|
1
|
Kalaydzhiev P, Borizanova A, Georgieva N, Voynova G, Yakov S, Kocev T, Tomova-Lyutakova G, Krastev B, Spasova N, Ilieva R, Kinova E, Goudev A. CPAP Treatment at Home after Acute Decompensated Heart Failure in Patients with Obstructive Sleep Apnea. J Clin Med 2024; 13:5676. [PMID: 39407737 PMCID: PMC11477449 DOI: 10.3390/jcm13195676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 09/14/2024] [Accepted: 09/18/2024] [Indexed: 10/20/2024] Open
Abstract
Background: Acute decompensated heart failure (ADHF) is a condition with a high frequency of hospitalizations and mortality, and obstructive sleep apnea (OSA) is a common comorbidity. Continuous positive airway pressure (CPAP) therapy at home can be a good adjunctive non-drug therapy for these patients. Methods: We conducted a single-center, prospective cohort study from 150 consecutive patients hospitalized for heart failure exacerbation in the cardiology department. Of these, 57 patients had obstructive sleep apnea. After discharge, CPAP therapy at home was offered. We divided them into two groups and followed them for 1 year. All patients received optimal medical treatment. At the end of the period, patients underwent a follow-up physical examination, a follow-up echocardiography, and a follow-up evaluation of the Epworth Sleepiness Scale (ESS). Results: From 81 patients with sleep apnea, 72.8% (n = 59) had obstructive sleep apnea (OSA) and 27.2% (n = 22) had central sleep apnea (CSA). There was a statistically significant difference in body mass index (BMI), ESS, systolic blood pressure (SBP), diastolic blood pressure (DBP), and left ventricular ejection fraction (LVEF%) in the group with CPAP therapy compared to the no-CPAP group. The CPAP group had a median survival of 11.7 months vs. 10.1 months in the no-CPAP group (log-rank (Mantel-Cox) p = 0.044). Conclusions: This study suggests that obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improves the symptoms and the prognosis.
Collapse
Affiliation(s)
- Petar Kalaydzhiev
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Angelina Borizanova
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Neli Georgieva
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Gergana Voynova
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Slavi Yakov
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Tsvetan Kocev
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Galya Tomova-Lyutakova
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Bozhidar Krastev
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Natalia Spasova
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Radostina Ilieva
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Elena Kinova
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| | - Assen Goudev
- Department of Emergency Medicine, Medical University—Sofia, 1000 Sofia, Bulgaria
- Cardiology Department, University Hospital “Tsaritsa Yoanna—ISUL”, 1000 Sofia, Bulgaria
| |
Collapse
|
|
2
|
Boulos MI, Chi L, Chernyshev OY. The mobile sleep medicine model in neurologic practice: Rationale and application. Front Neurol 2022; 13:1032463. [PMID: 36388176 PMCID: PMC9650181 DOI: 10.3389/fneur.2022.1032463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022] Open
Abstract
Background Undiagnosed obstructive sleep apnea (OSA) is prevalent in neurological practice and significantly contributes to morbidity and mortality. OSA is prevalent in US adults and causes poor quality sleep and significant neurocognitive, cardiovascular, and cerebrovascular impairments. Timely treatment of OSA reduces cardio-cerebrovascular risks and improves quality of life. However, most of the US population has limited systematic access to sleep medicine care despite its clinical significance. Focus We discuss the importance of systematic screening, testing, and best-practice management of OSA and hypoventilation/hypoxemia syndromes (HHS) in patients with stroke, neurocognitive impairment, and neuromuscular conditions. This review aims to introduce and describe a novel integrated Mobile Sleep Medicine (iMSM) care model and provide the rationale for using an iMSM in general neurological practice to assist with systematic screening, testing and best-practice management of OSA, HHS, and potentially other sleep conditions. Key points The iMSM is an innovative, patient-centered, clinical outcome-based program that uses a Mobile Sleep Medicine Unit—a “sleep lab on wheels”—designed to improve access to OSA management and sleep care at all levels of health care system. The protocol for the iMSM care model includes three levels of operations to provide effective and efficient OSA screening, timely testing/treatment plans, and coordination of further sleep medicine care follow-up. The iMSM care model prioritizes effective, efficient, and patient-centered sleep medicine care; therefore, all parties and segments of care that receive and provide clinical sleep medicine services may benefit from adopting this innovative approach.
Collapse
Affiliation(s)
- Mark I. Boulos
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sleep Laboratory, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Luqi Chi
- Washington University School of Medicine, St. Louis, MO, United States
| | - Oleg Y. Chernyshev
- Sleep Medicine Division, Department of Neurology, Louisiana State University Health Sciences Center, Shreveport, LA, United States
- Ochsner LSU Health Sleep Medicine Center, Shreveport, LA, United States
- *Correspondence: Oleg Y. Chernyshev
| |
Collapse
|
|
3
|
Javaheri S, Javaheri S. Obstructive Sleep Apnea in Heart Failure: Current Knowledge and Future Directions. J Clin Med 2022; 11:jcm11123458. [PMID: 35743529 PMCID: PMC9225117 DOI: 10.3390/jcm11123458] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 02/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) is highly prevalent among patients with asymptomatic left ventricular systolic and diastolic dysfunction and congestive heart failure, and if untreated may contribute to the clinical progression of heart failure (HF). Given the health and economic burden of HF, identifying potential modifiable risk factors such as OSA and whether appropriate treatment improves outcomes is of critical importance. Identifying the subgroups of patients with OSA and HF who would benefit most from OSA treatment is another important point. This focused review surveys current knowledge of OSA and HF in order to provide: (1) a better understanding of the pathophysiologic mechanisms that may increase morbidity among individuals with HF and comorbid OSA, (2) a summary of current observational data and small randomized trials, (3) an understanding of the limitations of current larger randomized controlled trials, and (4) future needs to more accurately determine the efficacy of OSA treatment among individuals with HF.
