Diuretics in Obstructive Sleep Apnea With Diastolic Heart Failure

Bucca, Caterina; Brussino, Luisa; Battisti, Alberto; Mutani, Roberto; Rolla, Giovanni; Mangiardi, L; Cicolin, Alessandro

doi:10.1378/chest.07-0311

Cited by 160 publications

(109 citation statements)

References 35 publications

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“…24 A study in nondialysis obese subjects with OSA and diastolic heart failure demonstrated a reduction in AHI with an increase in upper airway cross-sectional area after a 3-day course of furosemide and spironolactone. 25 Our group demonstrated in systolic heart failure with coexisting OSA that overnight reduction in leg fluid volume was significantly correlated with an increase in AHI and neck circumference.12 Finally, in a study of DRH patients, spironolactone significantly reduced the AHI and BP, likely secondary to the volume-depleting action of the drug. …”

mentioning

confidence: 68%

Influence of Lower Body Positive Pressure on Upper Airway Cross-Sectional Area in Drug-Resistant Hypertension

Friedman

Bradley²,

Logan³

2013

Hypertension

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Abstract-We previously showed that in hypertensive patients the amount of fluid displaced from the legs overnight is directly related to the severity of obstructive sleep apnea and that the rostral fluid shift was greater in drug-resistant hypertensive patients. The findings suggested that this fluid redistribution increases upper airway collapsibility, yet more direct evidence is lacking. The present study examines the effects of graded lower body positive pressure on leg fluid volume, upper airway cross-sectional area, and neck circumference in patients with drug-resistant hypertension (n=25) and controlled hypertension (n=15). In both groups, the reduction in mean upper airway cross-sectional area and oropharyngeal junction area, assessed by acoustic pharyngometry, and the increase in neck circumference, determined by mercury strain gauge plethysmography, were related to the amount of fluid displaced from the legs (R 2 =0.41, P<0.0001; R 2 =0.42, P<0.0001; and R 2 =0.47, P<0.0001, respectively). Displacement of leg fluid volume was significantly greater in patients with drug-resistant hypertension than in controlled hypertension (P<0.0001), and as a consequence, the former experienced greater reductions in mean upper airway cross-sectional area and oropharyngeal junction area (P=0.001 and P<0.0001, respectively). The findings support the concept that in hypertensive subjects, rostral fluid displacement may participate in the pathogenesis of obstructive sleep apnea by narrowing the upper airway and making it more susceptible to collapse during sleep. The exaggerated fluid volume displacement from the legs and upper airway response to lower body positive pressure in patients with drug-resistant hypertension provide additional evidence of an important link between drug-resistant hypertension and obstructive sleep apnea. 112.203547/-/DC1Correspondence to Alexander G. Friedman et al Lower Body Positive Pressure in Hypertension 241increases pharyngeal resistance and upper airway collapsibility in healthy subjects. [14][15][16] In this study, we examined the effects of LBPP on the upper airway cross-sectional area of patients with DRH and controlled hypertension (CH). We hypothesized that the degree of upper airway narrowing would be related to the amount of fluid shifted from the legs and the extent of narrowing would be greater in patients with DRH than those with CH. Methods Study DesignThe study was carried in a human physiology laboratory during the daytime. The human subjects review committee of Mount Sinai Hospital, University Health Network, and Toronto Rehabilitation Institute, all in Toronto, approved the study. All subjects provided written informed consent before participation. Study SubjectsPatients with CH and DRH were recruited from the Hypertension Clinic at the Mount Sinai Hospital in Toronto. DRH was defined as uncontrolled hypertension on optimal doses of a diuretic and 2 additional antihypertensive medications or normal blood pressure (BP) on ≥4 drugs and CH as normal BP on ≤3 agents.1 In deter...

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mentioning

confidence: 68%

Influence of Lower Body Positive Pressure on Upper Airway Cross-Sectional Area in Drug-Resistant Hypertension

Friedman

Bradley²,

Logan³

2013

Hypertension

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“…In a small uncontrolled shortterm interventional study [148], 15 patients with severe OSA and hypertensive aetiology of diastolic heart failure were hospitalised to receive furosemide 20 mg and spironolactone 100 mg twice daily for 3 days. Before and after the intervention, AHI by polysomnography and upper airway dimensions by acoustic pharyngometry were determined.…”

Section: From Hf To Osamentioning

confidence: 99%

Sleep apnoea and the heart

Lévy

Ryan

Oldenburg

et al. 2013

European Respiratory Review

108

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Sleep apnoea is associated with significant daytime functioning impairment and marked cardiovascular morbidities, leading to a significant increase in mortality. Sympathetic activation, oxidative stress and systemic inflammation have been shown to be the main intermediary mechanisms associated with sleep apnoea and intermittent hypoxia. There are now convincing data regarding the association between hypertension, arrhythmias, coronary heart disease, heart failure, increased cardiovascular mortality and sleep apnoea. This has been evidenced in sleep apnoea patients and is supported by experimental data obtained in intermittent hypoxia. Whether treating sleep apnoea enables chronic cardiovascular consequences to be reversed is not fully established as regard coronary heart disease, arrhythmias and heart failure. In this late condition, complex bidirectional relationships occur, with obstructive sleep apnoea being a risk factor for heart failure whilst central sleep apnoea mainly appears as a consequence of heart failure. It remains to be established in adequately designed studies, i.e. large randomised controlled trials, whether treating sleep apnoea can improve heart failure morbidity and mortality. @ERSpublications Sleep apnoea is associated with arrhythmias, coronary disease and heart failure through intermittent hypoxia http://ow.ly/ne19T

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“…27- 29 The amount of fluid displaced from the legs overnight correlated strongly with an overnight increase in neck circumference and AHI in men without heart failure. 27 Diuresis was accompanied by attenuation of OSA and increased pharyngeal caliber in patients with diastolic heart failure and OSA, 28 and conversion from nocturnal to continuous peritoneal dialysis was accompanied by a worsening of OSA and increased airway congestion with a lower fluid removal during the night in patients with renal failure. 29 It was hypothesized that reduced airway congestion due to restoration of sinus rhythm by RFCA would decrease the AHI and OAI.…”

Section: Major Findingsmentioning

confidence: 99%