Sleep-disordered breathing in heart failure: facts and numbers.
Ontology highlight
ABSTRACT:
SUBMITTER: Pietrock C
PROVIDER: S-EPMC5542721 | biostudies-other | 2017 Aug
REPOSITORIES: biostudies-other
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Project description: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 SDB as a treatment target may lead to better clinical outcomes and improved quality of life for patients with heart failure.
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Project description:Acute heart failure (AHF) is a life-threatening emergency, which largely profits from early diagnosis and treatment. The prevalence of AHF is difficult to assess, estimates range between 1 and 12% in the general population. Despite recent therapeutic advances, in-hospital mortality is high with estimates varying from 4 and 18% in different registries. Due to large differences in AHF definitions and selection criteria AHF populations vary in their characteristics and outcomes. This is especially true for randomized clinical trials and the external validity of some of these trials is questionable. Additionally, the timing of data collection and/or initiation of new therapies vary with the setting of trials. The aim of this article is to call attention to the difference in AHF populations and to emphasize the need for research to clearly define these populations. AHF populations from registries and clinical trials are the basis for evidence-based management strategies. It is important that these populations represent the patients in whom these strategies will be applied in routine care.
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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 (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.
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Project description:Southeast Asia is home to a growing population of >600 million people, the majority younger than 65 years, but among whom, rapid epidemiological transition has led to high rates of premature death from non-communicable diseases (chiefly cardiovascular disease) (up to 28% in the Philippines vs. 12% in UK). There is a strikingly high prevalence of stage A heart failure (HF) risk factors in Southeast Asia, particularly hypertension (>24% in Cambodia and Laos vs. 13-15% in UK and USA), tobacco smoking (>36% in Indonesia), physical inactivity (>50% in Malaysia) and raised blood glucose (10-11% in Brunei, Malaysia, Singapore and Thailand) in spite of a low prevalence of overweight/obesity (21-26% in Southeast Asia vs. 67-70% in UK and USA). Accordingly, the prevalence of symptomatic HF appears to be higher in Southeast Asian countries compared with the rest of the world. Epidemiologic trends in Singapore showed a sharp 38% increase in age-adjusted HF hospitalizations (from 85.4 per 10?000 in 1991 to 110.3 per 10?000 in 1998) with notable ethnic differences (hospitalization rates ~35% higher in Malays and Indians vs. Chinese; mortality 3.5 times higher in Malays vs. Indians and Chinese). Furthermore, Southeast Asian patients present with acute HF at a younger age (54 years) compared with USA patients (75 years) but have more severe clinical features, higher rates of mechanical ventilation, longer lengths of stay (6 vs. 4.2 days) and higher in-hospital mortality (4.8 vs. 3.0%). Finally, there is under-usage of guideline-recommended HF medical therapies (prescribed in 31-63% of patients upon discharge) and device therapies in Southeast Asia. Large gaps in knowledge that need to be addressed in Southeast Asia include the prevalence of HF with preserved ejection fraction, clinical outcomes, barriers to recommended therapies and their cost-effectiveness, as well as possible ethnicity-specific pathophysiologic mechanisms.
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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.
| S-EPMC3296458 | biostudies-other
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.
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Project description:BACKGROUND AND PURPOSE:Sleep-disordered breathing is common in individuals with heart failure and may contribute to changes in the brain and decreased cognition. However, limited research has explored how the apnea-hypopnea index contributes to brain structure and cognition in this population. The aims of this study were to explore how the apnea-hypopnea index is associated with brain volume and cognition in heart failure patients. METHODS:Data of 28 heart failure patients (mean age = 67.93; SD = 5.78) were analyzed for this cross-sectional observational study. We evaluated the apnea-hypopnea index using a portable multichannel sleep-monitoring device. All participants were scanned using 3.0 Tesla magnetic resonance imaging and neuropsychological tests. Brain volume was evaluated using a voxel-based morphometry method with T1-weighted images. We used multiple regressions to analyze how the apnea-hypopnea index is associated with brain volume and cognition. RESULTS:We found an inverse association between apnea-hypopnea index scores and white matter volume (? = -0.002, p = 0.026), but not in gray matter volume (? = -0.001, p = 0.237). Higher apnea-hypopnea index was associated with reduced regional gray and white matter volume (p < 0.001, uncorrected). Cognitive scores were not associated with the apnea-hypopnea index (p-values were >0.05). CONCLUSION:Findings from this study provide exploratory evidence that higher apnea-hypopnea index may be associated with greater brain volume reduction in heart failure patients. Future studies are needed to establish the relationship between sleep-disordered breathing, brain volume, and cognition in heart failure samples.
| S-EPMC6043704 | biostudies-literature
Project description:Heart failure in older adults is frequently accompanied by sleep disordered breathing (SDB). Treatment of SDB in persons with heart failure with preserved ejection fraction (HFpEF) is unclear because most data is on heart failure with reduced ejection fraction (HFrEF). The purpose of this paper was to evaluate studies that report on the effects of positive airway pressure on patient outcomes in older adults with HFpEF and comorbid SDB. A search of the literature found six data-based studies (N = 36 to 126). Treatment with positive airway pressure reduced nighttime SDB symptoms and improved daytime functional status in persons with HFPEF and SDB (New York Heart Association Functional Class: effect sizes = -0.67 to -1.60). Limitations (i.e. only two studies were randomized controlled trials, small sample sizes, and women were under-represented) suggest that additional evidence is needed to guide treatment of SDB in older adults with HFpEF.
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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.
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