Effect of Theophylline on Sleep-Disordered Breathing in Heart Failure

Javaheri, Shahrokh; Parker, T. Jeffery; Wexler, Laura; Liming, Jeanne; Lindower, Paul D.; Roselle, Gary A.

doi:10.1056/nejm199608223350805

Cited by 317 publications

(156 citation statements)

References 26 publications

Supporting

Mentioning

133

Contrasting

Unclassified

Order By: Relevance

“…361 The potential adverse consequences of this positive inotropic and proarrhythmic agent preclude recommending it at this time for long-term use in patients with advanced heart failure. In a recent randomized, placebo-controlled, double-blind crossover protocol, a single dose of acetazolamide before sleep reduced CSA and attenuated related daytime symptoms.…”

Section: Treatment Options In Csamentioning

confidence: 99%

Sleep Apnea and Cardiovascular Disease

et al. 2008

View full text Add to dashboard Cite

Section: Treatment Options In Csamentioning

confidence: 99%

Sleep Apnea and Cardiovascular Disease

et al. 2008

View full text Add to dashboard Cite

“…41 In a 5 day trial, theophylline reduced the severity of CSA but did not cause any improvements in right or left ventricular ejection fraction, quality of life, or clinical outcomes. 43 The potential adverse consequences of theophylline's inotropic and arrhythmogenic effects in patients with advanced HF preclude its long-term use at the present time.…”

Section: Treatment Of Central Sleep Apnea In Heart Failurementioning

confidence: 99%

Sleep Apnea and Heart Failure

2003

View full text Add to dashboard Cite

“…There are peripheral and central mechanisms of theophylline actions that may result eventually in BP lower ing, including endothelium-dependent and -independent vasorelaxation, 11 , 12 a diuretic effect, and central apnea elimination via adenosine antagonism resulting in attenuation of hypoxemias and hypercapnias. 7 Other potential factors contributing to our fi ndings include pharmacologic interactions between the antihypertensive drugs and theophylline and a history of smoking and regular alcohol consumption. In the reported case, during theophylline discontinuation the rise in BP was not linear, as drug concentration was decreasing over time but was more dependent on that level of BP that was set after a nighttime sleep ( Fig 2 ).…”

Section: Discussionmentioning

confidence: 99%

Theophylline Therapy for Cheyne-Stokes Respiration During Sleep in a 41-Year-Old Man With Refractory Arterial Hypertension

Wolf

Świerblewska

Jasiel-Wojculewicz

et al. 2014

Chest

View full text Add to dashboard Cite

We report a case of a 41-year-old man who was noted to have position-dependent Cheyne-Stokes respiration with central sleep apnea (CSA) during sleep. The patient had multiple cardiovascular risk factors and target organ damages, including a history of two myocardial infarctions, transient ischemic attack, and chronic kidney disease. His hypertension was refractory to a number of antihypertensive medicines, however, a complete elimination of sleep-disordered breathing with oral theophylline treatment was paralleled by a signifi cant BP fall with a subsequent need for reduction of antihypertensive drugs. Following these surprising observations we decided to withdraw theophylline from treatment (in-clinic). Theophylline discontinuation resulted in a gradual increase in BP and an urgent call for antihypertensive treatment modifi cation. These observations suggest a potent hypotensive action of oral theophylline via CheyneStokes respiration with CSA elimination. Our data suggest that CSA may be a mechanism that raises BP even during the daytime. CHEST 2014; 146 ( 1 ): e8 -e10Abbreviations : AHI 5 apnea-hypopnea index ; CSA 5 central sleep apnea ; CSR 5 Cheyne-Stokes respiration ; LVEF 5 left ventricular ejection fraction ; Sp o 2 5 oxygen saturation by pulse oximetry ; TIA 5 transient ischemic attack C heyne-Stokes respiration (CSR) with central sleep apnea (CSA) is frequently encountered in pathologic conditions (eg, neurologic dysfunction or congestive heart failure), where it may be implicated in increased morbidity and mortality. 1 -3 Although sleep apnea has been linked to arterial hypertension, only the obstructive type of sleep apnea, and not CSA, is believed to be a causative factor in developing hypertension. 4 -6 In this case report, we show that attenuation of CSR-CSA during sleep with oral theophylline treatment in a patient with hypertensive heart failure (left ventricular ejection fraction [LVEF] 5 45%) signifi cantly improved BP control. Case ReportA 41-year-old man with a longstanding history of complicated, essential hypertension refractory to seven antihypertensives was noted to have CSR-CSA during sleep ( Fig 1 ), exclusively in the supine position. His BP control was poor and showed measurements up to 280/180 mm Hg on home and offi ce measurements and up to 200/140 mm Hg without nocturnal BP dip on 24-h ambulatory BP. The patient had an atherogenic lipid profi le, was overweight (BMI 5 28), smoked cigarettes, frequently drank alcohol to excess, and had a strong family history of cardiovascular disease. He had left ventricle hypertrophy with segmental contractility impairment, a history of two non-ST segment elevation myocardial infarctions, transient ischemic attack (TIA), retinopathy, and chronic kidney disease (plasma creatinine level, 150 m mol/L). The patient was free of diabetes mellitus. Several forms of secondary hypertension (renovascular, hormonal, vasculitis) as well as noncompliance with medications were excluded. Sleep-Related HistoryDespite poor sleep quality for approximately 20 yea...

show abstract

Effect of Theophylline on Sleep-Disordered Breathing in Heart Failure

Abstract: In patients with stable heart failure, oral theophylline therapy reduced the number of episodes of apnea and hypopnea and the duration of arterial oxyhemoglobin desaturation during sleep.

Cited by 317 publications

References 26 publications

Sleep Apnea and Cardiovascular Disease

Sleep Apnea and Cardiovascular Disease

Sleep Apnea and Heart Failure

Theophylline Therapy for Cheyne-Stokes Respiration During Sleep in a 41-Year-Old Man With Refractory Arterial Hypertension

Contact Info

Product

Resources

About