A Paradigm Shift in the Treatment of Central Sleep Apnea in Heart Failure

Mehra, Reena; Gottlieb, Daniel J.

doi:10.1378/chest.15-1536

Cited by 12 publications

(8 citation statements)

References 19 publications

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“…However, in the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure (CANPAP) trial, although continuous positive airways pressure (CPAP) attenuated CSA, improved nocturnal oxygenation, increased the LVEF, lowered norepinephrine levels, and increased the distance walked in 6 min, it did not affect survival . Moreover, in the Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients With Heart Failure (SERVE‐HF) trial, which was designed to compare the effect of standard medical management plus adaptive servo‐ventilation (ASV) vs. medical management alone in symptomatic HF and predominantly CSA, the preliminary results showed a statistically significant increased risk of cardiovascular mortality with ASV compared with control: 10% per year in ASV compared with 7.5% per year in controls (HR 1.34, 95% CI 1.07–1.67, P = 0.01) …”

Section: Sleep‐disordered Breathingmentioning

confidence: 96%

Reframing the association and significance of co‐morbidities in heart failure

Triposkiadis

Giamouzis

Parissis

et al. 2016

European J of Heart Fail

194

159

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Several co-existing diseases and/or conditions (co-morbidities) are present in patients with heart failure (HF), with diverse clinical relevance. Multiple mechanisms may underlie the co-existence of HF and co-morbidities, including direct causation, associated risk factors, heterogeneity, and independence. The complex inter-relationship of co-morbidities and their impact on the cardiovascular system contribute to the features of HF, both with reduced (HFrEF) and preserved ejection fraction (HFpEF). The purpose of this work is to provide an overview of the contribution of major cardiac and non-cardiac co-morbidities to HF development and outcomes, in the context of both HFpEF and HFrEF. Accordingly, epidemiological evidence linking co-morbidities to HF and the effect of prevalent and incident co-morbidities on HF outcome will be reviewed.

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Section: Sleep‐disordered Breathingmentioning

confidence: 96%

Reframing the association and significance of co‐morbidities in heart failure

Triposkiadis

Giamouzis

Parissis

et al. 2016

European J of Heart Fail

194

159

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“…The interpretation of this study was complicated by several methodologic limitations. 36 The Cardiovascular Improvements With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure (CAT-HF) randomized controlled trial also evaluated ASV compared with standard medical management in 126 patients with heart failure. 37 This trial was terminated early because of the results of the SERVE-HF trial.…”

Section: Treatmentmentioning

confidence: 99%

Sleep apnea and the heart

Mehra

2019

CCJM

Self Cite

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The normal sleep-wake cycle is characterized by diurnal variations in blood pressure, heart rate, and cardiac events. Sleep apnea disrupts the normal sleep-heart interaction, and the pathophysiology varies for obstructive sleep apnea (OSA) and central sleep apnea (CSA). Associations exist between sleep-disordered breathing (which encompasses both OSA and CSA) and heart failure, atrial fi brillation, stroke, coronary artery disease, and cardiovascular mortality. Treatment options include positive airway pressure as well as adaptive servo-ventilation and phrenic nerve stimulation for CSA. Treatment improves blood pressure, quality of life, and sleepiness, the last particularly in those at risk for cardiovascular disease. Results from clinical trials are not defi nitive in terms of hard cardio vascular outcomes. ■ KEY POINTS Diurnal variations in blood pressure, heart rate, and cardiac events occur during normal sleep. While normal sleep may be cardioprotective, sleep apnea disrupts the normal sleep-heart interaction. Untreated severe sleep apnea increases the risk for cardiovascular events. Treatment with continuous positive airway pressure (CPAP) may reduce the risk of cardiac events based on some data, though randomized studies suggest no improvement in cardiovascular mortality.

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“…Special attention was given to the effects of ASV on the breathing pattern, with a possible aggravation by increased ventilation due to pressure support, which was charged to induce an electrolyte imbalance, thereby increasing the risk for arrhythmias [25][26][27].…”

Section: Introductionmentioning

confidence: 99%

Ventilation Parameters under Adaptive Servo Ventilation: A Comparison on Behalf of CSA-Pattern, BNP/NT-pro-BNP, and Ejection Fraction

Westhoff

Litterst

2018

Respiration

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Background: The SERVE-HF study has raised questions concerning the higher mortality under adaptive servoventilation. The ventilatory mode was discussed as a possible aggravating factor. Objectives: We wondered if the data recorded by the adaptive servo-ventilation (ASV)-devices in heart failure patients with CSA-CSR ± OSA are different in terms of respiratory parameters and therapeutic pressures compared to patients with CPAP-resistant/emergent-CSA with normal BNP/NT-pro-BNP. Methods: Patients were included, if ASV had normalized respiratory disturbance index in the first night of application and after at least 6 weeks. ASV-device data were analyzed in terms of respiratory rate (RR), min ventilation (MV), endexpiratory (EEP), peak inspiratory pressure (Ppeak) and median pressure. Results: Compared to CPAP-resistant/emergent-CSA with normal BNP/NT-pro-BNP (n = 25), CSA-CSR- (n = 13) CSA-CSR+OSA-patients (n = 32) with elevated BNP/NT-pro-BNP had higher RR (p < 0.01) in the first night of ASV therapy and during follow-up (15.3 ± 1.3 vs. 17.3 ± 2.4/min) with similar MV (6.5 ± 1.3 vs. 6.6 ± 1.3 L), resulting in significantly lower tidal volumes. EEP (5.6 ± 1.1 vs. 5.5 ± 1.1 hPa), Pmedian and Ppeak (9.8 ± 1.5 vs. 9.7 ± 1.2 hPa) were comparable. Ventilatory parameters were not different between LVEF < 40, 40–49, and ≥50%, neither within the whole group nor the group of CSA-CSR ± OSA and heart failure. Conclusion: Patients with heart failure and CSA-CSR ± OSA have higher RRs but similar MV under ASV-therapy than patients with CSA and normal BNP. This indicates higher dead space ventilation. EF was not found to have an influence on the ventilatory parameters.

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A Paradigm Shift in the Treatment of Central Sleep Apnea in Heart Failure

Cited by 12 publications

References 19 publications

Reframing the association and significance of co‐morbidities in heart failure

Reframing the association and significance of co‐morbidities in heart failure

Sleep apnea and the heart

Ventilation Parameters under Adaptive Servo Ventilation: A Comparison on Behalf of CSA-Pattern, BNP/NT-pro-BNP, and Ejection Fraction

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