Sleep-disordered breathing in patients with heart failure.
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ABSTRACT:
SUBMITTER: Mentz RJ
PROVIDER: S-EPMC3964361 | biostudies-literature | 2014 Apr
REPOSITORIES: biostudies-literature
Publications
Sleep-disordered breathing in patients with heart failure.
Mentz Robert J RJ Fiuzat Mona M
Heart failure clinics 20140110 2
Sleep-disordered breathing (SDB) is prevalent in patients with heart failure, and is associated with increased morbidity and mortality. SDB is proinflammatory, with nocturnal oxygen desaturations and hypercapnia appearing to play a pivotal role in the development of oxidative stress and sympathetic activation. Preliminary data suggest that attention to the diagnosis and management of SDB in patients with heart failure may improve outcomes. Ongoing research into the roles of comorbidities such as ...[more]
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Project description:Sleep disordered breathing (SDB) is common in heart failure patients across the range of ejection fractions and is associated with adverse prognosis. Although effective pharmacologic and device-based treatment of heart failure may reduce the frequency or severity of SDB, heart failure treatment alone may not be adequate to restore normal breathing during sleep. Continuous positive airway pressure (CPAP) is the major treatment for SDB in heart failure, especially if obstructive rather than central sleep apnea (CSA) predominates. Adequate suppression of CSA by PAP is associated with a heart transplant-free survival benefit, although randomized trials are ongoing. Bilevel PAP (BPAP) may be as effective as CPAP in treating SDB and may be preferable over CPAP in patients who experience expiratory pressure discomfort. Adaptive (or auto) servo-ventilation (ASV), which adjusts the PAP depending on the patient's airflow or tidal volume, may be useful in congestive heart failure patients if CPAP is ineffective. Other therapies that have been proposed for SDB in congestive heart failure include nocturnal oxygen, CO(2) administration (by adding dead space), theophylline, and acetazolamide; most of which have not been systematically studied in outcome-based prospective randomized trials.
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Project description:Sleep-disordered breathing has a high prevalence in the general population, but is especially prominent in patients with heart failure (HF). HF and sleep-disordered breathing share a bidirectional relationship, with sleep-disordered breathing being both cause and effect of poor cardiac functioning. The high inter-individual variability of symptom presentation can impede the clinical diagnostic process. Polysomnography is the gold-standard method of diagnosing sleep-disordered breathing. Therapy of sleep-disordered breathing should always consist of optimizing the treatment of the underlying disorder of HF. Additional therapeutic measures include continuous positive airway pressure ventilation therapy. New therapeutic options using neurostimulation are yielding promising results; however, long-term benefits still need to be confirmed.
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Project description:Sleep-disordered breathing (SDB), either obstructive sleep apnoea (OSA) or central sleep apnoea (CSA)/Cheyne-Stokes respiration (CSR) and often a combination of the two, is highly prevalent in patients with heart failure (HF), is associated with reduced functional capacity and quality of life, and has a negative prognostic impact. European HF guidelines identify that sleep apnoea is of concern in patients with HF. Continuous positive airway pressure is the treatment of choice for OSA, and adaptive servoventilation (ASV) appears to be the most consistently effective therapy for CSA/CSR while also being able to treat concomitant obstructive events. There is a growing body of evidence that treating SDB in patients with HF, particularly using ASV for CSA/CSR, improves functional outcomes such as HF symptoms, cardiac function, cardiac disease markers, exercise tolerance and quality of life. However, conflicting results have been reported on 'hard' outcomes such as mortality and healthcare utilisation, and the influence of effectively treating SDB, including CSA/CSR, remains to be determined in randomised clinical trials. Two such trials (SERVE-HF and ADVENT-HF) in chronic stable HF and another in post-acute decompensated HF (CAT-HF) are currently underway.
