/h. In addition, we identified groaning events that were consistently preceded by a cortical arousal associated with a "rescue" respiration after an obstructive hypopnea or apnea. These events exhibited characteristics of "mixed apnea's", but the "central apnea-like part" was a prolonged expiratory groaning phase, with immediately after the terminal expiratory snort appearance of an obstructive apnea. In case the duration of this expiration was at least 10 s we calculated these events separately and the index was 8.4 ± 7.7/h. More rarely (index 0.6 ± 0.5/h) a "central apnea mimicking event" with groaning not followed by an obstruction, was observed. We also observed groaning episodes during expiration with a shorter duration (less than 10 s), not calculated separately. Positive airway pressure, which was well tolerated, eliminated these events. CONCLUSIONS This novel catathrenia entity preceded by a cortical arousal and "rescue" respiration in response to obstructive events is intriguing. Possible explanations for these observations are further discussed in this article.
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Affiliation(s)
- Bertien Buyse
- Department of Pulmonology, Leuven University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven-University, Leuven, Belgium.
| | - Alexandros Kalkanis
- Department of Pulmonology, Leuven University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium
| | - Dries Testelmans
- Department of Pulmonology, Leuven University Center for Sleep and Wake Disorders (LUCS), University Hospitals Leuven Campus Gasthuisberg, Leuven, Belgium; Laboratory of Respiratory Disease and Thoracic Surgery (BREATH), KU Leuven-University, Leuven, Belgium
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15
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Nomura K, Narimatsu E, Oke Y, Oku Y. The lesion site of organophosphorus-induced central apnea and the effects of antidotes. Sci Rep 2023; 13:20419. [PMID: 37990100 PMCID: PMC10663552 DOI: 10.1038/s41598-023-47745-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023] Open
Abstract
Organophosphorus poisoning kills individuals by causing central apnea; however, the underlying cause of death remains unclear. Following findings that the pre-Bötzinger complex impairment alone does not account for central apnea, we analyzed the effect of paraoxon on the brainstem-spinal cord preparation, spanning the lower medulla oblongata to phrenic nucleus. Respiratory bursts were recorded by connecting electrodes to the ventral 4th cervical nerve root of excised brainstem-spinal cord preparations obtained from 6-day-old Sprague-Dawley rats. We observed changes in respiratory bursts when paraoxon, neostigmine, atropine, and 2-pyridine aldoxime methiodide were administered via bath application. The percentage of burst extinction in the paraoxon-poisoning group was 50% compared with 0% and 18.2% in the atropine and 2-pyridine aldoxime methiodide treatment groups, respectively. Both treatments notably mitigated the paraoxon-induced reduction in respiratory bursts. In the neostigmine group, similar to paraoxon, bursts stopped in 66.7% of cases but were fully reversed by atropine. This indicates that the primary cause of central apnea is muscarinic receptor-mediated in response to acetylcholine excess. Paraoxon-induced central apnea is hypothesized to result from neural abnormalities within the inferior medulla oblongata to the phrenic nucleus, excluding pre-Bötzinger complex. These antidotes antagonize central apnea, suggesting that they may be beneficial therapeutic agents.
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Affiliation(s)
- Kazuhito Nomura
- Department of Physiology, Hyogo Medical University, 1-1, Mukogawa-Cho, Nishinomiya-Shi, Hyogo-Ken, 663-8501, Japan.
- Department of Emergency Medicine, Sapporo Medical University, Sapporo-Shi, 064-8543, Japan.
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University, Sapporo-Shi, 064-8543, Japan
| | - Yoshihiko Oke
- Department of Physiology, Hyogo Medical University, 1-1, Mukogawa-Cho, Nishinomiya-Shi, Hyogo-Ken, 663-8501, Japan
| | - Yoshitaka Oku
- Department of Physiology, Hyogo Medical University, 1-1, Mukogawa-Cho, Nishinomiya-Shi, Hyogo-Ken, 663-8501, Japan
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16
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Luo YM, Chen YY, Liang SF, Wu LG, Wellman A, McEvoy RD, Steier J, Eckert DJ, Polkey MI. Central sleep apnea treated by a constant low-dose CO 2 supplied by a novel device. J Appl Physiol (1985) 2023; 135:977-984. [PMID: 37675475 DOI: 10.1152/japplphysiol.00312.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/08/2023] Open
Abstract
CO2 inhalation has been previously reported as a treatment for central sleep apnea both when associated with heart failure or where the cause is unknown. Here, we evaluated a novel CO2 supply system using a novel open mask capable of comfortably delivering a constantly inspired fraction of CO2 ([Formula: see text]) during sleep. We recruited 18 patients with central sleep apnea (13 patients with cardiac disease, and 5 patients idiopathic) diagnosed by diaphragm electromyogram (EMG) recordings made during overnight full polysomnography (PSG) (night 1). In each case, the optimal [Formula: see text] was determined by an overnight manual titration with PSG (night 2). Titration commenced at 1% CO2 and increased by 0.2% increments until central sleep apnea (CSA) disappeared. Patients were then treated on the third night (night 3) with the lowest therapeutically effective concentration of CO2 derived from night 2. Comparing night 1 and night 3, both apnea-hypopnea index (AHI; 31 ± 14 vs. 6 ± 3 events/h, P < 0.01) and arousal index (22 ± 8 vs. 15 ± 8 events/h, P < 0.01) were significantly improved during CO2 treatment. Sleep efficiency improved from 71 ± 18 to 80 ± 11%, P < 0.05, and sleep latency was shorter (23 ± 18 vs. 10 ± 10 min, P < 0.01). Heart rate was not different between night 1 and night 3. Our data confirm the feasibility of our CO2 delivery system and indicate that individually titrated CO2 supplementation with a novel device including a special open mask can reduce sleep disordered breathing severity and improve sleep quality. Randomized controlled studies should now be undertaken to assess therapeutic benefit for patients with CSA.NEW & NOTEWORTHY A novel device using a special mask was developed and proved that CO2 therapy using the device could eliminate central sleep apnea (CSA) events and improve sleep quality including reducing arousal index in patients with heart failure. The device would become a useful clinical treatment for heart failure patients with CSA.
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Affiliation(s)
- Yuan-Ming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, People's Republic of China
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
- College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Yong-Yi Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Shan-Feng Liang
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lu-Guang Wu
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - R Doug McEvoy
- College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Joerg Steier
- Lane Fox Respiratory Unit/Sleep Disorders Centre, London, United Kingdom
| | - Danny J Eckert
- College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael I Polkey
- Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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17
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Khayat RN, Porter K, Germany RE, McKane SW, Healy W, Randerath W. Clinical and financial impact of sleep disordered breathing on heart failure admissions. Sleep Breath 2023; 27:1917-1924. [PMID: 36930416 PMCID: PMC10539452 DOI: 10.1007/s11325-023-02813-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/04/2023] [Accepted: 03/08/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The impact of sleep disordered breathing (SDB) on heart failure (HF) is increasingly recognized. However, limited data exist in support of quantification of the clinical and financial impact of SDB on HF hospitalizations. METHODS A sleep-heart registry included all patients who underwent inpatient sleep testing during hospitalization for HF at a single cardiac center. Readmission data and actual costs of readmissions were obtained from the institutional honest broker. Patients were classified based on the inpatient sleep study as having no SDB, obstructive sleep apnea (OSA), or central sleep apnea (CSA). Cumulative cardiac readmission rates and costs through 3 and 6 months post-discharge were calculated. Unadjusted and adjusted (age, sex, body mass index, and left ventricular ejection fraction) modeling of cost was performed. RESULTS The cohort consisted of 1547 patients, 393 (25%) had no SDB, 438 (28%) had CSA, and 716 (46%) had OSA. Within 6 months of discharge, 195 CSA patients (45%), 264 OSA patients (37%), and 109 no SDB patients (28%) required cardiovascular readmissions. Similarly, 3- and 6-month mortality rates were higher in both SDB groups than those with no SDB. Both unadjusted and adjusted readmission costs were higher in the OSA and CSA groups compared to no SDB group at 3 and 6 months post-discharge with the CSA and OSA group costs nearly double (~ $16,000) the no SDB group (~ $9000) through 6 months. INTERPRETATION Previously undiagnosed OSA and CSA are common in patients hospitalized with HF and are associated with increased readmissions rate and mortality.
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Affiliation(s)
- Rami N Khayat
- Division of Pulmonary and Critical Care Medicine, The UCI Comprehensive Sleep Center, University of California-Irvine, 20350 SW Birch Street, Newport Beach, CA, 92660, USA.
