All You Need Is Sleep: the Effects of Sleep Apnea and Treatment Benefits in the Heart Failure Patient

Holfinger, Steven; Chan, Lawrence; Donald, Ryan

doi:10.1007/s11897-021-00506-1

Cited by 6 publications

(7 citation statements)

References 86 publications

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“…Therefore, SA is thought to be a potential target for therapeutic approaches which can improve the health status of HF patients ( 15 ). Whilst current evidence indicates that OSA treatment with continuous positive airway pressure (CPAP) decreases all-cause mortality in HF patients ( 16 – 18 ), the benefits of non-invasive ventilation (NIV) for CSA therapy are still debated ( 19 – 21 ), as suggested by the results of both SERVE-HF ( 22 ) and ADVENT-HF ( 23 ) randomized clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Effects of Sacubitril-Valsartan on Clinical, Echocardiographic, and Polygraphic Parameters in Patients Affected by Heart Failure With Reduced Ejection Fraction and Sleep Apnea

Pelaia

Armentaro

Volpentesta

et al. 2022

Front. Cardiovasc. Med.

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BackgroundHeart failure with reduced ejection fraction (HFrEF) is a clinical condition frequently diagnosed in clinical practice. In patients affected by HFrEF, sleep apnea (SA) can be detected among the most frequent comorbidities. Sacubitril–valsartan (sac/val) association has been proven to be effective in reducing disease progression and all-cause mortality in HFrEF patients. Sac/val treatment can potentially attenuate SA development via several pathophysiologic mechanisms, including improvement of global hemodynamics, reduction of extracellular fluid overload, and decrease of sympathetic neural activity.MethodsWe recruited 132 patients affected by HFrEF and SA, already under treatment with continuous positive airway pressure (CPAP), which was discontinued 24 h before the scheduled study timepoints. Physical examination, echocardiography, nocturnal cardio-respiratory monitoring, and laboratory tests were performed in each patient at baseline and after a 6-month treatment with sac/val.ResultsAfter 6 months, sac/val induced statistically significant changes in clinical, hemodynamic, biohumoral (NT-proBNP, serum electrolytes, creatinine, and uric acid), and echocardiographic parameters. In particular, cardiac index (CI), both atrial and ventricular volumes and global longitudinal strain (GLS) improved. Moreover, polysomnography, carried out during a temporary CPAP interruption, revealed a significant reduction in global apnea-hypopnea index (AHI) value (p < 0.0001), central AHI (p < 0.0001), obstructive AHI (p < 0.0001), oxygen desaturation index (ODI) (p < 0.0001), and percentage time of saturation below 90% (TC90) (p < 0.0001). The changes of CI, estimated glomerular filtration rate (eGFR), NT-proBNP, and tricuspid annular plane excursion (TAPSE) contributed to 23.6, 7.6, 7.3, and 4.8% of AHI variability, respectively, and the whole model accounted for a 43.3% of AHI variation.ConclusionsOur results suggest that treatment with sac/val is able to significantly improve the cardiorespiratory performance of patients with HFrEF and SA, integrating the positive impact of CPAP. Thus, both CPAP and sac/val therapy may synergistically contribute to lower the risks of both cardiac and pulmonary complications in HFrEF patients with SA.

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Section: Introductionmentioning

confidence: 99%

Effects of Sacubitril-Valsartan on Clinical, Echocardiographic, and Polygraphic Parameters in Patients Affected by Heart Failure With Reduced Ejection Fraction and Sleep Apnea

Pelaia

Armentaro

Volpentesta

et al. 2022

Front. Cardiovasc. Med.

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“…In concurrence, we found an association with heart failure. Previous studies have shown that heart failure is associated with both CSA and OSA and suggested that heart failure may promote OSA through CSA or upper airway edema [ 53 ], but the mechanisms have not been established. In the current study, central apneas were rare.…”

Section: Discussionmentioning

confidence: 99%

“…Comorbidities like heart failure, obesity, and respiratory muscle weakness may represent such vulnerabilities. Furthermore, SA treatment has shown potential to improve comorbidities such as obesity, metabolic disease, and heart failure [ 53 , 55 ], which emphasizes the importance of considering morbidity profile in the monitoring of SDB.…”

Section: Discussionmentioning

confidence: 99%

Insomnia and sleep-disordered breathing in FKRP-related limb-girdle muscular dystrophy R9. The Norwegian LGMDR9 cohort study (2020)

