Association between sleep‐disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction

Suzuki, Satoshi; Yoshihisa, Akiomi; Sato, Yu; Watanabe, Susumu; Yokokawa, Tetsuro; Sato, Toshio; Oikawa, Masayoshi; Kobayashi, Atsushi; Yamaki, Takashi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu‐ichi; Ishida, Takafumi; Takeishi, Yasuchika

doi:10.1002/ehf2.12273

Cited by 10 publications

(15 citation statements)

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“…Up to now, the association between HF and sleep‐disordered breathing (SDB) has been reported. Although SDB is broadly classified into two types, obstructive sleep apnoea and central sleep apnoea (CSA), CSA is more often associated with HF . In SDB, the repeated episodes of apnoea, hypoxia, re‐oxygenation, and arousal throughout the night cause further sympathetic nervous system activation.…”

Section: Discussionmentioning

confidence: 99%

Differences in blood pressure riser pattern in patients with acute heart failure with reduced mid‐range and preserved ejection fraction

et al. 2019

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AimsHeart failure (HF) is classified into three types according to left ventricular ejection fraction (EF). The effect of blood pressure (BP) on the pathogenesis of each type is assumed to be different. However, the association between the prognosis of each type of HF and abnormal BP variations assessed by ambulatory BP monitoring (ABPM), such as nocturnal hypertension and the riser pattern, remains unclear.Methods and resultsWe studied 325 consecutive patients with decompensated HF who were acutely admitted to our hospital and underwent ABPM at discharge. During a mean follow‐up of 30.0 months, 52 cardiovascular and 112 all‐cause deaths occurred. The Cox proportional hazards model showed that the mean values of 24 h, awake, and sleep‐time systolic BP (SBP), and abnormal 24 h ABPM patterns, such as nocturnal hypertension and non‐dipper pattern, were not associated with either all‐cause or cardiovascular mortality in patients with HF with reduced EF (HFrEF), HF with mid‐range EF (HFmrEF), or HF with preserved EF (HFpEF), except for sleep‐time SBP in HFrEF. However, the riser pattern was a significant and independent predictor of all‐cause and cardiovascular deaths in patients with HFpEF (hazard ratio, 2.01; 95% confidence interval, 1.12–3.62; 0.0200; and hazard ratio, 2.48; 95% confidence interval, 1.08–5.90; 0.0332, respectively). Sleep‐time pulse rate was similarly decreased in both the riser and non‐riser groups.ConclusionsThe riser pattern of SBP was associated with an increased risk of adverse outcomes among patients with HFpEF but not HFrEF or HFmrEF.

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Section: Discussionmentioning

confidence: 99%

Differences in blood pressure riser pattern in patients with acute heart failure with reduced mid‐range and preserved ejection fraction

et al. 2019

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“…The presence of comorbidities and past medical history was defined in accordance with previous reports. [15][16][17][18][19] These assessments were performed during hospitalization. We evaluated CHADS 2 score, which consists of clinical parameters, such as congestive HF, arterial hypertension (AH), age ≥ 75 years old, diabetes mellitus, and prior stroke.…”

Section: Study Populationmentioning

confidence: 99%

“…The study protocol was approved by the ethical committee of Fukushima Medical University, the investigation conforms with the principles outlined in the Declaration of Helsinki, and reporting of the study conforms to the Strengthening the Reporting of Observational Studies in Epidemiology statement. [15][16][17][18][19] The written informed consent was obtained from all study participants at discharge.…”

Section: Study Populationmentioning

confidence: 99%

“…The left ventricular ejection fraction (LVEF) was determined and measured from the four-chamber view using Simpson's methods. [15][16][17][18][19] HF with preserved ejection fraction was defined as LVEF ≥ 50%, HF with mid-range ejection fraction was defined as LVEF 40-49%, and HF with reduced ejection fraction LVEF <40%. 22 In the present study, there were 862 (47.8%) HF with preserved ejection fraction patients, 233 (12.3%) HFmrEF patients, and 390 (21.6%) HF with reduced ejection fraction patients.…”