- The Ohio State University Sleep Heart Program, Columbus, OH, USA.
| | - Kyle Porter
- Division of Pulmonary and Critical Care Medicine, The UCI Comprehensive Sleep Center, University of California-Irvine, 20350 SW Birch Street, Newport Beach, CA, 92660, USA
- The Ohio State University Sleep Heart Program, Columbus, OH, USA
| | - Robin E Germany
- ZOLL Medical, Minnetonka, MN, USA
- Division of Cardiovascular Diseases, University of Oklahoma, Oklahoma City, OK, USA
| | | | - William Healy
- Division of Pulmonary, Critical Care, and Sleep Medicine, The Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Winfried Randerath
- Centre of Sleep Medicine and Respiratory Care, Clinic for Pneumology and Allergology, Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany
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18
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Nayır Büyükşahin H, Emiralioglu N, Simşek Kiper PÖ, Sunman B, Güzelkaş I, Alboğa D, Akgül Erdal M, Boduroglu K, Utine GE, Yalcın E, Doğru D, Kiper N, Ozcelik U. Evaluation of polysomnography findings in children with genetic skeletal disorders. J Sleep Res 2023; 32:e13914. [PMID: 37128177 DOI: 10.1111/jsr.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 05/03/2023]
Abstract
Children with genetic skeletal disorders have variable conditions that can lead to sleep-disordered breathing, and polysomnography is the gold standard for diagnosing this condition. We aimed to review polysomnography findings, to assess the severity of sleep apnea, and to investigate the clinical variables predictive of sleep-disordered breathing in these patients. We retrospectively collected the medical records of patients with genetic skeletal disorders who underwent polysomnography for 5 years. Twenty-seven children with various genetic skeletal disorders, including achondroplasia (14), Crouzon syndrome (3), acromesomelic dysplasia Maroteaux type (3), Apert syndrome (2), osteopetrosis (1), Jeune dysplasia (1), Desbuquois dysplasia (1), acrodysostosis (1), and spondyloepiphyseal dysplasia (1) were enrolled. The median age at the first polysomnography was 58 (1st-3rd quartile: 31-113) months. The overall sleep-disordered breathing results were: 19 (70.3%) had obstructive sleep apneas (OSA) (4 mild, 6 moderate, 9 severe), 2 (7.4%) had central apneas, 4 (14.8%) had nocturnal hypoventilation. There was a significant correlation between non-ambulatory status with both total AHI and OSA (p < 0.001, rho: -0.66/p = 0.04, rho: 0.38, respectively). Nine patients received positive airway pressure titration, and the oAHI values of all returned to the normal range. These patients were started with positive airway pressure treatment. Our cohort showed that the majority of the patients with skeletal dysplasia had sleep apnea syndrome characterised mainly by OSA, highlighting the importance of polysomnography screening for sleep disorders. Positive airway pressure therapy represents an effective treatment for sleep-disordered breathing in those patients.
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Affiliation(s)
- Halime Nayır Büyükşahin
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nagehan Emiralioglu
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pelin Özlem Simşek Kiper
- Division of Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Birce Sunman
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ismail Güzelkaş
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Didem Alboğa
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Akgül Erdal
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Koray Boduroglu
- Division of Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülen Eda Utine
- Division of Genetics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ebru Yalcın
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Deniz Doğru
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Nural Kiper
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Ozcelik
- Division of Pulmonology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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19
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Lisabeth LD, Zhang G, Chervin RD, Shi X, Morgenstern LB, Campbell M, Tower S, Brown DL. Longitudinal Assessment of Sleep Apnea in the Year After Stroke in a Population-Based Study. Stroke 2023; 54:2356-2365. [PMID: 37485665 PMCID: PMC10527822 DOI: 10.1161/strokeaha.123.042325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The aim of this study was to characterize change in sleep-disordered breathing severity in the year following stroke, overall, and by ethnicity, within the population-based Brain Attack Surveillance in Corpus Christi Project. METHODS First-ever ischemic strokes (n=414) were ascertained by active and passive surveillance and validated by stroke-trained physicians. Patients with stroke were invited to participate in portable sleep apnea testing (ApneaLink Plus) at baseline and 3, 6, and 12 months poststroke. Sleep-disordered breathing severity was assessed by the respiratory event index (apneas and hypopneas/hour of recording). The component obstructive apnea index and central apnea index were also assessed. Time and ethnicity effects on outcomes, as well as ethnic differences in time effects, were analyzed using generalized estimating equations with multivariable adjustment for confounding factors. RESULTS Mean age (n=414) was 63.9 years (SD=10.9); 68.4% were Mexican American. Baseline mean respiratory event index, obstructive apnea index, and central apnea index were 21.3 (SD=16.6), 8.6 (SD=11.5), and 1.5 (SD=3.2), respectively. There was no time effect on respiratory event index (P=0.35) but obstructive apnea index increased over time (P<0.01). Averaged over follow-up, respiratory event index and obstructive apnea index were significantly higher in Mexican American than non-Hispanic White persons. No ethnic difference in the time effect was found for either outcome. For central apnea index, there was an ethnicity-time interaction (P=0.01) such that central apnea index increased in non-Hispanic White but did not change in Mexican American persons. CONCLUSIONS Sleep-disordered breathing severity was significant and stable for most individuals in the year after stroke. These results do not confirm previous reports of diminishing sleep-disordered breathing severity over time after stroke and would support early assessment and treatment where indicated.
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Affiliation(s)
- Lynda D Lisabeth
- Department of Epidemiology (L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor
- Stroke Program (L.D.L., L.B.M., D.L.B.), University of Michigan Health System
| | - Guanghao Zhang
- Department of Biostatistics (G.Z., X.S.), University of Michigan School of Public Health, Ann Arbor
| | - Ronald D Chervin
- Michael S Aldrich Sleep Disorders Laboratory (R.D.C.), University of Michigan Health System
| | - Xu Shi
- Department of Biostatistics (G.Z., X.S.), University of Michigan School of Public Health, Ann Arbor
| | - Lewis B Morgenstern
- Department of Epidemiology (L.D.L., L.B.M.), University of Michigan School of Public Health, Ann Arbor
- Stroke Program (L.D.L., L.B.M., D.L.B.), University of Michigan Health System
| | | | | | - Devin L Brown
- Stroke Program (L.D.L., L.B.M., D.L.B.), University of Michigan Health System
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20
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Sivathamboo S, Myers KA, Pattichis A, White EJ, Ku KN, O'Brien TJ, Perucca P, Kwan P. Sleep and respiratory abnormalities in adults with developmental and epileptic encephalopathies using polysomnography and video-EEG monitoring. Epilepsia Open 2023; 8:1157-1168. [PMID: 37277988 PMCID: PMC10472408 DOI: 10.1002/epi4.12772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 06/03/2023] [Indexed: 06/07/2023] Open
Abstract
This study evaluated sleep and respiratory abnormalities, and their relationship with seizures, in adults with developmental and epileptic encephalopathies (DEEs). We studied consecutive adults with DEEs undergoing inpatient video-EEG monitoring and concurrent polysomnography between December 2011 and July 2022. Thirteen patients with DEEs were included (median age: 31 years, range: 20-50; 69.2% female): Lennox-Gastaut syndrome (n = 6), Lennox-Gastaut syndrome-like phenotype (n = 2), Landau-Kleffner syndrome (n = 1), epilepsy with myoclonic-atonic seizures (n = 1), and unclassified DEEs (n = 3). Sleep architecture was often fragmented by epileptiform discharges and seizures resulting in arousals (median arousal index: 29.0 per h, range: 5.1-65.3). Moderate-to-severe obstructive sleep apnea (OSA) was observed in seven patients (53.8%). Three patients (23.1%) had tonic seizures that frequently occurred with central apnea; one met criteria for mild central sleep apnea. Of the patients with tonic seizures, two had other identifiable seizure manifestations, but in one patient, central apnea was commonly the only discernable seizure manifestation. Polysomnography during video-EEG is an effective diagnostic tool in detecting sleep and seizure-related respiratory abnormalities. Clinically significant OSA may increase the risk of comorbid cardiovascular disease and premature mortality. Treatment of epilepsy may improve sleep quality, and conversely, improved sleep, may decrease seizure burden.