Collapse
Affiliation(s)
- Shahrokh Javaheri
- Division of Pulmonary and Sleep Medicine, Bethesda North Hospital, Cincinnati, OH 45242, USA;
- Division of Cardiology, The Ohio State University, Columbus, OH 43210, USA
- Division of Pulmonary and Sleep Medicine, University of Cincinnati, Cincinnati, OH 45242, USA
| | - Sogol Javaheri
- Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02130, USA
- Correspondence:
| |
Collapse
|
|
4
|
A Prospective Study of CPAP Therapy in Relation to Cardiovascular Outcome in a Cohort of Romanian Obstructive Sleep Apnea Patients. J Pers Med 2021; 11:jpm11101001. [PMID: 34683142 PMCID: PMC8540427 DOI: 10.3390/jpm11101001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Despite efforts at treatment, obstructive sleep apnea (OSA) remains a major health problem, especially with increasing evidence showing an association with cardiovascular morbidity and mortality. The treatment of choice for OSA patients is Continuous Positive Airway Pressure (CPAP), which has been proven in randomized controlled trials to be an effective therapy for this condition. The impact of CPAP on the cardiovascular pathology associated with OSA remains, however, unclear. Although the effect of CPAP has been previously studied in relation to cardiovascular outcome, follow-up of the treatment impact on cardiovascular risk factors at one year of therapy is lacking in a Romanian population. Thus, we aimed to evaluate the one-year effect of CPAP therapy on lipid profile, inflammatory state, blood pressure and cardiac function, assessed by echocardiography, on a cohort of Romanian OSA patients. Methods: We enrolled 163 participants and recorded their baseline demographic and clinical characteristics with a follow-up after 12 months. Inflammatory and cardiovascular risk factors were assessed at baseline and follow up. Results: Our results show that CPAP therapy leads to attenuation of cardiovascular risk factors including echocardiographic parameters, while having no effect on inflammatory markers. Conclusion: Treatment of OSA with CPAP proved to have beneficial effects on some of the cardiovascular risk factors while others remained unchanged, raising new questions for research into the treatment and management of OSA patients.
Collapse
|
|
5
|
Zota IM, Sascău RA, Stătescu C, Tinică G, Leon Constantin MM, Roca M, Boișteanu D, Anghel L, Mitu O, Mitu F. Short-Term CPAP Improves Biventricular Function in Patients with Moderate-Severe OSA and Cardiometabolic Comorbidities. Diagnostics (Basel) 2021; 11:diagnostics11050889. [PMID: 34067692 PMCID: PMC8156277 DOI: 10.3390/diagnostics11050889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing, exhibiting an increasing prevalence and several cardiovascular complications. Continuous positive airway pressure (CPAP) is the gold-standard treatment for moderate-severe OSA, but it is associated with poor patient adherence. We performed a prospective study that included 57 patients with newly diagnosed moderate-severe OSA, prior to CPAP initiation. The objective of our study was to assess the impact of short-term CPAP on ventricular function in patients with moderate-severe OSA and cardiometabolic comorbidities. The patients underwent a clinical exam, ambulatory blood pressure monitoring and comprehensive echocardiographic assessment at baseline and after 8 weeks of CPAP. Hypertension, obesity and diabetes were highly prevalent among patients with moderate-severe OSA. Baseline echocardiographic parameters did not significantly differ between patients with moderate and severe OSA. Short-term CPAP improved left ventricular global longitudinal strain (LV-GLS), isovolumetric relaxation time, transmitral E wave amplitude, transmitral E/A ratio, right ventricular (RV) diameter, RV wall thickness, RV systolic excursion velocity (RV S‘) and tricuspid annular plane systolic excursion (TAPSE). Short-term CPAP improves biventricular function, especially the LV-GLS, which is a more sensitive marker of CPAP-induced changes in LV systolic function, compared to LVEF. All these benefits are dependent on CPAP adherence.
Collapse
Affiliation(s)
- Ioana Mădălina Zota
- Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.M.Z.); (M.M.L.C.); (M.R.); (L.A.); (O.M.); (F.M.)
| | - Radu Andy Sascău
- Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.M.Z.); (M.M.L.C.); (M.R.); (L.A.); (O.M.); (F.M.)
- Correspondence: (R.A.S.); (C.S.); Tel.: +40-0232-211834 (R.A.S. & C.S.)
| | - Cristian Stătescu
- Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.M.Z.); (M.M.L.C.); (M.R.); (L.A.); (O.M.); (F.M.)