Jensen,

Abeler,

Friborg

et al. 2023

J Neurol

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Limb-girdle muscular dystrophy R9 (LGMDR9) is a progressive and disabling genetic muscle disease. Sleep is relevant in the patient care as it impacts on health, functioning, and well-being. LGMDR9 may potentially affect sleep by physical or emotional symptoms, myalgia, or sleep-disordered breathing (SDB) through cardiorespiratory involvement. The objective was to investigate the occurrence of insomnia and unrecognized or untreated SDB in LGMDR9, associated factors, and relationships with fatigue and health-related quality of life (HRQoL). All 90 adults in a Norwegian LGMDR9 cohort received questionnaires on sleep, fatigue, and HRQoL. Forty-nine of them underwent clinical assessments and 26 without mask-based therapy for respiration disorders additionally underwent polysomnography (PSG) and capnometry. Among 77 questionnaire respondents, 31% received mask-based therapy. The prevalence of insomnia was 32% of both those with and without such therapy but was significantly increased in fatigued respondents (54% vs 21%). Insomnia levels correlated inversely with mental HRQoL. Among 26 PSG candidates, an apnea–hypopnea index (AHI) ≥ 5/h was observed in 16/26 subjects (≥ 15/h in 8/26) with median 6.8 obstructive apneas and 0.2 central apneas per hour of sleep. The AHI was related to advancing age and an ejection fraction < 50%. Sleep-related hypoventilation was detected in one subject. Fatigue severity did not correlate with motor function or nocturnal metrics of respiration or sleep but with Maximal Inspiratory Pressure (r = − 0.46). The results indicate that insomnia and SDB are underrecognized comorbidities in LGMDR9 and associated with HRQoL impairment and heart failure, respectively. We propose an increased attention to insomnia and SDB in the interdisciplinary care of LGMDR9. Insomnia and pulmonary function should be examined in fatigued patients.

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“…Previous studies have confirmed that sleep apnea, including obstructive sleep apnea (OSA) and central sleep apnea (CSA), is independently associated with a higher risk of heart failure (HF) related symptom progression, hospitalization, and mortality. Insomnia, one of the most common sleep disorders, affecting ∼10-15% of the population and having long-term adverse cardiovascular consequences [2][3][4] . However, it is largely unknown whether insomnia is prospectively associated with an increased incidence of HF.…”

Section: Abbreviations Introductionmentioning

confidence: 99%

Association between Insomnia Symptoms and Risk of Heart Failure: A Meta-analysis of Prospective Cohort Studies

Gao,

Han,

Cao

et al. 2024

Preprint

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Background: Insomnia, as one of the most prevalent sleep disorders, is frequently linked to Heart failure (HF). However, the precise relationship and potential risk of HF events associated with insomnia and subtypes of symptoms necessitate further investigation. Objective: This updated meta-analysis aimed to evaluate the associations between HF and various insomnia symptoms, including difficulty initiating sleep (DIS), difficulty maintaining sleep (DMS), early-morning awakening (EMA) and non-restorative sleep (NRS). Methods: A comprehensive literature search was conducted in PubMed, Web of Science, Embase, and the Cochrane Library to identify prospective cohort studies from inception to October 2023. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to assess the correlation between insomnia and the risk of HF. Funnel plots and Egger's tests were employed to assess publication bias. Results: A total of 177,008 patients from seven eligible prospective cohort studies were included. The pooled minimally adjusted HR for HF was 1.26 (95% CI:1.09-1.45; P=0.001), indicating that insomnia was associated with increased risk of HF. Among the individual insomnia symptoms, only DIS showed a positive association with risk of HF (HR:1.14, 95% CI:1.04-1.25; P=0.005). DMS and NRS had no significant effect on the risk of HF (P>0.05). In the subgroup analysis including age, sex and BMI, there were no significant differences between each group. Conclusion: This meta-analysis confirms the link between insomnia and an increased risk of HF, particularly highlighting the importance of DIS as a potential predictor for HF. Keywords: Insomnia symptoms, DIS, Heart failure events, Meta-analysis, Prospective cohort studies

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All You Need Is Sleep: the Effects of Sleep Apnea and Treatment Benefits in the Heart Failure Patient

Cited by 6 publications

References 86 publications

Effects of Sacubitril-Valsartan on Clinical, Echocardiographic, and Polygraphic Parameters in Patients Affected by Heart Failure With Reduced Ejection Fraction and Sleep Apnea

Effects of Sacubitril-Valsartan on Clinical, Echocardiographic, and Polygraphic Parameters in Patients Affected by Heart Failure With Reduced Ejection Fraction and Sleep Apnea

Insomnia and sleep-disordered breathing in FKRP-related limb-girdle muscular dystrophy R9. The Norwegian LGMDR9 cohort study (2020)

Association between Insomnia Symptoms and Risk of Heart Failure: A Meta-analysis of Prospective Cohort Studies

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