Effects of Exercise Training and CPAP in Patients With Heart Failure and OSA

Servantes, Denise Maria; Javaheri, Shahrokh; Kravchychyn, Ana Claudia Pelissari; Storti, Luciana Julio; Almeida, Dirceu Rodrigues; Mello, Marco Túlio de; Cintra, Fátima Dumas; Tufik, Sérgio; Bittencourt, Lia

doi:10.1016/j.chest.2018.05.011

Cited by 36 publications

(19 citation statements)

References 30 publications

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“…In some cases, lifestyle changes may expand the benefits of CPAP treatment sufficiently to improve a patient’s QoL. For example, physical exercise combined with CPAP treatment has been demonstrated to improve QoL and subjective EDS [ 81 ].…”

Section: Management Of Reds Due To Osamentioning

confidence: 99%

Current Management of Residual Excessive Daytime Sleepiness Due to Obstructive Sleep Apnea: Insights for Optimizing Patient Outcomes

2021

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Although excessive daytime sleepiness (EDS) attributable to obstructive sleep apnea (OSA) can be resolved by consistent usage of and effective treatment (often with the use of continuous positive airway pressure therapy), 12–58% of patients report residual EDS (REDS). While REDS is difficult to treat, a proportion of cases are possibly due to reversible issues, and wake-promoting medications can prove useful for the remaining cases. Given the challenges associated with effective management of REDS and its relationship to multiple comorbidities, multidisciplinary management of patients with REDS is often recommended. Here we aim to bridge the knowledge gap on the burden, risk factors, prevalence, and potential pathophysiologic mechanisms of REDS in patients with OSA after first-line treatment. The roles of primary care physicians and sleep specialists, as well as the importance of the use of objective assessment tools for the evaluation of REDS and the effective management of comorbidities, are discussed. An update of approved treatments and emerging candidate treatments is also presented.

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Section: Management Of Reds Due To Osamentioning

confidence: 99%

Current Management of Residual Excessive Daytime Sleepiness Due to Obstructive Sleep Apnea: Insights for Optimizing Patient Outcomes

2021

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“…A previous study showed that an increasing VE/VCO 2 slope was a potential negative sign ( 23 ). As presented in Table 2 , the VE/VCO 2 slope showed no obvious changes post-CAVI probably due to our very small sample size.…”

Section: Discussionmentioning

confidence: 97%

Feasibility of Transcatheter Caval Valve Implantation to Improve Sleep-Disordered Breathing in Patients With Severe Tricuspid Regurgitation—A Pilot Study

Wang

Branco

Fietzeck

et al. 2021

Front. Cardiovasc. Med.

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Transcatheter caval valve implantation (CAVI) has been evaluated as a treatment option for inoperable patients with severe symptomatic tricuspid regurgitation (TR). We studied the effect of CAVI on sleep disorder breathing (SDB) in patients with right heart failure and TR. Twenty right heart failure patients with severe symptomatic TR who underwent portable monitoring of SDB (ApneaLink), echocardiography, cardiopulmonary exercise (CPET), and laboratory testing were enrolled. This was a single-center, nonblinded study. There were no significant changes in sleep variables, echocardiographic parameters, laboratory results, lung function, and CPET after CAVI. In conclusion, these data suggest that CAVI may not have an effect on SDB; however, additional follow-up fully powered studies with appropriate statistical analyses are needed.

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“…Therapies Targeting More Than One Pathway of OSA Exercise and OSA: Exercise has been shown to improve OSA in the general population. 37 We recently performed a controlled trial 38 in which 65 subjects with OSA/ HFrEF were randomized to one of four arms: usual guideline-based care alone, or that combined with either exercise only, CPAP plus exercise, or CPAP alone. After 3 months of follow-up, the mean AHI did not change significantly in the usual care group, decreased in the exercise group (28 to 18), and decreased significantly more in the CPAP group (32 to 8) and in the exercise plus CPAP group (25 to 10).…”

Section: Reduced Pharyngeal Dilator Muscle Tone and Osamentioning

confidence: 99%

“…Consistent with the results of these 2 polysomnographic studies are studies showing that, in patients with HF, exercise and cardiac rehabilitation programs (which inevitably involve programmed exercise) attenuate exertional oscillatory ventilation. 38,40 The mechanism by which exercise improves OSA is likely multifactorial. Possible pathways include factors such as weight loss, decreasing lower extremity edema and consequent cephalad fluid translocation when the patient reclines for sleep, 41 or stabilization of ventilatory control.…”

Section: Reduced Pharyngeal Dilator Muscle Tone and Osamentioning

confidence: 99%

Apneas of Heart Failure and Phenotype-Guided Treatments

Javaheri

Brown

Abraham

et al. 2020

Chest

Self Cite

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Sleep-disordered breathing (SDB), including OSA and central sleep apnea, is highly prevalent in patients with heart failure (HF). Multiple studies have reported this high prevalence in asymptomatic as well as symptomatic patients with reduced left ventricular ejection fraction (HFrEF), as well as in those with HF with preserved ejection fraction.The acute pathobiologic consequences of OSA, including exaggerated sympathetic activity, oxidative stress, and inflammation, eventually could lead to progressive left ventricular dysfunction, repeated hospitalization, and excessive mortality. Large numbers of observational studies and a few small randomized controlled trials have shown improvement in various cardiovascular consequences of SDB with treatment. There are no long-term randomized controlled trials to show improved survival of patients with HF and treatment of OSA. One trial of positive airway pressure treatment of OSA included patients with HF and showed no improvement in clinical outcomes. However, any conclusions derived from this trial must take into account several important pitfalls that have been extensively discussed in the literature. With the role of positive airway pressure as the sole therapy for SDB in HF increasingly questioned, a critical examination of long-accepted concepts in this field is needed. The objective of this review was to incorporate recent advances in the field into a phenotype-based approach to the management of OSA in HF.

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Effects of Exercise Training and CPAP in Patients With Heart Failure and OSA

Cited by 36 publications

References 30 publications

Current Management of Residual Excessive Daytime Sleepiness Due to Obstructive Sleep Apnea: Insights for Optimizing Patient Outcomes

Current Management of Residual Excessive Daytime Sleepiness Due to Obstructive Sleep Apnea: Insights for Optimizing Patient Outcomes

Feasibility of Transcatheter Caval Valve Implantation to Improve Sleep-Disordered Breathing in Patients With Severe Tricuspid Regurgitation—A Pilot Study

Apneas of Heart Failure and Phenotype-Guided Treatments

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