- Correspondence: (R.A.S.); (C.S.); Tel.: +40-0232-211834 (R.A.S. & C.S.)
| | - Grigore Tinică
- Department of Surgical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Maria Magdalena Leon Constantin
- Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.M.Z.); (M.M.L.C.); (M.R.); (L.A.); (O.M.); (F.M.)
| | - Mihai Roca
- Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.M.Z.); (M.M.L.C.); (M.R.); (L.A.); (O.M.); (F.M.)
| | - Daniela Boișteanu
- Department of Medical Specialties (III), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania;
| | - Larisa Anghel
- Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.M.Z.); (M.M.L.C.); (M.R.); (L.A.); (O.M.); (F.M.)
| | - Ovidiu Mitu
- Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.M.Z.); (M.M.L.C.); (M.R.); (L.A.); (O.M.); (F.M.)
| | - Florin Mitu
- Department of Medical Specialties (I), Faculty of Medicine, Grigore T. Popa—University of Medicine and Pharmacy, 700115 Iasi, Romania; (I.M.Z.); (M.M.L.C.); (M.R.); (L.A.); (O.M.); (F.M.)
| |
Collapse
|
|
6
|
Chen C, Wen T, Liao W. Nocturnal supports for patients with central sleep apnea and heart failure: a systemic review and network meta-analysis of randomized controlled trials. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:337. [PMID: 31475207 DOI: 10.21037/atm.2019.06.72] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Sleep apnea probably brings poor outcomes of chronic heart failure (CHF), and some methods show benefit to patients with heart failure (HF) and central sleep apnea (CSA). Our study based on the randomized controlled trials (RCTs) to find out the most beneficial therapy of nocturnal support to decrease the apnea hypopnea index (AHI). Methods The PubMed, and the Web of Science were used to find out the included studies. RevMan 5.3 and Stata 15.1 were performed to this systemic review and network meta-analysis. Results After searching and screening the articles, finally we included 14 articles with total 919 patients, and 4 arms [adaptive servo ventilation (ASV), continuous positive airway pressure (CPAP), oxygen treatment, control]. Compared with the control group, the therapeutic regimens did not show significant difference in AHI. Ranking the different nocturnal supports in the order of estimated probabilities of each treatment by using the network meta-analysis, the result showed that ASV was the best one (87.8%), followed by oxygen (12.2%), CPAP (0%), and control (0%). Conclusions Based on our study, the adoptive servo ventilation is probably the best choice to down the AHI in patients with HF and CSA.
Collapse
Affiliation(s)
- Chongxiang Chen
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| | - Tianmeng Wen
- School of Public Health, Sun Yat-sen University, Guangzhou 510060, China
| | - Wei Liao
- Department of Intensive Care Unit, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China
| |
Collapse
|
|
7
|
Abstract
PURPOSE OF REVIEW The bidirectional relationships that have been demonstrated between heart failure (HF) and central sleep apnea (CSA) demand further exploration with respect to the implications that each condition has for the other. This review discusses the body of literature that has accumulated on these relationships and how CSA and its potential treatment may affect outcomes in patients with CSA. RECENT FINDINGS Obstructive sleep apnea (OSA) can exacerbate hypertension, type 2 diabetes, obesity, and atherosclerosis, which are known predicates of HF. Conversely, patients with HF more frequently exhibit OSA partly due to respiratory control system instability. These same mechanisms are responsible for the frequent association of HF with CSA with or without a Hunter-Cheyne-Stokes breathing (HCSB) pattern. Just as is the case with OSA, patients with HF complicated by CSA exhibit more severe cardiac dysfunction leading to increased mortality; the increase in severity of HF can in turn worsen the degree of sleep disordered breathing (SDB). Thus, a bidirectional relationship exists between HF and both phenotypes of SDB; moreover, an individual patient may exhibit a combination of these phenotypes. Both types of SDB remain significantly underdiagnosed in patients with HF and hence undertreated. Appropriate screening for, and treatment of, OSA is clearly a significant factor in the comprehensive management of HF, while the relevance of CSA remains controversial. Given the unexpected results of the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure trial, it is now of paramount importance that additional analysis of these data be expeditiously reported. It is also critical that ongoing and proposed prospective studies of this issue proceed without delay.