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Affiliation(s)
- Shobi Sivathamboo
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Kenneth A. Myers
- Research Institute of the McGill University Health CentreMontrealQuebecCanada
- Department of Pediatrics, Montreal Children's HospitalMcGill UniversityMontrealQuebecCanada
- Department of Neurology and Neurosurgery, Montreal Children's HospitalMcGill UniversityMontrealQuebecCanada
| | - Andreas Pattichis
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
- Department of Respiratory MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Department of Respiratory MedicineAlfred HealthMelbourneVictoriaAustralia
| | - Elise J. White
- Department of NeurologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Ka Nyuk Ku
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Terence J. O'Brien
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
- Bladin‐Berkovic Comprehensive Epilepsy ProgramAustin HealthHeidelbergVictoriaAustralia
- Epilepsy Research Centre, Department of Medicine (Austin Health)The University of MelbourneHeidelbergVictoriaAustralia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
- Department of Medicine (The Royal Melbourne Hospital)The University of MelbourneParkvilleVictoriaAustralia
- Department of NeurologyThe Royal Melbourne HospitalParkvilleVictoriaAustralia
- Department of NeurologyAlfred HealthMelbourneVictoriaAustralia
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21
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Gentile F, Sciarrone P, Buoncristiani F, Castiglione V, Bramanti F, Iudice G, Poletti R, Passino C, Emdin M, Giannoni A. [Central apneas and cardiovascular diseases]. G Ital Cardiol (Rome) 2023; 24:701-710. [PMID: 37642122 DOI: 10.1714/4084.40680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Central apneas (CA) and periodic breathing (PB) are the most common related breathing disorders in heart failure, being observed in up to 50% of patients. Once considered only a sleep-related phenomenon, actually CA/PB occur across the whole 24 h period and their presence in the awake patient even in the upright position and during physical effort has been associated with a worse clinical profile and a greater mortality. Chemoreflex activation, circulatory time delay and altered plant gain are the pathophysiological determinants. While the use of guideline-recommended medical and device treatment represents the first step in the management of CA in heart failure patients, no specific therapy has been demonstrated to reduce CA-related impact on mortality. In particular, the use of non-invasive ventilation has yielded contradictory results in the context of large-scale randomized clinical trials. The design and testing of therapies targeting the pathophysiological triggers of CA, such as chemoreflex sensitivity, may prove valuable in the next future.
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Affiliation(s)
- Francesco Gentile
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa
| | | | | | | | | | | | | | - Claudio Passino
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa - Fondazione Toscana Gabriele Monasterio, Pisa
| | - Michele Emdin
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa - Fondazione Toscana Gabriele Monasterio, Pisa
| | - Alberto Giannoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa - Fondazione Toscana Gabriele Monasterio, Pisa
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22
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Slattery SM, Zelko FA, Vu EL, Dunne EC, Rand CM, Bradley A, Zhou A, Carroll MS, Khaytin I, Brady KM, Stewart TM, Weese-Mayer DE. Ventilatory and Orthostatic Challenges Reveal Biomarkers for Neurocognition in Children and Young Adults With Congenital Central Hypoventilation Syndrome. Chest 2023; 163:1555-1564. [PMID: 36610668 DOI: 10.1016/j.chest.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/15/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Children and young adults with congenital central hypoventilation syndrome (CCHS) are at risk of cognitive deficits. They experience autonomic dysfunction and chemoreceptor insensitivity measured during ventilatory and orthostatic challenges, but relationships between these features are undefined. RESEARCH QUESTION Can a biomarker be identified from physiologic responses to ventilatory and orthostatic challenges that is related to neurocognitive outcomes in CCHS? STUDY DESIGN AND METHODS This retrospective study included 25 children and young adults with CCHS tested over an inpatient stay. Relationships between physiologic measurements during hypercarbic and hypoxic ventilatory challenges, hypoxic ventilatory challenges, and orthostatic challenges and neurocognitive outcomes (by Wechsler intelligence indexes) were examined. Independent variable inclusion was determined by significant associations in Pearson's analyses. Multivariate linear regressions were used to assess relationships between measured physiologic responses to challenges and neurocognitive scores. RESULTS Significant relationships were identified between areas of fluid intelligence and measures of oxygen saturation (SpO2) and heart rate (HR) during challenges. Specifically, perceptual reasoning was related to HR (adjusted regression [β] coefficient, -0.68; 95% CI, 1.24 to -0.12; P = .02) during orthostasis. Working memory was related to change in HR (β, -1.33; 95% CI, -2.61 to -0.05; P = .042) during the hypoxic ventilatory challenge. Processing speed was related to HR (β, -1.19; 95% CI, -1.93 to -0.46; P = .003) during orthostasis, to baseline SpO2 (hypercarbic and hypoxic β, 8.57 [95% CI, 1.63-15.51]; hypoxic β, 8.37 [95% CI, 3.65-13.11]; P = .002 for both) during the ventilatory challenges, and to intrachallenge SpO2 (β, 5.89; 95% CI, 0.71-11.07; P = .028) during the hypoxic ventilatory challenge. INTERPRETATION In children and young adults with CCHS, SpO2 and HR-or change in HR-at rest and as a response to hypoxia and orthostasis are related to cognitive outcomes in domains of known risk, particularly fluid reasoning. These findings can guide additional research on the usefulness of these as biomarkers in understanding the impact of daily physical stressors on neurodevelopment in this high-risk group.
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Affiliation(s)
- Susan M Slattery
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Frank A Zelko
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric L Vu
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emma C Dunne
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Casey M Rand
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Stanley Manne Children's Research Institute, Chicago, IL
| | - Allison Bradley
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Amy Zhou
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Ilya Khaytin
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kenneth M Brady
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Anesthesia, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tracey M Stewart
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Debra E Weese-Mayer
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Chicago, IL
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23
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Shah AS, Leu RM, Shah SP, Martinez F, Kasi AS. Images: Caffeine therapy for central sleep apnea, hypoxemia, and hypoventilation in a term neonate. J Clin Sleep Med 2023; 19:1005-1008. [PMID: 36747487 PMCID: PMC10152353 DOI: 10.5664/jcsm.10504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/08/2023]
Abstract
The evaluation of higher-risk infants with brief resolved unexplained events and term infants with central sleep apnea can be clinically challenging due to the multitude of potential etiologies. We report a 7-day-old term neonate hospitalized for evaluation of brief resolved unexplained events with oxygen desaturations during sleep. Polysomnography showed central sleep apnea, hypoxemia, hypoventilation, periodic breathing, and mild obstructive sleep apnea. Following initial evaluations and while awaiting genetic testing, primary central sleep apnea of infancy was suspected and caffeine was initiated. Three days after initiating caffeine, polysomnography showed resolution of hypoxemia, hypoventilation, obstructive sleep apnea, and periodic breathing and improved central sleep apnea. The central apnea-hypopnea index reduced from 58 to 6.8 events/h. Although caffeine is utilized in apnea of prematurity, there is limited literature regarding caffeine in term infants with apnea. Our case demonstrates that in term infants with primary central sleep apnea of infancy, immature regulation of respiration may persist and a trial of caffeine could be considered. CITATION Shah AS, Leu RM, Shah SP, Martinez F, Kasi AS. Caffeine therapy for central sleep apnea, hypoxemia, and hypoventilation in a term neonate. J Clin Sleep Med. 2023;19(5):1005-1008.
