Altered Breathing Syndrome in Heart Failure: Newer Insights and Treatment Options

Tomita, Yasuhiro; Kasai, Takatoshi; Kisaka, Tomohiko; Rossiter, Harry B.; Kihara, Yasuki; Wasserman, Karlman; Daida, Hiroyuki

doi:10.1007/s11897-014-0250-4

Cited by 12 publications

(3 citation statements)

References 65 publications

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“…Physiologic PB is not seen in healthy children or adults except with exposure to acute hypoxia on ascending to high altitude. ( 19 ) Pathologic forms of PB occur in adults with acute or chronic illness, including Cheyne-Stokes respiration in congestive heart failure,( 20 ) and central PB following brain injury such as stroke. ( 21 ) These forms of PB are linked to poor outcomes and mortality.…”

Section: Introductionmentioning

confidence: 99%

Clinical associations with immature breathing in preterm infants: part 2—periodic breathing

et al. 2016

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Background Periodic breathing (PB) is a normal immature breathing pattern in neonates that, if extreme, may be associated with pathologic conditions. Methods We used our automated PB detection system to analyze all bedside monitor chest impedance data on all infants <35 weeks’ gestation in the University of Virginia Neonatal Intensive Care Unit from 2009-2014 (n=1211). Percent time spent in PB was calculated hourly (>50 infant-years’ data). Extreme PB was identified as a 12h period with PB >6 standard deviations above the mean for gestational age (GA) and post-menstrual age (PMA) and >10% time in PB. Results PB increased with GA, with the highest amount in infants 30-33 weeks’ GA at about 2 weeks’ chronologic age. Extreme PB was identified in 76 infants and in 45% was temporally associated with clinical events including infection or necrotizing enterocolitis (NEC), immunizations, or caffeine discontinuation. In 8/28 cases of septicemia and 10/21 cases of NEC there was a >2-fold increase in %PB over baseline in the day prior to diagnosis. Conclusion Infants <35 weeks GA spend, on average, <6% of the time in PB. An acute increase in PB may reflect illness or physiological stressors or may occur without any apparent clinical event.

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Section: Introductionmentioning

confidence: 99%

Clinical associations with immature breathing in preterm infants: part 2—periodic breathing

et al. 2016

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“…This may be associated with the stabilization of respiration by ASV, which has sympathoinhibitory effects (Ushijima et al, 2014 ). In a study by Ushijima et al ( 2014 ), the sympathoinhibitory effects by ASV were predominantly observed in patients with periodic breathing while awake, which is generally observed in patients with advanced HF (Tomita et al, 2015 ). Despite the lack of assessment of such periodic breathing while awake, the findings of Ushijima's study and our findings that patients with a low baseline fSVI who are also likely to have periodic breathing while awake showed significant reductions in the SVR index in addition to the fact that all of our patients have SDB, which frequently coexists with periodic breathing while awake (Emdin et al, 2017 ), may help explain why ASV showed similar alleviation of MR and changes in fSVI to CPAP at 8 cm H 2 O.…”

Section: Discussionmentioning

confidence: 99%

Acute Effects of Positive Airway Pressure on Functional Mitral Regurgitation in Patients with Systolic Heart Failure

et al. 2017

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Background: Acute effects of positive airway pressure (PAP) [including continuous PAP (CPAP) and adaptive servo-ventilation, an advanced form of bi-level PAP] on functional mitral regurgitation (fMR) in patients with heart failure (HF) with left ventricular (LV) systolic dysfunction remain unclear. Thus, whether PAP therapy reduces fMR in such patients with HF was investigated.Methods and Results: Twenty patients with HF and LV systolic dysfunction defined as LV ejection fraction (LVEF) <50% (14 men; mean LVEF, 35.0 ± 11.5%) with fMR underwent echocardiography during 10-min CPAP (4 and 8 cm H2O) and adaptive servo-ventilation. For fMR assessment, MR jet area fraction, defined as the ratio of MR jet on color Doppler to the left atrial area, was measured. The forward stroke volume (SV) index (fSVI) was calculated from the time-velocity integral, cross-sectional area of the aortic annulus, and body surface area. fMR significantly reduced on CPAP at 8 cm H2O (0.30 ± 0.12) and adaptive servo-ventilation (0.29 ± 0.12), compared with the baseline phase (0.37 ± 0.12) and CPAP at 4 cm H2O (0.34 ± 0.12) (P < 0.001). The fSVI did not change in any of the PAP sessions (P = 0.888). However, significant differences in fSVI responses to PAP were found between sexes (P for interaction, 0.006), with a significant reduction in fSVI in women (P = 0.041) and between patients with baseline fSVI ≥ and < the median value (27.8 ml/m2, P for interaction, 0.018), with a significant fSVI reduction in patients with high baseline fSVI (P = 0.028). In addition, significant differences were found in fSVI responses to PAP between patients with LV end-systolic volume (LVESV) index ≥ and < the median value (62.0 ml/m2, P for interaction, 0.034), with a significant fSVI increase in patients with a high LVESV index (P = 0.023).Conclusion: In patients with HF, LV systolic dysfunction, and fMR, PAP can alleviate fMR without any overall changes in forward SV. However, MR alleviation due to PAP might be associated with a decrease in forward SV in women with high baseline SV, whereas MR alleviation due to PAP might be accompanied by increased forward SV in patients with a dilated LV.

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“…Since all forms of these abnormal breathing patterns cause similar detrimental effects on clinical outcomes, they are considered collectively as "altered breathing syndrome," which should be recognized as a comorbid condition of heart failure. 16) The mechanisms of altered breathing syndrome include but are not limited to prolongation of circulation time accompanied by severe heart failure, excessive activated reflex of the chemoreceptor/baroreceptor, and increased dead space due to pleural effusion and pulmonary edema. 17) In chronic heart failure patients with central sleep apnea and Cheyne-Stokes breathing, hypoxemia may contribute to increased C-reactive protein levels and augment the release of inflammatory cytokines, adhesion molecules, and insulin.…”

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confidence: 99%

Is It Possible to Distinguish Patients with Terminal Stage of Heart Failure by Analyzing Their Breathing Patterns?

Yamaoka‐Tojo

2018

Int. Heart J.

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Altered Breathing Syndrome in Heart Failure: Newer Insights and Treatment Options

Cited by 12 publications

References 65 publications

Clinical associations with immature breathing in preterm infants: part 2—periodic breathing

Clinical associations with immature breathing in preterm infants: part 2—periodic breathing

Acute Effects of Positive Airway Pressure on Functional Mitral Regurgitation in Patients with Systolic Heart Failure

Is It Possible to Distinguish Patients with Terminal Stage of Heart Failure by Analyzing Their Breathing Patterns?

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