Collapse
|
|
8
|
Cowie MR, Woehrle H, Wegscheider K, Vettorazzi E, Lezius S, Koenig W, Weidemann F, Smith G, Angermann C, d'Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Zannad F, Teschler H. Adaptive servo-ventilation for central sleep apnoea in systolic heart failure: results of the major substudy of SERVE-HF. Eur J Heart Fail 2017; 20:536-544. [DOI: 10.1002/ejhf.1048] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 02/05/2023] Open
Affiliation(s)
| | - Holger Woehrle
- ResMed Science Centre; ResMed Germany Inc.; Martinsried Germany
- Sleep and Ventilation Center Blaubeuren; Respiratory Center Ulm; Ulm Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology; University Medical Center Eppendorf; Hamburg Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology; University Medical Center Eppendorf; Hamburg Germany
| | - Susanne Lezius
- Department of Medical Biometry and Epidemiology; University Medical Center Eppendorf; Hamburg Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München; Technische Universität München; Munich Germany
- DZHK (German Centre for Cardiovascular Research); partner site Munich Heart Alliance; Munich Germany
- Department of Internal Medicine II-Cardiology University of Ulm Medical Center; Ulm Germany
| | - Frank Weidemann
- Department of Medicine I; University and University Hospital Würzburg; Würzburg Germany
- Katharinen-Hospital Unna; Unna Germany
| | | | - Christiane Angermann
- Comprehensive Heart Failure Center; University Hospital and University of Würzburg; Würzburg Germany
| | - Marie-Pia d'Ortho
- University Paris Diderot, Sorbonne Paris Cité; Hôpital Bichat, Explorations Fonctionnelles, DHU FIRE; AP-HP Paris France
| | | | | | | | | | - Faiez Zannad
- Inserm, Université de Lorraine; CHU Nancy France
| | - Helmut Teschler
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen; University Duisburg-Essen; Essen Germany
| |
Collapse
|
|
9
|
da Silva RP, Martinez D, Lopez P, Cadore EL. Effect of strength training on sleep apnea severity in the elderly: study protocol for a randomized controlled trial. Trials 2017; 18:489. [PMID: 29058628 PMCID: PMC5651603 DOI: 10.1186/s13063-017-2238-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 10/05/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) occurs due to sleep-induced upper airway muscle relaxation resulting in increased pharyngeal collapsibility. Clinical trials have shown a favorable effect of exercise training on OSA severity in middle-aged adults. Aging is characterized by motor-unit loss. Force training may affect the whole body muscle tone. We hypothesize that interventions increasing muscle strength might propagate to motor units at the abductor pharyngeal muscles, reducing collapsibility and, hence, sleep apnea severity in elderly patients with obstructive sleep apnea. METHODS/DESIGN This is a randomized clinical trial including patients between 65 and 80 years of age, with obstructive sleep apnea, and an apnea-hypopnea index (AHI) between 20 and 50 events/hour, diagnosed by out-of-center in-home type III polysomnography. Forty subjects will be included and randomly assigned to two equal sized groups. The participants allocated to the intervention group will attend two sessions per week of one-hour strength training for the legs, arms, chest, back, and abdomen and the controls will receive advice on lifestyle change. The primary outcome measure of the study will be the change in apnea-hypopnea index and the secondary outcomes will be the body composition, evaluated by anthropometric and bioelectrical impedance variables; maximum dynamic force, appraised by one-repetition maximum strength test; muscle quality and thickness by ultrasound; physical function assessed by sit-to-stand test, timed up and go test, handgrip strength test. The study duration will be 12 weeks. Intention-to-treat and per-protocol analyses will be performed. DISCUSSION The high prevalence of obstructive sleep apnea in elderly people is a public health issue. OSA is a recognized cause of cardiovascular disease and reduces quality of life due to sleepiness and fatigue. Exercise is a low-cost intervention that could help to detain the trend towards age-dependent loss of pharyngeal motor units and progressive severity of obstructive sleep apnea. Home-based strength exercises may represent a more practical approach than aerobic exercise for elderly patients. If the results confirm our hypothesis, further research on the clinical application of our findings will be warranted. TRIAL REGISTRATION ClinicalTrials.gov, NCT02742792 . Registered on 1 April 2016.
Collapse
Affiliation(s)
- Roberto Pacheco da Silva
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS Brazil
| | - Denis Martinez
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS Brazil
- Cardiology Unit, Hospital de Clinicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS Brazil
| | - Pedro Lopez
- Exercise Research Laboratory, UFRGS, Porto Alegre, RS Brazil
| | - Eduardo Lusa Cadore
- Exercise Research Laboratory, UFRGS, Porto Alegre, RS Brazil
- Physical Education School, UFRGS, Porto Alegre, RS Brazil
| |
Collapse
|
|
10
|
Woehrle H, Cowie MR, Eulenburg C, Suling A, Angermann C, d'Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Zannad F, Teschler H, Wegscheider K. Adaptive servo ventilation for central sleep apnoea in heart failure: SERVE-HF on-treatment analysis. Eur Respir J 2017; 50:50/2/1601692. [PMID: 28860264 PMCID: PMC5593355 DOI: 10.1183/13993003.01692-2016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 05/28/2017] [Indexed: 12/24/2022]
Abstract
This on-treatment analysis was conducted to facilitate understanding of mechanisms underlying the increased risk of all-cause and cardiovascular mortality in heart failure patients with reduced ejection fraction and predominant central sleep apnoea randomised to adaptive servo ventilation versus the control group in the SERVE-HF trial.Time-dependent on-treatment analyses were conducted (unadjusted and adjusted for predictive covariates). A comprehensive, time-dependent model was developed to correct for asymmetric selection effects (to minimise bias).The comprehensive model showed increased cardiovascular death hazard ratios during adaptive servo ventilation usage periods, slightly lower than those in the SERVE-HF intention-to-treat analysis. Self-selection bias was evident. Patients randomised to adaptive servo ventilation who crossed over to the control group were at higher risk of cardiovascular death than controls, while control patients with crossover to adaptive servo ventilation showed a trend towards lower risk of cardiovascular death than patients randomised to adaptive servo ventilation. Cardiovascular risk did not increase as nightly adaptive servo ventilation usage increased.On-treatment analysis showed similar results to the SERVE-HF intention-to-treat analysis, with an increased risk of cardiovascular death in heart failure with reduced ejection fraction patients with predominant central sleep apnoea treated with adaptive servo ventilation. Bias is inevitable and needs to be taken into account in any kind of on-treatment analysis in positive airway pressure studies.