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Affiliation(s)
- Amit S. Shah
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Roberta M. Leu
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Samar P. Shah
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Frances Martinez
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Ajay S. Kasi
- Department of Pediatrics, Division of Pediatric Pulmonology and Sleep Medicine, Emory University, Children’s Healthcare of Atlanta, Atlanta, Georgia
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24
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Agrawal R, Sharafkhaneh A, Gottlieb DJ, Nowakowski S, Razjouyan J. Mortality Patterns Associated with Central Sleep Apnea among Veterans: A Large, Retrospective, Longitudinal Report. Ann Am Thorac Soc 2023; 20:450-455. [PMID: 36375082 PMCID: PMC9993148 DOI: 10.1513/annalsats.202207-648oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/14/2022] [Indexed: 11/15/2022] Open
Abstract
Rationale: Central sleep apnea (CSA) is associated with high mortality. Current knowledge stems from studies with limited sample size (fewer than 100 subjects) and in homogeneous populations such as heart failure (HF). Objectives: To address this knowledge gap, we compared the mortality pattern and time to death between the CSA and obstructive sleep apnea (OSA) patients in the large Veterans Health Administration patient population using the big data analytic approach. Methods: This is a retrospective study using national Veterans Health Administration electronic medical records from October 1, 1999, through September 30, 2020. We grouped the patients with underlying sleep disorders into CSA and OSA, using the International Classification of Diseases, Ninth and Tenth Revision codes. We applied Cox regression analysis to compare the mortality rate and hazard ratio (HR) among the two groups and adjusted HR by gender, race, body mass index (BMI), age, and Charlson Comorbidity Index. In CSA groups, a machine-learning algorithm was used to determine the most important predictor of time to death. Further subgroup analysis was also performed in patients that had comorbid HF. Results: Evaluation of patients resulted in 2,961 grouped as CSA and 1,487,353 grouped as OSA. Patients with CSA were older (61.8 ± 15.6 yr) than those with OSA (56.7 ± 13.9 yr). A higher proportion of patients with CSA (25.1%) died during the study period compared with the OSA cohort (14.9%). The adjusted HR was 1.53 (95% confidence interval [CI], 1.43-4.65). Presence of HF history of cerebrovascular disease, hemiplegia, and having a BMI less than 18.5 were among the highest predictors of mortality in CSA. The subgroup analysis revealed that the presence of HF was associated with increased mortality both in CSA (HR, 7.4; 95% CI, 6.67-8.21) and OSA (HR, 4.3; 95% CI, 4.26-4.34) groups. Conclusions: Clinically diagnosed CSA was associated with a shorter time to death from the index diagnostic date. Almost one-fifth of patients with CSA died within 5 years of diagnosis. The presence of HF, history of cerebrovascular disease and hemiplegia, male sex, and being underweight were among the highest predictors of mortality in CSA. CSA was associated with higher mortality than OSA, independent of associated comorbidity.
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Affiliation(s)
- Ritwick Agrawal
- Medical Care Line, Section of Pulmonary, Critical Care, and Sleep Medicine
- Section of Pulmonary, Critical Care, and Sleep Medicine and
| | - Amir Sharafkhaneh
- Medical Care Line, Section of Pulmonary, Critical Care, and Sleep Medicine
- Section of Pulmonary, Critical Care, and Sleep Medicine and
| | - Daniel J. Gottlieb
- Veteran Affairs Boston Healthcare System, West Roxbury, Massachusetts
- Brigham & Women’s Hospital, Boston, Massachusetts; and
| | - Sara Nowakowski
- VA Health Services Research and Development Service (HSR&D) Center for Innovations in Quality, Effectiveness, and Safety, and
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Javad Razjouyan
- VA Health Services Research and Development Service (HSR&D) Center for Innovations in Quality, Effectiveness, and Safety, and
- VA Quality Scholars Coordinating Center, IQuESt, Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
- Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, District of Columbia
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25
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Borrelli C, Spiesshoefer J, Macefield V, Giannoni A. Central apnoeas, sympathetic activation and mortality in heart failure: look before you leap. Eur Respir J 2023; 61:13993003.02197-2022. [PMID: 36894188 DOI: 10.1183/13993003.02197-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 03/11/2023]
Affiliation(s)
- Chiara Borrelli
- Emergency Medicine Division, University of Pisa, Pisa, Italy
| | - Jens Spiesshoefer
- Pneumology and Intensive Care Medicine Department, University Hospital RWTH Aachen, Aachen, Germany
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Vaughan Macefield
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Australia
| | - Alberto Giannoni
- Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology and Cardiovascular Medicine Department, Fondazione Toscana G. Monasterio, Pisa, Italy
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26
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Tamisier R, Pépin JL, Lévy P. Reply to: Central apnoeas, sympathetic activation and mortality in heart failure: look before you leap. Eur Respir J 2023; 61:61/3/2300042. [PMID: 36894190 DOI: 10.1183/13993003.00042-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 03/11/2023]
Affiliation(s)
- Renaud Tamisier
- University Grenoble Alpes, HP2, Inserm 1300, Grenoble Alpes University Hospital Grenoble, Grenoble, France
| | - Jean-Louis Pépin
- University Grenoble Alpes, HP2, Inserm 1300, Grenoble Alpes University Hospital Grenoble, Grenoble, France
| | - Patrick Lévy
- University Grenoble Alpes, HP2, Inserm 1300, Grenoble Alpes University Hospital Grenoble, Grenoble, France
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27
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Zhang Y, Cheng Y, Li N, Hou Y, Jiao L, Yuan Y, Wang L, Huang Z, Han F, Li H, Zhan S. Central sleep apnea and daytime sleepiness in Niemann-Pick type C disease: a report of 2 cases. J Clin Sleep Med 2023; 19:409-414. [PMID: 36199263 PMCID: PMC9892737 DOI: 10.5664/jcsm.10310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 02/04/2023]
Abstract
Niemann-Pick disease type C (NPC) is an autosomal recessive hereditary disease in which sphingomyelin and cholesterol are deposited in various organs of the body. The clinical manifestations of NPC include neurologic symptoms and cataplexy; other symptoms related to sleep have seldom been reported. One previous study described various sleep disorders including chronic insomnia, obstructive sleep apnea, restless legs syndrome, and rapid eye movement sleep behavior disorder, thus suggesting that sleep disorders in patients with NPC are more prevalent than previously thought and warrant close attention. Here, we describe sleep disorders in 2 patients with NPC and discuss the clinical characteristics and, for the first time, discuss potential pathogenic mechanisms underlying sleep disorders in such patients. CITATION Zhang Y, Cheng Y, Li N, et al. Central sleep apnea and daytime sleepiness in Niemann-Pick type C disease: a report of 2 cases. J Clin Sleep Med. 2023;19(2):409-414.
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Affiliation(s)
- Yimeng Zhang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yueyang Cheng
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ning Li
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yue Hou
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lidong Jiao
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuan Yuan
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhaoyang Huang
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fang Han
- Peking University People’s Hospital, Beijing, China
| | - Haifeng Li
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shuqin Zhan
- Xuanwu Hospital, Capital Medical University, Beijing, China
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Delorme M, Leroux K, Leotard A, Boussaid G, Prigent H, Louis B, Lofaso F. Noninvasive Ventilation Automated Technologies: A Bench Evaluation of Device Responses to Sleep-Related Respiratory Events. Respir Care 2023; 68:18-30. [PMID: 36220193 PMCID: PMC9993515 DOI: 10.4187/respcare.09807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Noninvasive ventilation (NIV) is the reference standard treatment for most situations of chronic respiratory failure. NIV settings must be titrated to both preserve upper-airway patency and control hypoventilation. Automatic adjustment of pressure support (PS) and expiratory positive airway pressure (EPAP) may facilitate the initiation and follow-up of domiciliary NIV. However, whether the automatic-adjustment algorithms embedded into current devices accurately detect, respond to, and score common sleep-related respiratory events remains unclear. METHODS A bench was set up to simulate central hypopnea (CH), central apnea (CA), obstructive hypopnea (OH), and obstructive apnea (OA). Four home ventilators were evaluated, with their dedicated modes for automatic PS and EPAP adjustment. RESULTS All 4 devices increased PS during CH, CA, and OH. However, PS adjustment varied widely in magnitude, with tidal volumes within 100 ± 20% of the target being provided by only 3 devices for CH, one for CA, and one for OH. Two devices increased EPAP for OH and 3 for OA, including one that also increased EPAP for CA. Only 2 devices scored residual hypopnea after simulated CA, and only one scored a residual event after OH. One device scored no event. CONCLUSIONS Current NIV devices differed markedly in their responses to, and reporting of, standardized sleep-related respiratory events. Further improvements in embedded NIV algorithms are needed to allow more widespread out-of-laboratory initiation and follow-up of NIV.