Section: Assessment Of Echocardiographic Datamentioning

confidence: 99%

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B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

et al. 2020

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Aims Recently, B-type natriuretic peptide (BNP) has been attracting attention as a predictor of stroke in patients with atrial fibrillation or those with prior stroke experience. However, the association between BNP and stroke has not been examined in patients with chronic heart failure (CHF). In the current study, we assessed whether BNP is associated with future occurrence of stroke in patients with CHF. Methods and results We prospectively studied 1803 consecutive patients who were admitted for decompensated HF and assessed the predictive value of circulating BNP levels for occurrence of post-discharge stroke. A total of 69 (3.8%) patients experienced a stroke (the stroke group) during the post-discharge follow-up period of a median of 1150 days. The stroke group showed a higher CHADS 2 score. With respect to past medical history, the stroke group had a higher prevalence of arterial hypertension, atrial fibrillation, prior stroke, and chronic kidney disease. Echocardiographic parameters showed no significant differences between the two groups. In contrast, BNP levels were significantly higher in the stroke group than in the non-stroke group (452.1 vs. 222.7 pg/mL, P < 0.001). Multivariate Cox proportional hazard analysis indicated that BNP levels were independently associated with post-discharge stroke (hazard ratio 2.636, 95% confidence interval 1.595-4.357, P < 0.001). The survival classification and regression tree analysis revealed that the accurate cutoff point of BNP in predicting post-discharge stroke was 187.7 pg/mL. We added high BNP level (BNP ≥ 180 pg/mL) as one point to CHADS 2 score. The BNP-added CHADS 2 score was compared with CHADS 2 score alone by using c-statistics. The areas under the curve of CHADS 2 score, BNP, and BNP-added CHADS 2 score were 0.698, 0.616, and 0.723, respectively. The predictive value of BNP-added CHADS 2 score was higher compared with those of CHADS 2 score (P = 0.026). Conclusions The assessment of BNP may predict the occurrence of stroke in CHF patients used alone or in combination with established CHADS 2 score.

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“…Taken together, it seems that CPAP for OSA in patients with HF ameliorates LVEF, and possibly improves cardiovascular prognosis 83) . On the contrary, treatment of CSA or CSA-CSR in HF improves not only LV systolic 84–87) and diastolic function 88) but also pulmonary 82) , renal 89, 90) , and vascular functions 88, 91) ; thus, it also potentially improves prognosis in patients with HF having reduced or preserved EF 4, 29, 82, 84–89, 92–94, 95) However, a recent RCT failed to demonstrate that treatment of CSA improves the prognosis of patients with HF having CSA 96) .…”

Section: Effects Of Sdb Therapy On Cvd Outcome In Patients With Hfmentioning

confidence: 99%

Sleep Disordered Breathing and Cardiovascular Diseases

Yoshihisa

Takeishi

2019

JAT

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Sleep disordered breathing (SDB), which causes sleep deprivation, intermittent hypoxia, and negative intrathoracic pressure swings, can be accompanied by other harmful pathophysiologies relating to cardiovascular diseases (CVD), including sudden death, atrial fibrillation, stroke, and coronary artery disease leading to heart failure. Continuous positive airway pressure (CPAP) therapy for SDB has been reported to provide favorable effects such as lowered systemic blood pressure and improved endothelial function. However, in recent randomized controlled trials, CPAP has failed to demonstrate its beneficial prognostic impact on the primary or secondary setting of CVD. In this review article, we describe the characteristics of SDB complicated with CVD, the prognostic impacts of SDB in CVD, and the beneficial effects of CPAP on CVD. strate its beneficial prognostic impact on the primary or secondary setting of CVD 18, 23-27). In this review article, we describe the characteristics of SDB complicated with CVD, prognostic impacts of SDB in CVD, and beneficial effects of CPAP on CVD. Diagnosis, Definition and Classification of SDB Overnight polysomnography, which includes assessments of electroencephalogram, electrooculogram, electrocardiogram, and electromyogram, as well as the nasal and oral airflows, respiratory movement (thorax and abdominal respiratory effort), snore, oxygen saturation, body position, and sleep stage, is the gold standard test for SDB (Fig. 2) 1, 28). Apnea is the absence of inspiratory airflow for at least 10 s. Hypopnea, a decrease in airflow lasting 10 s or longer, is associated with a drop in arterial oxygen saturation and/or an electroencephalographic arousal.1, 28 The total counts of apnea or hypopnea per hour are defined as the apnea hypopnea index (AHI), and is used to determine SDB: normal, AHI 5/h; mild, 5 ≤ AHI 15/ h; moderate, 15 ≤ AHI 30/h; severe, AHI ≥ 30/h. Apnea and hypopnea are classified as obstructive or central, but they both result from an absence or reduc-Copyright©2019 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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Association between sleep‐disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction

Cited by 10 publications

References 45 publications

Differences in blood pressure riser pattern in patients with acute heart failure with reduced mid‐range and preserved ejection fraction

Differences in blood pressure riser pattern in patients with acute heart failure with reduced mid‐range and preserved ejection fraction

B‐type natriuretic peptide is associated with post‐discharge stroke in hospitalized patients with heart failure

Sleep Disordered Breathing and Cardiovascular Diseases

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