Acute Increase of Cardiac Output Reduces Central Sleep Apneas in Heart Failure Patients

Agostoni, Piergiuseppe; Contini, Mauro; Vignati, Carlo; Torto, Alberico Del; Lajolo, Giorgio De Vecchi; Salvioni, Elisabetta; Spadafora, Emanuele; Lombardi, Carolina; Gerosa, Gino; Bottio, Tomaso; Morosin, Marco; Tarzia, Vincenzo; Scuri, Silvia; Parati, Gianfranco; Apostolo, Anna

doi:10.1016/j.jacc.2015.09.074

Cited by 13 publications

(9 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We included other metrics of cardiovascular function based on CNAP and ECG signals that reflect aspects of autonomic status, including mean BP (MBP), CO, HR and time-domain HRV, and QRS duration. We predicted that, when compared with a healthy group, OSA would be associated with higher BP and HR, 55 no difference in resting CO (since CO differences mainly appear acutely 56 ), higher timedomain HRV, 57 and longer QRS duration. 58…”

Section: Introductionmentioning

confidence: 99%

Beat-to-beat blood pressure variability in patients with obstructive sleep apnea

Pal¹,

Martínez²,

Aguila³

et al. 2021

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

Study Objectives: Cardiovascular comorbidities in obstructive sleep apnea (OSA) are difficult to treat, perhaps due to autonomic dysfunction. We assessed beat-to-beat blood pressure (BP) variability (BPV) in OSA while considering other markers derived from electrocardiogram and continuous BP signals.Methods: We studied 66 participants (33 participants with OSA: respiratory event index [mean ± SEM]: 21.1 ± 2.7 events/h; 12 females, aged 51.5 ± 2.4 years; body mass index: 32.8 ± 1.4 kg/m 2 ; 33 healthy controls: 20 females; aged 45.3 ± 2.4 years; body mass index: 26.3 ± 0.7 kg/m 2 ). We collected 5-minute resting noninvasive beat-to-beat BP and electrocardiogram values. From BP, we derived systolic, diastolic, and mean BP values, and calculated variability as standard deviations (systolic BPV, diastolic BPV, BPV). We also calculated diastole-to-systole time (time to peak). From the electrocardiogram, we derived QRS markers and calculated heart rate and heart rate variability. We performed a multivariate analysis of variance based on sex and group (OSA vs control), with Bonferronicorrected post hoc comparisons (P ≤ .05) between groups. We calculated correlations of BPV with biological variables. Results: Multivariate analysis of variance showed effects of diastolic BPV and BPV in OSA; post hoc comparisons revealed high diastolic BPV and BPV only in female participants with OSA vs controls. QRS duration was higher in OSA, with post hoc comparisons showing the effect only in males. BPV correlated positively with heart rate variability in controls but not in participants with OSA. BPV correlated positively with time to peak in females with OSA and OSA combined, whereas there was no BPV-time-to-peak correlation in healthy participants. Conclusions: The findings show sex-specific autonomic dysfunction reflected in beat-to-beat BP in OSA. The higher BPV may reflect poor baroreflex control or vascular damage in OSA, which are potential precursors to cardiovascular complications.

show abstract

Section: Introductionmentioning

confidence: 99%

Beat-to-beat blood pressure variability in patients with obstructive sleep apnea

Pal¹,

Martínez²,

Aguila³

et al. 2021

Journal of Clinical Sleep Medicine

View full text Add to dashboard Cite

show abstract

“…14,15 Notably, central sleep apneas (CSAs) have been linked with a reduced CO; indeed, we recently reported in a pilot study that CSAs can be reduced by increasing LVAD rpm. 16 This study was designed to give a comprehensive overview of the effects of LVAD rpm changes on exercise onset, exercise at constant workload, maximal performance, and muscle oxygenation, and finally, alveolar-capillary membrane diffusion and ventilatory pattern during sleep, because all of these are at least partly hemodynamic dependent. Some of the patients whose data are reported here participated in previous studies published by our group.…”

mentioning

confidence: 99%

Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance

Apostolo

Paolillo

Contini

et al. 2018

The Journal of Heart and Lung Transplantation

Self Cite

View full text Add to dashboard Cite

“…Instinctively, an exercise-induced stimulus may operate differently on central and peripheral hemodynamics and control respiratory systems. However, and of note, both exercise-induced periodic breathing and nocturnal apneas/hypopneas are significantly reduced by increasing cardiac output in patients with heart failure with left ventricular assist devices (34).…”

Section: Mechanisms Of Period Breathing During Exercise In Heart Failure Due To Left Ventricular Dysfunctionmentioning

confidence: 99%

Periodic Breathing during Incremental Exercise

2017

Self Cite

View full text Add to dashboard Cite

Periodic breathing during incremental cardiopulmonary exercise testing is a regularly recurring waxing and waning of tidal volume due to oscillations in central respiratory drive. Periodic breathing is a sign of respiratory control system instability, which may occur at rest or during exercise. The possible mechanisms responsible for exertional periodic breathing might be related to any instability of the ventilatory regulation caused by: (1) increased circulatory delay (i.e., circulation time from the lung to the brain and chemoreceptors due to reduced cardiac index leading to delay in information transfer), (2) increase in controller gain (i.e., increased central and peripheral chemoreceptor sensitivity to arterial partial pressure of oxygen and of carbon dioxide), or (3) reduction in system damping (i.e., baroreflex impairment). Periodic breathing during exercise is observed in several cardiovascular disease populations, but it is a particularly frequent phenomenon in heart failure due to systolic dysfunction. The detection of exertional periodic breathing is linked to outcome and heralds worse prognosis in heart failure, independently of the criteria adopted for its definition. In small heart failure cohorts, exertional periodic breathing has been abolished with several dedicated interventions, but results have not yet been confirmed. Accordingly, further studies are needed to define the role of visceral feedbacks in determining periodic breathing during exercise as well as to look for specific tools for preventing/treating its occurrence in heart failure.

show abstract

Acute Increase of Cardiac Output Reduces Central Sleep Apneas in Heart Failure Patients

Cited by 13 publications

References 4 publications

Beat-to-beat blood pressure variability in patients with obstructive sleep apnea

Beat-to-beat blood pressure variability in patients with obstructive sleep apnea

Comprehensive effects of left ventricular assist device speed changes on alveolar gas exchange, sleep ventilatory pattern, and exercise performance

Periodic Breathing during Incremental Exercise

Contact Info

Product

Resources

About