| S-EPMC5491026 | biostudies-other
Project description:Heart failure patients often manifest white matter hyperintensites on brain magnetic resonance imaging (MRI). White matter hyperintnsities have also been linked with cognitive problems in patients with heart failure. Sleep disordered breathing may contribute to structural brain changes in heart failure. The purpose of this study was to test the extent to which the apnea hypopnea index is associated with global and regional white matter hyperintensities, and is a moderating factor in the relationship between age and white matter hyperintensites. A total of 28 HF patients [mean age (SD)?=?67.89 (5.8)] underwent T1-weighted and T2FLAIR MRI and a home sleep monitoring study. The apnea hypopnea index cut off of 10 was used to compare between higher and lower risks of sleep disordered breathing. Regression analysis was used to test the association between apnea hypopnea index and both global and regional white matter hyperintensities. The interaction term was entered to identify the moderation effect. Apnea hypopnea index was associated with higher regional white matter hyperintensities but not global white matter hyperintensities. There was a significant interaction between the apnea hypopnea index and age, such that older participants with the apnea hypopnea index ?10 showed greater regional white matter hyperintensities than those with the apnea hypopnea index <10. The results of this preliminary study indicate that a higher apnea hypopnea index is associated with more white matter hyperintensities. The age-related white matter hyperintensities appear to be exacerbated by apnea hypopnea index in our individuals with heart failure. Future studies are needed to further investigate the underlying mechanisms.
| S-EPMC6408271 | biostudies-literature
Project description:BackgroundSleep-disordered breathing (SDB) is a highly common comorbidity in patients with heart failure (HF), and a known risk factor for ventricular tachycardia (VT) development. However, little is known about the impact of SDB treatment on VT burden in HF patients to date. Therefore, this study investigated VT burden, as well as implantable cardioverter-defibrillator (ICD) therapies in HF patients with SDB treatment, in comparison to untreated SDB HF patients.MethodsThis retrospective study analyzed VT burden, rate of antitachycardia pacing (ATP), and the number of shocks delivered in a propensity score-matched patient cohort of patients with SDB treatment or control. Patients had moderate or severe SDB (n = 73 per each group; standardized mean difference of 0.08) and were followed for a minimum of one year. In addition, survival over 4 years was assessed.ResultsMean patient age was 67.67 ± 10.78 and 67.2 ± 10.10, respectively, with 15.06% and 10.95% of the patients, respectively, being female. Regarding SDB subtypes in the control and SDB treatment group, central sleep apnea was present in 42.46% and 41.09% of the patients, respectively, and obstructive sleep apnea was present in 26.02% and 31.50% of the patients, respectively. Mixed type sleep disorder was present in 31.50% and 27.40% of cases. Among the SDB treatment group, a significantly lower number of VTs (28.8% vs. 68.5%; p = 0.01), ATP (21.9% vs. 50.7%; p = 0.02), as well as a lower shock rate (5.5% vs. 31.5%; p < 0.01), was observed compared to the control group. Furthermore, the VT burden was significantly lower in the SDB treatment group when compared to the time prior to SDB treatment (p = 0.02). Event-free survival was significantly higher in the SDB treatment group (Log-rank p < 0.01).ConclusionSDB treatment in HF patients with ICD leads to significant improvements in VT burden, ATP and shock therapy, and may even affect survival. Thus, HF patients should be generously screened for SDB and treated appropriately.
| S-EPMC9369567 | biostudies-literature
Project description:BackgroundHeart failure (HF) is often comorbid with sleep disordered breathing (SDB). This prospective study investigated the prevalence, clinical characteristics, and predictors of SDB in hospitalized HF patients.MethodsSleep studies were performed on hospitalized HF patients from January 2015 to February 2019. SDB was categorized as no/mild SDB, obstructive sleep apnea (OSA), and central sleep apnea (CSA).ResultsThe study included 1069 hospitalized HF patients. The prevalence rates of OSA and CSA were 16.6% and 36.9%, respectively. Patients with OSA or CSA were more likely to be male and have a higher body mass index (BMI) and more comorbidities. Multivariate logistic regression analysis showed that male sex (odds ratio [OR] = 1.803, 95% confidence interval [CI] = 1.099-2.958), BMI (per 5 kg/m2 increase: OR = 2.270, 95% CI = 1.852-2.783), hypertension (OR = 2.719, 95% CI = 1.817-4.070), diabetes (OR = 1.477, 95% CI = 1.020-2.139), and left ventricular ejection fraction (LVEF) (per 5% increase, OR = 1.126, 95% CI = 1.053-1.204) were independent predictors of OSA. Male sex (OR = 1.699, 95% CI = 1.085-1.271), age (per 10 years, OR = 1.235, 95% CI = 1.118-1.363), heart rate (per 10 bpm, OR = 1.174, 95% CI = 1.099-2.958), LVEF (per 5% increase, OR = 0.882, 95% CI = 0.835-0.932), NT-proBNP (lnNT-proBNP, OR = 1.234, 95% CI = 1.089-1.398) and hypocapnia (OR = 1.455, 95% CI = 1.105-1.915) were independent predictors of CSA. The areas under the receiver operating characteristic curves were 0.794 (95% CI = 0.758-0.830) and 0.673 (95% CI = 0.640-0.706), respectively.ConclusionsMore than half of hospitalized HF patients had OSA or CSA, and CSA was the predominant type. OSA and CSA predictors differ. The clinical characteristics of HF patients can help make preliminary predictions for SDB patients.