Collapse
Affiliation(s)
- Holger Woehrle
- ResMed Science Center, ResMed Germany Inc., Martinsried, Germany .,Sleep and Ventilation Center Blaubeuren, Respiratory Center Ulm, Ulm, Germany
| | | | - Christine Eulenburg
- Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Anna Suling
- Department of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Christiane Angermann
- Department of Medicine I and Comprehensive Heart Failure Center, University Hospital and University of Würzburg, Würzburg, Germany
| | - Marie-Pia d'Ortho
- University Paris Diderot, Sorbonne Paris Cité, Hôpital Bichat, Explorations Fonctionnelles, DHU FIRE, AP-HP, Paris, France
| | | | | | | | | | - Faiez Zannad
- INSERM, Université de Lorraine, CHU Nancy, France
| | - Helmut Teschler
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| |
Collapse
|
|
11
|
Javaheri S, Sharma RK, Bluemke DA, Redline S. Association between central sleep apnea and left ventricular structure: the Multi-Ethnic Study of Atherosclerosis. J Sleep Res 2017; 26:477-480. [PMID: 28220556 PMCID: PMC5501736 DOI: 10.1111/jsr.12501] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 12/10/2016] [Indexed: 01/23/2023]
Abstract
We assessed whether the presence of central sleep apnea is associated with adverse left ventricular structural changes. We analysed 1412 participants from the Multi-Ethnic Study of Atherosclerosis who underwent both overnight polysomnography and cardiac magnetic resonance imaging. Subjects had been recruited 10 years earlier when free of cardiovascular disease. Our main exposure is the presence of central sleep apnea as defined by central apnea-hypopnea index = 5 or the presence of Cheyne-Stokes breathing. Outcome variables were left ventricular mass/height, left ventricular ejection fraction, and left ventricular mass/volume ratio. Multivariate linear regression models adjusted for age, gender, race, waist circumference, tobacco use, hypertension, and the obstructive apnea-hypopnea index were fit for the outcomes. Of the 1412 participants, 27 (2%) individuals had central sleep apnea. After adjusting for covariates, the presence of central sleep apnea was significantly associated with elevated left ventricular mass/volume ratio (β = 0.11 ± 0.04 g mL-1 , P = 0.0071), an adverse cardiac finding signifying concentric remodelling.
Collapse
Affiliation(s)
| | | | | | - Susan Redline
- Brigham and Women’s Hospital, Boston, MA
- Beth Israel Deaconess Medical Center, Boston, MA
| |
Collapse
|
|
12
|
Eulenburg C, Wegscheider K, Woehrle H, Angermann C, d'Ortho MP, Erdmann E, Levy P, Simonds AK, Somers VK, Zannad F, Teschler H, Cowie MR. Mechanisms underlying increased mortality risk in patients with heart failure and reduced ejection fraction randomly assigned to adaptive servoventilation in the SERVE-HF study: results of a secondary multistate modelling analysis. THE LANCET RESPIRATORY MEDICINE 2016; 4:873-881. [DOI: 10.1016/s2213-2600(16)30244-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 07/30/2016] [Accepted: 08/09/2016] [Indexed: 12/01/2022]
|
|
13
|
Treatment of Obstructive Sleep Apnea. Prospects for Personalized Combined Modality Therapy. Ann Am Thorac Soc 2016; 13:101-8. [PMID: 26569377 DOI: 10.1513/annalsats.201508-537fr] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a common sleep disorder with serious associated morbidities. Although several treatment options are currently available, variable efficacy and adherence result in many patients either not being treated or receiving inadequate treatment long term. Personalized treatment based on relevant patient characteristics may improve adherence to treatment and long-term clinical outcomes. Four key traits of upper airway anatomy and neuromuscular control interact to varying degrees within individuals to cause OSA. These are: (1) the pharyngeal critical closing pressure, (2) the stability of ventilator chemoreflex feedback control (loop gain), (3) the negative intraesophageal pressure that triggers arousal (arousal threshold), and (4) the level of stimulus required to activated upper airway dilator muscles (upper airway recruitment threshold). Simplified diagnostic methods are being developed to assess these pathophysiological traits, potentially allowing prediction of which treatment would best suit each patient. In contrast to current practice of using various treatment modes alone, model predictions and pilot clinical trials show improved outcomes by combining several treatments targeted to each patient's pathophysiology profile. These developments could theoretically improve efficacy and adherence to treatment and in turn reduce the social and economic health burden of OSA and the associated life-threatening morbidities. This article reviews OSA pathophysiology and identifies currently available and investigational treatments that may be combined in the future to optimize therapy based on individual profiles of key patient pathophysiological traits.