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Affiliation(s)
| | | | - Antoine Leotard
- Service de physiologie - explorations fonctionnelles, Unité des pathologies du sommeil, AP-HP, Hôpital Raymond Poincaré, Garches, France; and Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3, Versailles, France
| | | | - Helene Prigent
- Service de physiologie - explorations fonctionnelles, Unité des pathologies du sommeil, AP-HP, Hôpital Raymond Poincaré, Garches, France; and Université Paris-Saclay, UVSQ, INSERM U1179, Equipe 3, Versailles, France
| | - Bruno Louis
- INSERM, U955, Université Paris Est Créteil, Faculté de Médecine, CNRS ERL 7000, Créteil, France
| | - Frederic Lofaso
- Université Paris-Saclay, UVSQ, ERPHAN, Versailles, France; and Service de physiologie - explorations fonctionnelles, Unité des pathologies du sommeil, AP-HP, Hôpital Raymond Poincaré, Garches, France
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Riha RL, Celmina M, Cooper B, Hamutcu-Ersu R, Kaditis A, Morley A, Pataka A, Penzel T, Roberti L, Ruehland W, Testelmans D, van Eyck A, Grundström G, Verbraecken J, Randerath W. ERS technical standards for using type III devices (limited channel studies) in the diagnosis of sleep disordered breathing in adults and children. Eur Respir J 2023; 61:13993003.00422-2022. [PMID: 36609518 DOI: 10.1183/13993003.00422-2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/27/2022] [Indexed: 02/01/2023]
Abstract
For more than three decades, type III devices have been used in the diagnosis of sleep disordered breathing in supervised as well as unsupervised settings. They have satisfactory positive and negative predictive values for detecting obstructive and central sleep apnoea in populations with moderately high pre-test probability of symptoms associated with these events. However, standardisation of commercially available type III devices has never been undertaken and the technical specifications can vary widely. None have been subjected to the same rigorous processes as most other diagnostic modalities in the medical field. Although type III devices do not include acquisition of electroencephalographic signals overnight, the minimum number of physical sensors required to allow for respiratory event scoring using standards outlined by the American Academy of Sleep Medicine remains debatable. This technical standard summarises data on type III studies published since 2007 from multiple perspectives in both adult and paediatric sleep practice. Most importantly, it aims to provide a framework for considering current type III device limitations in the diagnosis of sleep disordered breathing while raising research- and practice-related questions aimed at improving our use of these devices in the present and future.
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Affiliation(s)
- Renata L Riha
- Department of Sleep Medicine, The Royal Infirmary Edinburgh, Edinburgh, UK
| | - Marta Celmina
- Epilepsy and Sleep Medicine Centre, Children's Clinical University Hospital, Riga, Latvia
| | - Brendan Cooper
- Lung Function and Sleep, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, UK
| | | | - Athanasios Kaditis
- Division of Paediatric Pulmonology and Sleep Disorders Laboratory, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine and Agia Sofia Children's Hospital, Athens, Greece
| | | | - Athanasia Pataka
- Respiratory Failure Unit, G. Papanikolaou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Penzel
- Department of Cardiology and Angiology, Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Warren Ruehland
- Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Annelies van Eyck
- Laboratory of Experimental Medicine and Pediatrics, University of Antwerp, Antwerp (Edegem), Belgium
- Department of Pediatrics, Antwerp University Hospital, Antwerp (Edegem), Belgium
| | | | - Johan Verbraecken
- Antwerp University Hospital and University of Antwerp, Edegem (Antwerp), Belgium
| | - Winfried Randerath
- Bethanien Hospital, Clinic of Pneumology and Allergology, Center for Sleep Medicine and Respiratory Care, Institute of Pneumology at the University of Cologne, Solingen, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ueda A, Osawa M, Naito H, Ochiai E, Kakimoto Y. Non-polyalanine repeat mutation in PHOX2B is detected in autopsy cases of sudden unexpected infant death. PLoS One 2022; 17:e0267751. [PMID: 35486589 PMCID: PMC9053812 DOI: 10.1371/journal.pone.0267751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/15/2022] [Indexed: 11/18/2022] Open
Abstract
Background Congenital central hypoventilation syndrome (CCHS), which is caused by PHOX2B with phenotypic variations, has a point of controversy: CCHS is putatively involved in autopsy cases of sudden unexpected infant death (SUID) including sudden infant death syndrome. Objective The relation of CCHS to SUID cases was investigated by extensive genotyping of PHOX2B. Methods We analyzed 93 DNA samples of less than one-year-old SUID cases that were autopsied in our department. Unrelated adult volunteers (n = 942) were used as the control. Results No polyalanine tract expansion was detected in the SUID cases. The allelic frequencies of repeat contractions and SNP (rs28647582) in intron 2 were not significantly different from that in those control group. Further extensive sequencing revealed a non-polyalanine repeat mutation (NPARM) of c.905A>C in a sudden death case of a one-month-old male infant. This missense mutation (p.Asn302Thr), registered as rs779068107, was annotated to ‘Affected status is unknown’, but it might be associated with the sudden death. Conclusion NPARM was more plausibly related to sudden unexpected death than expansions because of severe clinical complications. This finding indicates possible CCHS involvement in forensic autopsy cases without ante-mortem diagnosis.
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Affiliation(s)
- Atsushi Ueda
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Motoki Osawa
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- * E-mail:
| | - Haruaki Naito
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Eriko Ochiai
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Department of Legal Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Yu Kakimoto
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Winczewska-Wiktor A, Hirschfeld AS, Badura-Stronka M, Wojsyk-Banaszak I, Sobkowiak P, Bartkowska-Śniatkowska A, Babak V, Steinborn B. Central Apneas Due to the CLIFAHDD Syndrome Successfully Treated with Pyridostigmine. Int J Environ Res Public Health 2022; 19:ijerph19020775. [PMID: 35055596 PMCID: PMC8776169 DOI: 10.3390/ijerph19020775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/12/2021] [Accepted: 01/06/2022] [Indexed: 02/05/2023]
Abstract
NALCN mutations lead to complex neurodevelopmental syndromes, including infantile hypotonia with psychomotor retardation and characteristic facies (IHPRF) and congenital contractures of limbs and face, hypotonia, and developmental delay (CLIFAHDD), which are recessively and dominantly inherited, respectively. We present a patient in whom congenital myasthenic syndrome (CMS) was suspected due to the occurrence of hypotonia and apnea episodes requiring resuscitation. For this reason, treatment with pyridostigmine was introduced. After starting the treatment, a significant improvement was observed in reducing the apnea episodes and slight psychomotor progress. In the course of further diagnostics, CMS was excluded, and CLIFAHDD syndrome was confirmed. Thus, we try to explain a possible mechanism of clinical improvement after the introduction of treatment with pyridostigmine in a patient with a mutation in the NALCN gene.
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Affiliation(s)
- Anna Winczewska-Wiktor
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland;
- Correspondence:
| | - Adam Sebastian Hirschfeld
- Chair and Department of Medical Genetics, Poznan University of Medical Sciences, 60-352 Poznan, Poland; (A.S.H.); (M.B.-S.); (V.B.)
| | - Magdalena Badura-Stronka
- Chair and Department of Medical Genetics, Poznan University of Medical Sciences, 60-352 Poznan, Poland; (A.S.H.); (M.B.-S.); (V.B.)
- Centers of Medical Genetics GENESIS, 60-529 Poznan, Poland
| | - Irena Wojsyk-Banaszak
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (I.W.-B.); (P.S.)
| | - Paulina Sobkowiak
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznan University of Medical Sciences, 60-572 Poznan, Poland; (I.W.-B.); (P.S.)
| | - Alicja Bartkowska-Śniatkowska
- Department of Pediatric Anesthesiology and Intensive Therapy, Poznan University of Medical Sciences, 60-572 Poznan, Poland;
| | - Valeriia Babak
- Chair and Department of Medical Genetics, Poznan University of Medical Sciences, 60-352 Poznan, Poland; (A.S.H.); (M.B.-S.); (V.B.)
| | - Barbara Steinborn
- Chair and Department of Developmental Neurology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355 Poznan, Poland;
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Abstract
Rapid-onset Obesity with Hypothalamic dysfunction, Hypoventilation, and Autonomic Dysregulation (ROHHAD) and Congenital Central Hypoventilation Syndrome (CCHS) are ultra-rare distinct clinical disorders with overlapping symptoms including altered respiratory control and autonomic regulation. Although both disorders have been considered for decades to be on the same spectrum with necessity of artificial ventilation as life-support, recent acquisition of specific knowledge concerning the genetic basis of CCHS coupled with an elusive etiology for ROHHAD have definitely established that the two disorders are different. CCHS is an autosomal dominant neurocristopathy characterized by alveolar hypoventilation resulting in hypoxemia/hypercarbia and features of autonomic nervous system dysregulation (ANSD), with presentation typically in the newborn period. It is caused by paired-like homeobox 2B (PHOX2B) variants, with known genotype-phenotype correlation but pathogenic mechanism(s) are yet unknown. ROHHAD is characterized by rapid weight gain, followed by hypothalamic dysfunction, then hypoventilation followed by ANSD, in seemingly normal children ages 1.5-7 years. Postmortem neuroanatomical studies, thorough clinical characterization, pathophysiological assessment, and extensive genetic inquiry have failed to identify a cause attributable to a traditional genetic basis, somatic mosaicism, epigenetic mechanism, environmental trigger, or other. To find the key to the ROHHAD pathogenesis and to improve its clinical management, in the present chapter, we have carefully compared CCHS and ROHHAD.
