Complex sleep apnoea in congestive heart failure

Bitter, Thomas; Westerheide, Nina; Hossain, Mohammed Sajid; Lehmann, Roman; Prinz, Christian; Kleemeyer, Astrid; Horstkotte, Dieter; Oldenburg, Olaf

doi:10.1136/thx.2010.146522

Cited by 66 publications

(40 citation statements)

References 38 publications

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“…22 It has been shown in one study of patients with both OSA and CHF to be related to a high respiratory controller gain prior to application of CPAP. 23 A high leak leading to CO 2 washout could also be responsible. It may be due to the changes in CO 2 excretion that occur with relief of the upper airway, leading to a fall in pCO 2 below the apneic threshold.…”

Section: Report Of Casementioning

confidence: 99%

Treatment of Cardiomyopathy with PAP Therapy in a Patient with Severe Obstructive Sleep Apnea

Grewal

2012

Journal of Clinical Sleep Medicine

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Obstructive sleep apnea is common in patients with heart failure. This case illustrates that treatment with PAP therapy can improve cardiac function in patients with both conditions. CPAP-emergent central apnea, as seen in this patient, has multiple etiologies. It is commonly seen in patients with severe sleep apnea, usually resolves over time, and does not need treatment with adaptive servoventilation. keywords: Heart failure, obstructive sleep apnea, PAP therapy, CPAP-emergent central sleep apnea Citation: Grewal RG. 2 Despite its association with cardiovascular diseases, sleep apnea remains underdiagnosed in patients with heart disease.3,4 Meanwhile, there has been increased development and promotion of new, advanced, and more expensive devices by industry to treat sleep apnea despite the lack of any evidence that these devices have superior clinical outcomes. 5 Following is a case which highlights both these issues. repOrt Of CaSeTC, a 44-year-old obese African American male with a BMI of 41, longstanding history of hypertension, non-smoker, with no history of alcohol use, and a 2-3 year history of progressively increasing shortness of breath and cough, was diagnosed with New York Heart Association (NYHA) class III heart failure (HF) in July 2008. Electrocardiogram (ECG) fi ndings were notable for biatrial abnormality and borderline left ventricular (LV) hypertrophy, with no evidence of heart block. Echocardiogram showed severe dilation and global hypokinesis of LV with a LV ejection fraction (LVEF) of 10% and moderately reduced right ventricular (RV) function. Left heart catheterization did not show any occlusive coronary artery disease. Right heart catheterization showed elevated right atrial (RA) pressure at 17 mm Hg, pulmonary capillary wedge pressure (PCWP) of 30 mm Hg, pulmonary artery (PA) pressure of 74/30 mm Hg, and severely reduced right ventricular (RV) function. Cardiopulmonary exercise test showed maximum oxygen consumption (VO 2 ) of 12 cc/kg/minute. His clinical presentation was consistent with idiopathic dilated cardiomyopathy of unknown etiology. An endomyocardial biopsy was not performed to rule out any treatable causes of heart failure, in keeping with current recommendations by the American Heart Association/American college of Cardiology (AHA/ACC).6 He was treated with aspirin and maximal tolerated doses of ACE receptor inhibitor, β-blocker, and a diuretic. An ICD (implantable cardioverterdefi brillator) was placed, and he was evaluated and placed on the cardiac transplant list. Due to his longstanding history of snoring, witnessed apneas, and excessive daytime sleepiness (Epworth Sleepiness Scale [ESS] score of 17), he was evaluated for OSA in December 2008. Polysomnography, performed with a split-night protocol revealed an apnea-hypopnea index (AHI) of 68 with a SaO 2 nadir of 58%. Respiratory events were all obstructive in nature with no central apneas. Continuous positive airway pressure (CPAP) titration to a maximum pressure of 20 cm H 2 O was unsuccessful in controlling the obstruc...

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Section: Report Of Casementioning

confidence: 99%

Treatment of Cardiomyopathy with PAP Therapy in a Patient with Severe Obstructive Sleep Apnea

Grewal

2012

Journal of Clinical Sleep Medicine

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“…Moreover, as in HF patients with CSA-CSR, there is a parallel improvement in respiratory control. 80 …”

Section: Complex Sleep Apnea Syndromes (Complsa)mentioning

confidence: 99%

“…In a well-defined group of 192 HF patients with moderate to severe OSA, 34 (18%) went on to develop complSA. 80 In terms of suppression of nocturnal respiratory events, ASV has been shown to be more effective than CPAP. 81, 82 Regarding HF symptoms and cardiac performance, ASV has been shown to improve NYHA functional class, NT-proBNP concentrations and oxygen uptake during cardiopulmonary exercise testing.…”

Section: Complex Sleep Apnea Syndromes (Complsa)mentioning

confidence: 99%

“…79 One study documented respiratory control instability in these patients, comparable to that seen in those with HF and primarily CSA-CSR. 80 It seems likely that patients with complSA have undiagnosed HF, kidney disease or stroke. In a well-defined group of 192 HF patients with moderate to severe OSA, 34 (18%) went on to develop complSA.…”

Section: Complex Sleep Apnea Syndromes (Complsa)mentioning

confidence: 99%

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Cheyne-Stokes Respiration in Chronic Heart Failure

Oldenburg

2012

Circ J

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Sleep-disordered breathing (SDB) with predominant obstructive or central sleep apnea (OSA/CSA) with CheyneStokes respiration (CSR) is a common, but underestimated and underappreciated, comorbidity in patients with heart failure (HF). Regardless of the type of HF (systolic or diastolic) or its etiology (ischemic, non-ischemic, valvular etc), the prevalence of SDB is remarkably high in this patient group, at 70-76%. Even more so in HF than in the general population, OSA and CSA in particular are independently associated with an impaired prognosis. This review details the pathophysiology of CSA-CSR in HF, highlights the challenges and tools available for diagnosis, explains the concept of adaptive servoventilation (ASV) therapy, and summarizes the existing literature on the use of ASV therapy in HF patients in general and HF with reduced ejection fraction in particular. (Circ J 2012; 76: 2305 -2317 Key Words: Adaptive servoventilation; Cheyne-Stokes respiration; Heart failure; Sleep-disordered breathing Figure 1. Scheme of the relative prevalence and importance of obstructive (OSA) and central sleep apnea (CSA) according to heart failure severity. With increasing impairment in cardiac function there is an increase in CSA prevalence. NYHA, New York Heart Association class.

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“…However, the prevalence of CompSAS in a clinical setting is not so easy to define, given the dynamic features of this condition, with improvement or disappearance of this breathing pattern during sleep in some patients, and its de novo appearance in others. In general, CompSAS is more common in men, in the presence of more severe OSAS, and in patients with coronary artery disease or congestive heart failure, even if the available evidence on its occurrence is not very consistent (11)(12)(13).…”

mentioning

confidence: 99%