Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea

Kaneko, Yasuyuki; Floras, John S.; Usui, Kengo; Plante, Julie; Tkáčová, Ružena; Kubo, Toshihiko; Ando, Shin-ichi; Bradley, T. Douglas

doi:10.1056/nejmoa022479

Cited by 933 publications

(626 citation statements)

References 40 publications

(42 reference statements)

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“…In patients with HFrEF, CPAP improves functional class and reduces sympathetic activity, heart rate, and blood pressure 266, 267, 268. Furthermore, OSA therapy is associated with a trend toward improvement in survival 269.…”

Section: Comorbid Conditionsmentioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

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Section: Comorbid Conditionsmentioning

confidence: 99%

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Samson

Jaiswal

Ennezat

et al. 2016

JAHA

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“…[14] When treated with continuous positive airway pressure (CPAP) during sleep, daytime blood pressure and sympathetic activity decrease. [15,16] Similarly, in medically treated patients with heart failure, treatment of coexisting obstructive sleep apnea by CPAP reduces systolic blood pressure, sympathetic activity, improves left ventricular function [17] and increases oxygen body stores [18], while mild hyperoxia did not reduce sympathetic drive indicating that peripheral chemoreceptors do not contribute to sympathetic activation. [19] Slowing respiratory rate with respiratory training in patients with heart failure decreased dyspnea and increased exercise performance.…”

Section: Introductionmentioning

confidence: 99%

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Binggeli

Sudano²,

Corti³

et al. 2010

Journal of Hypertension

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OBJECTIVES: Intermittent periods of hypoxemia such as during periodic breathing are associated with hypertension and increased sympathetic activity. In patients with sleep apnea syndrome, hypertension is common. Treating apnea improves hypertension and reduces sympathetic outflow. The aim of the present study was to investigate the phenomenon and mechanisms of spontaneous periodic breathing in patients with hypertension. METHOD: We examined 43 hypertensive patients with untreated hypertension without left-ventricular dysfunction, heart failure or sleep apnea syndrome. Muscle sympathetic nerve activity (MSA), heart rate (HR), blood pressure (BP) and respiration were continuously recorded at rest and during cold-pressor testing. Oxygen and a CO2-enriched gas were used to test central and peripheral chemoreceptors, respectively. Baroreceptor gain was measured using the alpha method. RESULTS: Seven out of 43 patients showed spontaneous periodic breathing while awake. No difference in MSA, HR and BP was seen between patients with and without periodic breathing at rest except the breathing pattern. However, the cold-pressor test caused a larger increase of MSA in patients with periodic breathing (203 +/-62 vs. 62 +/-8%, P < 0.0001 by ANOVA), as well as systolic (46 +/-6 vs. 25 +/-3 mmHg, P = 0.002) and diastolic BP (26 +/-5 vs. 12 +/-1 mmHg, P = 0.004, ANOVA). Baroreceptor gain was markedly higher in patients with periodic breathing. Chemoreceptor sensitivity was comparable. CONCLUSION: Spontaneous periodic breathing is relatively common in patients with hypertension and is associated with greatly enhanced responses to cold-pressor testing. We suggest increased baroreceptor gain and sympathetic outflow as a cause for the oscillatory respiration pattern via barorespiratory coupling.

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“…There is evidence of a clear association between obstructive sleep apnea (OSA) and cardiovascular diseases, including hypertension [1], congestive heart failure [2], coronary artery disease, and stroke [3]. Endothelial cell injury or dysfunction is important in the pathogenesis of cardiovascular disease [4].…”

Section: Introductionmentioning

confidence: 99%

Circulating Endothelial Cells and Endothelial Progenitor Cells in Obstructive Sleep Apnea

Martin

Stanchina

Kouttab

et al. 2008

Lung

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Increased circulating endothelial cells (CECs) have been observed in patients with vascular injury associated with acute myocardial infarction, pulmonary hypertension, and congestive heart failure. Decreased circulating endothelial progenitor cells (EPCs) have been observed in patients with risk factors for cardiovascular disease. Obstructive sleep apnea (OSA) is associated with increased risk of cardiovascular disease and endothelial dysfunction. Subjects were recruited from patients referred for overnight polysomnograms; 17 subjects had OSA and 10 control subjects did not have OSA. All subjects lacked vascular disease and risk factors for vascular disease. Peripheral blood was obtained from fasting subjects in the morning, following sleep studies. CECs and EPCs were quantified using magnetic bead separation with UV epifluorescence microscopy and flow

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Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea

Cited by 933 publications

References 40 publications

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Clinical Phenotypes in Heart Failure With Preserved Ejection Fraction

Spontanous periodic breathing is associated with sympathetic hyperreactivity and baroreceptor dysfunction in hypertension

Circulating Endothelial Cells and Endothelial Progenitor Cells in Obstructive Sleep Apnea

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