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Project description:Sleep-disordered breathing (SDB) comprises a diverse set of disorders marked by abnormal respiration during sleep. Clinicians should realize that SDB may present as acute cardiopulmonary failure in susceptible patients. In this review, we discuss three clinical phenotypes of acute cardiopulmonary failure from SDB: acute ventilatory failure, acute congestive heart failure, and sudden death. We review the pathophysiologic mechanisms and recommend general principles for management. Timely recognition of, and therapy for, SDB in the setting of acute cardiopulmonary failure may improve short- and long-term outcomes.
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Project description:The majority of patients with heart failure have sleep-disordered breathing (SDB)-with central (rather than obstructive) sleep apnoea becoming the predominant form in those with more severe disease. Cyclical apnoeas and hypopnoeas are associated with sleep disturbance, hypoxaemia, haemodynamic changes, and sympathetic activation. Such patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and partially normalise the sleep and respiratory physiology, but recent randomised trials of cardiovascular outcomes in central sleep apnoea have been neutral or suggested the possibility of harm, likely from increased sudden death. Further randomised outcome studies (with cardiovascular mortality and hospitalisation endpoints) are required to determine whether mask-based treatment for SDB is appropriate for patients with chronic systolic heart failure and obstructive sleep apnoea, for those with heart failure with preserved ejection fraction, and for those with decompensated heart failure. New therapies for sleep apnoea-such as implantable phrenic nerve stimulators-also require robust assessment. No longer can the surrogate endpoints of improvement in respiratory and sleep metrics be taken as adequate therapeutic outcome measures in patients with heart failure and sleep apnoea.
| S-EPMC5069337 | biostudies-literature
Project description:PurposeAdaptive servo-ventilation (ASV) is a therapy designed for patients with central sleep apnea (CSA) and Cheyne Stokes respiration. The aim of this study was to find predictors of ASV usage in patients with CSA in a routine sleep clinic cohort.MethodsIn this retrospective study, consecutive patients in whom ASV therapy was initiated at the University Hospital Regensburg between 2011 and 2015, were analyzed. Analysis included polysomnographies of diagnostic and ASV initiation nights, a phone questionnaire on ASV usage, readout of the ASV device 1 month after initiation ("early ASV usage," 1 month after ASV initiation), and the readout of the last month before a reappointment date set in 2015 ("late ASV usage," median 17 months after ASV initiation).ResultsIn 69 consecutive patients, the mean early and late ASV usage per night was 4.8 ± 2.5 h and 4.1 ± 3.0 h, respectively. Seventeen months after initiation, 57% of patients used the device ≥ 4 h per night, and of those 91% reported a subjective benefit from ASV therapy. Early ASV usage was significantly associated with late ASV usage (univariable regression: Beta 0.8, 95%CI [0.6; 1.0] p < 0.001). In multivariable regression analysis, short duration of slow wave sleep (N3) during diagnostic polysomnography (Beta - 6.2, 95%CI [- 11.0; - 1.5]; p = 0.011) and subjective benefit from ASV (Beta 174.0, 95%CI [68.6; 279.5]; p = 0.002) were significantly associated with longer late ASV usage.ConclusionEarly ASV usage predicts late ASV usage. In addition, low slow wave sleep before ASV initiation and subjective benefit from ASV may contribute to higher late ASV usage.
| S-EPMC8195885 | biostudies-literature