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Affiliation(s)
- Isabella Ceccherini
- Laboratory of Genetics and Genomics of Rare Diseases, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Kyle C Kurek
- Department of Pathology & Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Debra E Weese-Mayer
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute; and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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Abstract
Brain PCO2 is sensed primarily via changes in [H+]. Small pH changes are detected in the medulla oblongata and trigger breathing adjustments that help maintain arterial PCO2 constant. Larger perturbations of brain CO2/H+, possibly also sensed elsewhere in the CNS, elicit arousal, dyspnea, and stress, and cause additional breathing modifications. The retrotrapezoid nucleus (RTN), a rostral medullary cluster of glutamatergic neurons identified by coexpression of Phoxb and Nmb transcripts, is the lynchpin of the central respiratory chemoreflex. RTN regulates breathing frequency, inspiratory amplitude, and active expiration. It is exquisitely responsive to acidosis in vivo and maintains breathing autorhythmicity during quiet waking, slow-wave sleep, and anesthesia. The RTN response to [H+] is partly an intrinsic neuronal property mediated by proton sensors TASK-2 and GPR4 and partly a paracrine effect mediated by astrocytes and the vasculature. The RTN also receives myriad excitatory or inhibitory synaptic inputs including from [H+]-responsive neurons (e.g., serotonergic). RTN is silenced by moderate hypoxia. RTN inactivity (periodic or sustained) contributes to periodic breathing and, likely, to central sleep apnea. RTN development relies on transcription factors Egr2, Phox2b, Lbx1, and Atoh1. PHOX2B mutations cause congenital central hypoventilation syndrome; they impair RTN development and consequently the central respiratory chemoreflex.
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Affiliation(s)
- Patrice G Guyenet
- Department of Pharmacology, University of Virginia, Charlottesville, VA, United States.
| | - Douglas A Bayliss
- Department of Pharmacology, University of Virginia, Charlottesville, VA, United States
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Abstract
Central apnea syndrome is a disorder with protean manifestations and concomitant conditions. It can occur as a distinct clinical entity or as part of another clinical syndrome. The pathogenesis of central sleep apnea (CSA) varies depending on the clinical condition. Sleep-related withdrawal of the ventilatory drive to breathe is the common denominator among all cases of central apnea, whereas hypocapnia is the final common pathway leading to apnea in the majority of central apnea. Medical conditions most closely associated with CSA include heart failure, stroke, spinal cord injury, and opioid use, among others. Nocturnal polysomnography is the standard diagnostic method, including measurement of sleep and respiration. The latter includes detection of flow, measurement of oxyhemoglobin saturation and detection of respiratory effort. Management strategy incorporates clinical presentation, associated conditions, and the polysomnographic findings in an individualized manner. The pathophysiologic heterogeneity may explain the protean clinical manifestations and the lack of a single effective therapy for all patients. While research has enhanced our understanding of the pathogenesis of central apnea, treatment options are extrapolated from treatment of obstructive sleep apnea. Co-morbid conditions and concomitant obstructive sleep apnea influence therapeutic approach significantly. Therapeutic options include positive pressure therapy, pharmacologic therapy, and supplemental Oxygen. Continuous positive airway pressure (CPAP) is the initial standard of care, although the utility of other modes of positive pressure therapy, as well as pharmacotherapy and device-based therapies, are currently being investigated.
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Affiliation(s)
- Geoffrey Ginter
- Department of Internal Medicine, University Health Center and John D. Dingell VA Medical Center, Wayne State University School of Medicine, Detroit, MI, United States
| | - M Safwan Badr
- Department of Internal Medicine, University Health Center and John D. Dingell VA Medical Center, Wayne State University School of Medicine, Detroit, MI, United States.
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36
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Javaheri S, Germany R. Sleep and breathing disorders in heart failure. Handb Clin Neurol 2022; 189:295-307. [PMID: 36031310 DOI: 10.1016/b978-0-323-91532-8.00009-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sleep disorders are prevalent in heart failure and include insomnia, poor sleep architecture, periodic limb movements and periodic breathing, and encompass both obstructive (OSA) and central sleep apnea (CSA). Polysomnographic studies show excess light sleep and poor sleep efficiency particularly in those with heart failure. Multiple studies of consecutive patients with heart failure show that about 50% of patients suffer from either OSA or CSA. While asleep, acute pathological consequences of apneas and hypopneas include altered blood gases, sleep fragmentation, and large negative swings in intrathoracic pressure. These pathological consequences are qualitatively similar in both types of sleep apnea, though worse in OSA than CSA. Sleep apnea results in oxidative stress, inflammation, and endothelial dysfunction, best documented in OSA. Multiple studies show that both OSA and CSA are associated with excess hospital readmissions and premature mortality. However, no randomized controlled trial (RCT) has been reported for OSA, but sensitivity analysis of two randomized controlled trials has concluded that use of positive airway pressure devices is associated with excess mortality in patients with heart failure and CSA. Phrenic nerve stimulation has shown improvement in sleep apnea events and daytime sleepiness; however, no randomized controlled trials have demonstrated improvement in survival in patients with heart failure. The correct identification and treatment of heart failure patients with sleep and breathing disorders could affect the long-term outcomes of these patients.
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Affiliation(s)
- Shahrokh Javaheri
- Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, OH, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, United States; Division of Cardiology, Ohio State University, Columbus, OH, United States.
| | - Robin Germany
- Division of Cardiovascular Disease, University of Oklahoma College of Medicine, Oklahoma City, OK, United States
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Teckchandani PH, Truong KK, Zezoff D, Healy WJ, Khayat RN. Transvenous Phrenic Nerve Stimulation for Central Sleep Apnea: Clinical and Billing Review. Chest 2021; 161:1330-1337. [PMID: 34808108 PMCID: PMC9131046 DOI: 10.1016/j.chest.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/18/2022] Open
Abstract
Central sleep apnea (CSA) frequently coexists with heart failure and atrial fibrillation and contributes to cardiovascular disease progression and mortality. A transvenous phrenic nerve stimulation (TPNS) system has been approved for the first time by the Food and Drug Administration for the treatment of CSA. This system, remedē® ZOLL Medical, Inc. is implanted during a minimally invasive outpatient procedure, and has shown a favorable safety and efficacy profile. Currently, patients' access to this therapy remains limited by the small number of specialized centers in the US and the absence of a standard coverage process by insurers. While a period of evaluation by insurers is expected for new therapies in their early stages, the impact on patients is particularly severe given the already limited treatment options for CSA. Implantation and management of this novel therapy requires the establishment of a specialized multidisciplinary program as part of a Sleep Medicine practice and support from health care systems and hospitals. Several centers in the US have been successful in building sustainable TPNS program offering this novel therapy to their patients by navigating the current reimbursement environment. In this article, we will review the background and efficacy data of TPNS and briefly address relevant aspects of the clinical activities involved in a TPNS program. The article will present the status of coverage and reimbursement for this novel therapy. We will also discuss the current approach to obtaining reimbursement from third party payors during this transitional period of evaluation by Medicare and other insurers.
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Affiliation(s)
| | - Kimberly Kay Truong
- Department of Pulmonary, Critical Care, and Sleep Medicine, Long Beach Veterans Affairs, Long Beach, CA
| | - Danielle Zezoff
- School of Medicine, University of California, Irvine, Irvine, CA
| | - William J Healy
- Division of Pulmonary, Critical Care, Sleep Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | - Rami N Khayat
- Division of Pulmonary and Critical Care Medicine, University of California, Irvine, Irvine, CA; UCI Sleep Disorders Center, University of California, Irvine, Irvine, CA.