Collapse
|
|
14
|
Papavasileiou LP, Santini L, Forleo GB, Ammirati F, Santini M. Novel devices to monitor heart failure and minimize hospitalizations. Expert Rev Cardiovasc Ther 2016; 14:905-13. [DOI: 10.1080/14779072.2016.1187064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
|
15
|
Shetty S, Le T, Parthasarathy S. Pulseless Electrical Activity during Polysomnography. J Clin Sleep Med 2016; 12:771-3. [PMID: 26951418 DOI: 10.5664/jcsm.5818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 01/18/2016] [Indexed: 11/13/2022]
Affiliation(s)
- Safal Shetty
- Center for Sleep Disorders and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ.,Department of Medicine, University of Arizona, Tucson, AZ
| | - Tam Le
- Center for Sleep Disorders and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ.,Department of Medicine, University of Arizona, Tucson, AZ
| | - Sairam Parthasarathy
- Center for Sleep Disorders and Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Arizona, Tucson, AZ.,Department of Medicine, University of Arizona, Tucson, AZ
| |
Collapse
|
|
16
|
Aurora RN, Bista SR, Casey KR, Chowdhuri S, Kristo DA, Mallea JM, Ramar K, Rowley JA, Zak RS, Heald JL. Updated Adaptive Servo-Ventilation Recommendations for the 2012 AASM Guideline: "The Treatment of Central Sleep Apnea Syndromes in Adults: Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses". J Clin Sleep Med 2016; 12:757-61. [PMID: 27092695 DOI: 10.5664/jcsm.5812] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 01/15/2023]
Abstract
ABSTRACT An update of the 2012 systematic review and meta-analyses were performed and a modified-GRADE approach was used to update the recommendation for the use of adaptive servo-ventilation (ASV) for the treatment of central sleep apnea syndrome (CSAS) related to congestive heart failure (CHF). Meta-analyses demonstrated an improvement in LVEF and a normalization of AHI in all patients. Analyses also demonstrated an increased risk of cardiac mortality in patients with an LVEF of ≤ 45% and moderate or severe CSA predominant sleep-disordered breathing. These data support a Standard level recommendation against the use of ASV to treat CHF-associated CSAS in patients with an LVEF of ≤ 45% and moderate or severe CSAS, and an Option level recommendation for the use of ASV in the treatment CHF-associated CSAS in patients with an LVEF > 45% or mild CHF-related CSAS. The application of these recommendations is limited to the target patient populations; the ultimate judgment regarding propriety of any specific care must be made by the clinician.
Collapse
Affiliation(s)
- R Nisha Aurora
- Johns Hopkins University, School of Medicine, Baltimore, MD
| | | | - Kenneth R Casey
- William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Susmita Chowdhuri
- John D. Dingell VA Medical Center and Wayne State University, Detroit, MI
| | | | - Jorge M Mallea
- Mayo Clinic Florida, Transplant Center, Jacksonville, FL
| | | | - James A Rowley
- Department of Medicine, Wayne State University School of Medicine, Detroit, MI
| | - Rochelle S Zak
- Sleep Disorders Center, University of California, San Francisco, San Francisco CA
| | | |
Collapse
|
|
17
|
Rabec C, Emeriaud G, Amadeo A, Fauroux B, Georges M. New modes in non-invasive ventilation. Paediatr Respir Rev 2016; 18:73-84. [PMID: 26688194 DOI: 10.1016/j.prrv.2015.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023]
Abstract
Non-invasive ventilation is useful to treat some forms of respiratory failure. Hence, the number of patients receiving this treatment is steadily increasing. Considerable conceptual and technical progress has been made in the last years by manufacturers concerning this technique. This includes new features committed to improve its effectiveness as well as patient-ventilator interactions. The goal of this review is to deal with latest advances in ventilatory modes and features available for non-invasive ventilation. We present a comprehensive analysis of new modes of ventilator assistance committed to treat respiratory failure (hybrid modes) and central and complex sleep apnea (adaptive servo ventilation), and of new modes of triggering and cycling (neurally adjusted ventilatory assist). Technical aspects, modes of operation and settings of these new features as well as an exhaustive review of published data, their benefits and limits, and the potential place of these devices in clinical practice, are discussed.
Collapse
Affiliation(s)
- Claudio Rabec
- Pulmonary Departement and Respiratory Critical Care Unit, University Hospital Dijon, France; Inserm U 866, University of Burgundy, School of Medicine, Dijon, France.
| | - Guillaume Emeriaud
- Pediatric Intensive Care Unit, Saint Justine Hospital, Université de Montréal, Montreal, Canada
| | - Alessandro Amadeo
- AP-HP, Hôpital Necker, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, France; Inserm U 955, Team 13, Créteil, France
| | - Brigitte Fauroux
- AP-HP, Hôpital Necker, Pediatric Noninvasive Ventilation and Sleep Unit, Paris, France; Paris Descartes University, France; Inserm U 955, Team 13, Créteil, France
| | - Marjolaine Georges
- Pulmonary Departement and Respiratory Critical Care Unit, University Hospital Dijon, France; Inserm U 866, University of Burgundy, School of Medicine, Dijon, France
| |
Collapse
|
|
18
|
The Course of Sleep Problems in Patients With Heart Failure and Associations to Rehospitalizations. J Cardiovasc Nurs 2015; 30:403-10. [DOI: 10.1097/jcn.0000000000000176] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
|
19
|
Linhart M, Sinning JM, Ghanem A, Kozhuppakalam FJ, Fistéra R, Hammerstingl C, Pizarro C, Grube E, Werner N, Nickenig G, Skowasch D. Prevalence and Impact of Sleep Disordered Breathing in Patients with Severe Aortic Stenosis. PLoS One 2015. [PMID: 26214183 PMCID: PMC4516302 DOI: 10.1371/journal.pone.0133176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Unlike the well-established association between sleep disordered breathing (SDB) and chronic heart failure, the relationship between SDB and severe aortic stenosis (AS) is not well investigated. Given the increasing prevalence of AS, and the improving prognosis of high risk AS patients attributable to transcatheter aortic valve implantation (TAVI), the prevalence and impact of SDB needs to be better understood. METHODS AND RESULTS In this study, 140 patients with severe AS underwent polygraphy prior to TAVI. Clinical and hemodynamic parameters were recorded. Patients were followed for 573±405 days. We found that 99/140 patients (71%) had SDB with a mean apnoea-hypopnoea-index of 24±17/h. SDB was mild in 27%, moderate in 23% and severe in 21% of patients. In addition, 35 patients (25%) had obstructive sleep apnoea (OSA), whereas 64 patients (46%) had central sleep apnoea (CSA). Patients with OSA had predominantly mild SDB (20/38 pts.), and patients with CSA mostly had severe SDB (24/29 pts.). The prevalence and distribution of OSA and CSA were independent of left ventricular function. Overall, 1 and 2 year survival rates (74% and 71%, resp.) did not differ significantly between patients without SDB or those with OSA and CSA (p=0.81). CONCLUSIONS SDB, with a preponderance of CSA, was found to be highly prevalent in patients with high-grade AS scheduled for TAVI. SDB prevalence was independent of left ventricular function. Mortality after TAVI was not influenced by the type or severity of SDB.