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Varisco G, Kommers D, Long X, Zhan Z, Nano MM, Cottaar W, Andriessen P, Pul CV. Optimized Detection of Central Apneas Preceding Late-Onset Sepsis in Premature Infants. Annu Int Conf IEEE Eng Med Biol Soc 2021; 2021:5463-5468. [PMID: 34892362 DOI: 10.1109/embc46164.2021.9629528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In neonatal intensive care units, respiratory traces of premature infants developing late onset sepsis (LOS) may also show episodes of apneas. However, since clinical patient monitors often underdetect apneas, clinical experts are required to investigate patients' traces looking for these events. In this work we present a method to optimize an existing algorithm for central apnea (CA) detection and how we used it together with human annotations to investigate the occurrence of CAs preceding LOS.The algorithm was optimized by using a previously-annotated dataset consisting of 90 hours, extracted from 10 premature infants. This allowed to double precision (19.7% vs 9.3%, median values per patient) without affecting recall (90.5% vs 94.5%) compared to the original algorithm. This choice caused the missed identification of just 1 additional CA (4 vs 3) in the whole dataset. The optimized algorithm was then used to annotate a second dataset consisting of 480 hours, extracted from 10 premature infants diagnosed with LOS. Annotations were corrected by two clinical experts.A significantly higher number of CA annotations was found in the 6 hours prior to sepsis onset (p-value < 0.05). The use of the optimized algorithm followed by human annotations proved to be a suitable, time-efficient method to annotate CAs before sepsis in premature infants, enabling future use in large datasets.
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Orr JE, Ayappa I, Eckert DJ, Feldman JL, Jackson CL, Javaheri S, Khayat RN, Martin JL, Mehra R, Naughton MT, Randerath WJ, Sands SA, Somers VK, Badr MS. Research Priorities for Patients with Heart Failure and Central Sleep Apnea. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2021; 203:e11-e24. [PMID: 33719931 PMCID: PMC7958519 DOI: 10.1164/rccm.202101-0190st] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Central sleep apnea (CSA) is common among patients with heart failure and has been strongly linked to adverse outcomes. However, progress toward improving outcomes for such patients has been limited. The purpose of this official statement from the American Thoracic Society is to identify key areas to prioritize for future research regarding CSA in heart failure. Methods: An international multidisciplinary group with expertise in sleep medicine, pulmonary medicine, heart failure, clinical research, and health outcomes was convened. The group met at the American Thoracic Society 2019 International Conference to determine research priority areas. A statement summarizing the findings of the group was subsequently authored using input from all members. Results: The workgroup identified 11 specific research priorities in several key areas: 1) control of breathing and pathophysiology leading to CSA, 2) variability across individuals and over time, 3) techniques to examine CSA pathogenesis and outcomes, 4) impact of device and pharmacological treatment, and 5) implementing CSA treatment for all individuals Conclusions: Advancing care for patients with CSA in the context of heart failure will require progress in the arenas of translational (basic through clinical), epidemiological, and patient-centered outcome research. Given the increasing prevalence of heart failure and its associated substantial burden to individuals, society, and the healthcare system, targeted research to improve knowledge of CSA pathogenesis and treatment is a priority.
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40
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Mubashir T, Nagappa M, Esfahanian N, Botros J, Arif AA, Suen C, Wong J, Ryan CM, Chung F. Prevalence of sleep-disordered breathing in opioid users with chronic pain: a systematic review and meta-analysis. J Clin Sleep Med 2020; 16:961-969. [PMID: 32105208 PMCID: PMC7849655 DOI: 10.5664/jcsm.8392] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVES Opioids have been reported to increase the risk for sleep-disordered breathing (SDB) in patients with noncancer chronic pain on opioid therapy. This study aims to determine the pooled prevalence of SDB in opioid users with chronic pain and compare it with patients with pain:no opioids and no pain:no opioids. METHODS A literature search of PubMed, Medline, Embase, and Cochrane Central Register of Controlled Trials was conducted. We included all observational studies that reported the prevalence of SDB in patients with chronic pain on long-term opioid therapy (≥3 months). The primary outcome was the pooled prevalence of SDB in opioid users with chronic pain (pain:opioids group) and a comparison with pain:no opioids and no pain:no opioids groups. The meta-analysis was performed using a random-effects model. RESULTS After screening 1,404 studies, 9 studies with 3,791 patients were included in the meta-analysis (pain:opioids group, n = 3181 [84%]; pain:no opioids group, n = 359 [9.4%]; no pain:no opioids group, n = 251 [6.6%]). The pooled prevalence of SDB in the pain:opioids, pain:no opioids, and no pain:no opioids groups were 91%, 83%, and 72% in sleep clinics and 63%, 10%, and 75% in pain clinics, respectively. Furthermore, in the pain: opioids group, central sleep apnea prevalence in sleep and pain clinics was 33% and 20%, respectively. CONCLUSIONS The pooled prevalence of SDB in patients with chronic pain on opioid therapy is not significantly different compared with pain:no opioids and no pain:no opioids groups and varies considerably depending on the site of patient recruitment (ie, sleep vs pain clinics). The prevalence of central sleep apnea is high in sleep and pain clinics in the pain:opioids group. Clinical Trial Registration: Registry: PROSPERO: International prospective register of systematic reviews; Name: Prevalence of sleep disordered breathing, hypoxemia and hypercapnia in patients on oral opioid therapy for chronic pain management; URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103298; Identifier: CRD42018103298.
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Affiliation(s)
- Talha Mubashir
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St. Joseph Health Care, Western University, London, Ontario, Canada
| | - Nilufar Esfahanian
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Joseph Botros
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Abdul A. Arif
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Colin Suen
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Clodagh M. Ryan
- Centre of Sleep Health and Research, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Callara AL, Morelli MS, Hartwig V, Landini L, Giannoni A, Passino C, Emdin M, Vanello N. Ld-EEG Effective Brain Connectivity in Patients With Cheyne-Stokes Respiration. IEEE Trans Neural Syst Rehabil Eng 2020; 28:1216-1225. [PMID: 32191895 DOI: 10.1109/tnsre.2020.2981991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The characterization of brain cortical activity in heart-failure patients affected by Cheyne-Stokes Respiration might provide relevant information about the mechanism underlying this pathology. Central autonomic network is gaining increasing attention for its role in the regulation of breathing and cardiac functions. In this scenario, evaluating changes in cortical connectivity associated with Cheyne-Stokes Respiration may be of interest in the study of specific brain-activity related to such disease. Nonetheless, the inter subject variability, the temporal dynamics of Central-Apnea/Hyperpnea cycles and the limitations of clinical setups lead to different methodological challenges. To this aim, we present a framework for the assessment of cortico-cortical interactions from Electroencephalographic signals acquired using low-density caps and block-design paradigms, arising from endogenous triggers. The framework combines ICA-decomposition, unsupervised clustering, MVAR modelling and a permutation-bootstrap strategy for evaluating significant connectivity differences between conditions. A common network, lateralized towards the left hemisphere, was depicted across 8 patients exhibiting Cheyne-Stokes Respiration patterns during acquisitions. Significant differences in connectivity at the group level were observed based on patients' ventilatory condition. Interactions were significantly higher during hyperpnea periods with respect to central apneas and occurred mainly in the delta band. Opposite-sign differences were observed for higher frequencies (i.e. beta, low-gamma).
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Dvir H, Guo S, Havlin S, Xin N, Jun T, Li D, Zhifei X, Kang R, Bartsch RP. Central Sleep Apnea Alters Neuronal Excitability and Increases the Randomness in Sleep-Wake Transitions. IEEE Trans Biomed Eng 2020; 67:3185-3194. [PMID: 32149619 DOI: 10.1109/tbme.2020.2979287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While most studies on Central Sleep Apnea (CSA) have focused on breathing and metabolic disorders, the neuronal dysfunction that causes CSA remains largely unknown. Here, we investigate the underlying neuronal mechanism of CSA by studying the sleep-wake dynamics as derived from hypnograms. METHODS We analyze sleep data of seven groups of subjects: healthy adults (n = 48), adults with obstructive sleep apnea (OSA) (n = 29), adults with CSA (n = 25), healthy children (n = 40), children with OSA (n = 18), children with CSA (n = 73) and CSA children treated with CPAP (n = 10). We calculate sleep-wake parameters based on the probability distributions of wake-bout durations and sleep-bout durations. We compare these parameters with results obtained from a neuronal model that simulates the interplay between sleep- and wake-promoting neurons. RESULTS We find that sleep arousals of CSA patients show a characteristic time scale (i.e., exponential distribution) in contrast to the scale-invariant (i.e., power-law) distribution that has been reported for arousals in healthy sleep. Furthermore, we show that this change in arousal statistics is caused by triggering more arousals of similar durations, which through our model can be related to a higher excitability threshold in sleep-promoting neurons in CSA patients. CONCLUSIONS We propose a neuronal mechanism to shed light on CSA pathophysiology and a method to discriminate between CSA and OSA. We show that higher neuronal excitability thresholds can lead to complex reorganization of sleep-wake dynamics. SIGNIFICANCE The derived sleep parameters enable a more specific evaluation of CSA severity and can be used for CSA diagnosis and monitor CSA treatment.
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Lu X, Guiraud D, Renaux S, Similowski T, Azevedo C. Breathing detection from tracheal sounds in both temporal and frequency domains in the context of phrenic nerve stimulation. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:5473-5476. [PMID: 31947094 DOI: 10.1109/embc.2019.8856440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electrical stimulation of the phrenic nerves via implanted devices allows to counteract some disadvantages of mechanical ventilation in patients with high tetraplegia or Ondine's syndrome. Existing devices do not allow to monitor breathing or to adapt the electroventilation to patients' actual needs. A reliable breathing monitor with an inbuilt alarm function would improve patient safety. In our study, a real-time acoustic breathing detection method is proposed as a possible solution to improve implanted phrenic stimulation. A new algorithm to process tracheal sounds has been developed. It combines breathing detection in both temporal and frequency domains. The algorithm has been applied on recordings from 18 healthy participants. The obtained average sensitivity, specificity and accuracy of the detection are: 99.31%, 96.84% and 98.02%, respectively. These preliminary results show a first positive proof of the interest of such an approach. Additional experiments are needed, including longer recordings from individuals with tetraplegia or Ondine Syndrome in various environments to go further in the validation.
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Schoebel C, Fietze I, Penzel T. Effects of optimized heart failure medication on central sleep apnea with Cheyne-Stokes respiration pattern in chronic heart failure with reduced left-ventricular ejection fraction. Annu Int Conf IEEE Eng Med Biol Soc 2019; 2019:5723-5726. [PMID: 31947152 DOI: 10.1109/embc.2019.8857849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Central Sleep Apnea with Cheyne Stokes Respiration (CSA-CSR) is often diagnosed in patients with chronic heart failure (CHF). CSA-CSR displays a periodic breathing pattern with a typical waxing and waning breathing with central sleep apnea phases in between. Optimization of heart failure medication with Angiotensin receptor neprilysin inhibition (ARNi) can effect phenotypic traits of CSA-CSR indicating improvements of both, hemodynamic parameters and central chemosensitivity.
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Abouda M. Heterogeneity of Periodic Limb Movements Associated With Central Sleep Apnea in Heart Failure Patients. Am J Cardiol 2019; 124:166-167. [PMID: 31029412 DOI: 10.1016/j.amjcard.2019.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 04/01/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Maher Abouda
- University of Tunis El-Manar, Faculty of Medicine of Tunis, Tunis, Tunisia; Department of Pulmonary Medicine, Chartres Hospital, France.
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Lairez O, Legallois D, Agostini D. Sympathetic nervous system, systolic heart failure, and central sleep apnea: Are we about to find the missing link? J Nucl Cardiol 2017; 24:1938-1940. [PMID: 27457530 DOI: 10.1007/s12350-016-0584-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Olivier Lairez
- Département de Médecine Nucléaire, CHU Rangueil, Toulouse, France
| | - Damien Legallois
- Service de Cardiologie, CHU Côte de Nacre, Caen, France
- Service de Médecine Nucléaire, CHU Côte de Nacre, Caen, France
| | - Denis Agostini
- Service de Médecine Nucléaire, CHU Côte de Nacre, Caen, France.
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Khushaba RN, Armitstead J, Schindhelm K. Monitoring of nocturnal central sleep apnea in Heart failure patients using noncontact respiratory differences. Annu Int Conf IEEE Eng Med Biol Soc 2017; 2017:1534-1538. [PMID: 29060172 DOI: 10.1109/embc.2017.8037128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Monitoring of respiration patterns allows the early detection of various breathing disorders and may better identify those at risk for adverse acute outcomes in a variety of clinical settings. In this paper, we report on the use of SleepMinder (SM), a bedside non-contact Doppler-based biomotion recording sensor, to monitor remotely the nocturnal respiration patterns of 50 patients with systolic Heart failure (HF) while undergoing a lab based Polysomnography (PSG) test. A new respiration rate (RR) monitoring algorithm was developed based on the collected overnight radar signals. Two schemes of RR scoring were utilized: respiratory rate count (RRC) and instantaneous respiratory rates (IRR). Analysis of SM vs. PSG revealed that the mean/median IRR scored by SM is highly correlated with that scored on the nasal flow/effort signals from the corresponding PSG studies on all patients, with a significant correlation coefficient of 0.98 (average absolute difference of 0.31 breaths/min), and 0.97 (p<;0.01, average absolute difference of 0.38 breaths/min) for the median and mean of RR respectively. Our experimental results also show that the difference between the RR estimations from IRR and RRC schemes can be utilized to identify central sleep apnea (CSA)/Cheyne-Stokes respiration (CSR) sections without additional apnea detection modules. As a result, with a sensitivity and specificity of 71% and 88% respectively, and an accuracy of 86%, our CSA/CSR screener, plugged with our RR estimation, can play an important role in the remote management of HF patients.
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48
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Visocchi M, Iacopino G, Germanò A, Barbagallo G. Focus on Functional Delayed Central Sleep Apnea Following Cervical Laminectomy. An Example of Respiratory Dysfunction in Restorative Neurosurgical Procedures. Acta Neurochir Suppl 2017; 124:219-220. [PMID: 28120077 DOI: 10.1007/978-3-319-39546-3_33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In sleep-related breathing disorders, sleep apnea is a clinical symptom that can be categorized as obstructive sleep apnea (OSA) or mixed apnea by analysis using polysomnography. The occurrence of delayed central sleep apnea (CSA) is an extremely rare complication of cervical laminectomy for spondylotic myelopathy. So far only three studies concerning such an event have been reported in the literature. Naim-ur-Rahman, in 1994, reported a case of postoperative CSA following C3-C6 laminectomy, and Visocchi and colleagues, in 2014, in two studies, stressed the lack of association with any other neurological sign of spinal cord damage. No definitive mechanism has been recognized so far for delayed CSA after cervical laminectomy. A transient dysfunction of the reticulo-spinal fibers directed to the nucleus of the phrenic nerve can be speculated, although neither emi-diaphragm paralysis, nor any prominent nocturnal sleep-related disorders are associated with this delayed CSA.
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Affiliation(s)
- Massimiliano Visocchi
- Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy.
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
| | - Gerardo Iacopino
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy
| | - Antonino Germanò
- Department of Neuroscience, Neurosurgical Clinic, University of Messina, Messina, Italy
| | - Giuseppe Barbagallo
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy
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Abstract
Physicians responsible for the care of patients with heart failure due to left ventricular systolic dysfunction have access to a broad range of evidence-based treatments that prolong life and reduce symptoms. In spite of the significant progress made over the last four decades, there is an ongoing need for novel therapies to treat a condition that is associated with stubbornly high morbidity and mortality. In this article, we discuss the findings of SERVE-HF, a randomised controlled trial of adaptive servo-ventilation in patients with left ventricular systolic dysfunction, as well as EMPA-REG, a study of the effects of a novel diabetic agent that may be of greater interest to heart failure specialists than diabetologists. We also examine further analyses of the groundbreaking PARADIGM-HF trial, which attempt to answer some of the unresolved questions from the original study of the first combined angiotensin-receptor blocker and neprilysin inhibitor, sacubitril valsartan. The recently published National Institute for Health and Care Excellence guidelines for the management of acute heart failure and plans to introduce best practice tariffs bring into focus the need for well-organised, multidisciplinary care. We discuss the challenges involved in developing and delivering a specialist service that meets the needs of a growing population of patients living with heart failure.
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Affiliation(s)
- Paul D Callan
- Advanced Heart Failure and Cardiac Transplantation, University Hospital of South Manchester, Manchester, UK
| | - Andrew L Clark
- Hull York Medical School and honorary consultant cardiologist, Hull and East Yorkshire NHS Hospitals Trust, York, UK
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50
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Silva BC, Elias RM. Relationship between chronic kidney disease and central sleep apnea: the importance of volume management. Sleep Breath 2016; 20:1273-1274. [PMID: 27638723 DOI: 10.1007/s11325-016-1403-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/13/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Bruno C Silva
- Nephrology Division. Hospital das Clínicas, University of São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255, 7° andar. Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Rosilene M Elias
- Nephrology Division. Hospital das Clínicas, University of São Paulo, Av. Dr Eneas de Carvalho Aguiar, 255, 7° andar. Cerqueira César, São Paulo, SP, 05403-000, Brazil
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