Collapse
Affiliation(s)
- Markus Linhart
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
- * E-mail:
| | - Jan-Malte Sinning
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Alexander Ghanem
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Finny J. Kozhuppakalam
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Rebecca Fistéra
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Christoph Hammerstingl
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Carmen Pizarro
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Eberhard Grube
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Nikos Werner
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Georg Nickenig
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| | - Dirk Skowasch
- Medizinische Klinik und Poliklinik II, Universitätsklinik Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany
| |
Collapse
|
|
20
|
Muza RT. Central sleep apnoea-a clinical review. J Thorac Dis 2015; 7:930-7. [PMID: 26101651 DOI: 10.3978/j.issn.2072-1439.2015.04.45] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/28/2015] [Indexed: 11/14/2022]
Abstract
Central sleep apnoea (CSA) is characterised by recurrent apnoeas during sleep with no associated respiratory effort. It mostly results from withdrawal of the wakefulness drive in sleep leaving ventilation under metabolic control. A detailed physiological understanding of the control of breathing in wakefulness and sleep is essential to the understanding of CSA. It encompasses a diverse group of conditions with differing aetiologies and pathophysiology. Likewise treatment varies according to underlying aetiology. Some of the conditions such as idiopathic (primary) CSA (ICSA) are relatively rare and benign. On the other hand Cheyne-Stokes breathing (CSB) pattern is quite common in patients with heart failure and might be a prognostic indicator of poor outcome. Unfortunately modern medical management of heart failure does not seem to have significantly reduced the prevalence of CSA in this group. Since the adoption of positive airway pressure (PAP) as a common treatment modality of obstructive sleep apnoea (OSA), complex CSA has been increasingly observed either as treatment emergent or persistent CSA. Depending on the particular condition, various treatment strategies have been tried in the past two decades which have included hypnotic therapy, respiratory stimulants, judicious administration of carbon dioxide, oxygen therapy, PAP and bi-level ventilatory support with a backup rate. In the past decade adaptive servo ventilation (ASV) has been introduced with much promise. Various studies have shown its superiority over other treatment modalities. Ongoing long term studies will hopefully shed more light on its impact on cardiovascular morbidity and mortality. Other rare forms are still poorly understood and treatments remain suboptimal.
Collapse
Affiliation(s)
- Rexford T Muza
- Sleep Disorders Centre, Nuffield House, Guy's & St Thomas' Hospital NHS Trust, London, UK
| |
Collapse
|
|
21
|
Yoshihisa A, Suzuki S, Yamauchi H, Sato T, Oikawa M, Kobayashi A, Yamaki T, Sugimoto K, Kunii H, Nakazato K, Suzuki H, Saitoh SI, Takeishi Y. Beneficial Effects of Positive Airway Pressure Therapy for Sleep-Disordered Breathing in Heart Failure Patients With Preserved Left Ventricular Ejection Fraction. Clin Cardiol 2015; 38:413-21. [PMID: 25966016 DOI: 10.1002/clc.22412] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 03/10/2015] [Accepted: 03/11/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Right-heart dysfunction is associated with poor prognosis in heart failure with preserved left ventricular ejection fraction (HFpEF). It remains unclear whether sleep-disordered breathing (SDB) treatment using positive airway pressure (PAP) improves right-heart and pulmonary function and exercise capacity and reduces mortality rates of HFpEF patients. HYPOTHESIS PAP may improve right-heart and pulmonary function, exercise capacity and prognosis in HFpEF patients with SDB. METHODS One hundred nine consecutive patients with HFpEF (left ventricular ejection fraction >50%) and moderate to severe SDB (apnea-hypopnea index ≥15/h) treated with medications were divided into 2 groups: 31 patients with PAP (PAP group) and 78 patients without PAP (non-PAP group). Right ventricular fractional area change (RV-FAC), tricuspid valve regurgitation pressure gradient (TR-PG), tricuspid valve E/E', forced expiratory volume in 1 second/forced vital capacity (FEV1 /FVC), percentage of vital capacity, and peak VO2 were determined before and 6 months later, and all-cause mortality was followed up for 916 days. RESULTS All parameters improved in the PAP group (RV-FAC, 36.0% -46.5%; TR-PG, 31.1 mm Hg-22.4 mm Hg; tricuspid valve E/E', 7.8-5.1; FEV1 /FVC, 83.9%-89.8%; percentage of vital capacity, 83.5%-89.9%; and peak VO2 , 16.6 mL/kg/min-19.6 mL/kg/min; P <0.05, respectively) but not in the non-PAP group. Importantly, all-cause mortality was significantly lower in the PAP group than in the non-PAP group (0% vs 12.8%; log-rank P = 0.014). CONCLUSIONS Positive airway pressure improves right-heart and pulmonary function and exercise capacity and may reduce all-cause mortality in patients with HFpEF and SDB.
Collapse
Affiliation(s)
- Akiomi Yoshihisa
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Satoshi Suzuki
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan.,Department of Advanced Cardiac Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Yamauchi
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Takamasa Sato
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Masayoshi Oikawa
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Atsushi Kobayashi
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Takayoshi Yamaki
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Koichi Sugimoto
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Hiroyuki Kunii
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Kazuhiko Nakazato
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Hitoshi Suzuki
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Shu-Ichi Saitoh
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| | - Yasuchika Takeishi
- Department of Cardiology and Hematology, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
|
22
|
Linz D, Woehrle H, Bitter T, Fox H, Cowie MR, Böhm M, Oldenburg O. The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol 2015; 104:705-18. [DOI: 10.1007/s00392-015-0859-7] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/15/2015] [Indexed: 01/22/2023]
|
|
23
|
Cowie MR, Woehrle H, Oldenburg O, Damy T, van der Meer P, Erdman E, Metra M, Zannad F, Trochu JN, Gullestad L, Fu M, Böhm M, Auricchio A, Levy P. Sleep-disordered Breathing in Heart Failure - Current State of the Art. Card Fail Rev 2015; 1:16-24. [PMID: 28785426 PMCID: PMC5491026 DOI: 10.15420/cfr.2015.01.01.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 02/07/2015] [Indexed: 11/04/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Holger Woehrle
- Imperial College London, London, UK;
- ResMed Science Centre, ResMed Europe, Munich, Germany;
| | - Olaf Oldenburg
- Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany;
| | | | - Peter van der Meer
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
| | | | | | | | | | | | - Michael Fu
- Sahlgrenska University Hospital/östra Hospital, Göteborg, Sweden;
| | | | | | | |
Collapse
|
|
24
|
Adaptive servo-ventilation for the treatment of central sleep apnea in congestive heart failure. Curr Opin Pulm Med 2014; 20:550-7. [DOI: 10.1097/mcp.0000000000000108] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
|
25
|
Surani SR. Diabetes, sleep apnea, obesity and cardiovascular disease: Why not address them together? World J Diabetes 2014; 5:381-384. [PMID: 24936259 PMCID: PMC4058742 DOI: 10.4239/wjd.v5.i3.381] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/01/2014] [Accepted: 05/16/2014] [Indexed: 02/05/2023] Open
Abstract
Obesity, sleep apnea, diabetes and cardiovascular diseases are some of the most common diseases encountered by the worldwide population, with high social and economic burdens. Significant emphasis has been placed on obtaining blood pressure, body mass index, and placing importance on screening for signs and symptoms pointing towards cardiovascular disease. Symptoms related to sleep, or screening for sleep apnea has been overlooked by cardiac, diabetic, pulmonary and general medicine clinics despite recommendations for screening by several societies. In recent years, there is mounting data where obesity and obstructive sleep apnea sit at the epicenter and its control can lead to improvement and prevention of diabetes and cardiovascular complications. This editorial raises questions as to why obstructive sleep apnea screening should be included as yet another vital sign during patient initial inpatient or outpatient visit.
Collapse
|
|
26
|
Stopford E, Ravi K, Nayar V. The association of sleep disordered breathing with heart failure and other cardiovascular conditions. Cardiol Res Pract 2013; 2013:356280. [PMID: 24455403 PMCID: PMC3877588 DOI: 10.1155/2013/356280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 10/07/2013] [Accepted: 10/30/2013] [Indexed: 11/26/2022] Open
Abstract
An abundance of evidence exists in support of primary and secondary prevention for tackling the scourge of cardiovascular disease. Despite our wealth of knowledge, certain deficiencies still remain. One such example is the association between sleep disordered breathing (SDB) and cardiovascular disease. A clear body of evidence exists to link these two disease entities (independent of other factors such as obesity and smoking), yet our awareness of this association and its clinical implication does not match that of other established cardiovascular risk factors. Here, we outline the available evidence linking SDB and cardiovascular disease as well as discussing the potential consequences and management in the cardiovascular disease population.
Collapse
Affiliation(s)
- Elizabeth Stopford
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
| | - Karthik Ravi
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
| | - Vikrant Nayar
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
| |
Collapse
|
|
27
|
Esquinas AM, Kasai T. Non-invasive mechanical ventilation for sleep disordered breathing and cardiac function in chronic heart failure. More CPAP or more ASV? That is the question. Int J Cardiol 2013; 168:2978. [PMID: 23659883 DOI: 10.1016/j.ijcard.2013.04.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
|
|
28
|
Kourouklis SP, Vagiakis E, Paraskevaidis IA, Kostikas K, Filippatos G. Tailored treatment of sleep disordered breathing in patients with chronic heart failure improves cardiac function. Int J Cardiol 2013; 168:4529. [DOI: 10.1016/j.ijcard.2013.06.101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 06/30/2013] [Indexed: 11/16/2022]
|
|
29
|
Randerath WJ, Treml M. Heterogeneity of Response to Constant Positive Pressure in Patients With Heart Failure and Coexisting Central and Obstructive Sleep Apnea: Response. Chest 2013; 143:1834. [DOI: 10.1378/chest.13-0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|