Evaluation of a Noninvasive Algorithm for Differentiation of Obstructive and Central Hypopneas

Randerath, Winfried; Treml, Marcel; Priegnitz, Christina; Stieglitz, Sven; Hagmeyer, Lars; Morgenstern, Christian

doi:10.5665/sleep.2450

Cited by 75 publications

(66 citation statements)

References 29 publications

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“…If quality was not acceptable, specific training was provided, followed by another quality assessment. A key element of the PSG scoring was the differentiation of apneas and hypopneas as central or obstructive using flattening of the inspiratory airflow curve, paradoxical breathing, arousal position, sleep stages, and breathing pattern at the end of the hypopnea 25, 26…”

Section: Methodsmentioning

confidence: 99%

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Phenotyping of Sleep‐Disordered Breathing in Patients With Chronic Heart Failure With Reduced Ejection Fraction—the SchlaHF Registry

Arzt

Oldenburg

Graml

et al. 2017

JAHA

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BackgroundDifferent sleep‐disordered breathing (SDB) phenotypes, including coexisting obstructive and central sleep apnea (OSA‐CSA), have not yet been characterized in a large sample of patients with heart failure and reduced ejection fraction (HFrEF) receiving guideline‐based therapies. Therefore, the aim of the present study was to determine the proportion of OSA, CSA, and OSA‐CSA, as well as periodic breathing, in HFrEF patients with SDB.Methods and ResultsThe German SchlaHF registry enrolled patients with HFrEF receiving guideline‐based therapies, who underwent portable SDB monitoring. Polysomnography (n=2365) was performed in patients with suspected SDB. Type of SDB (OSA, CSA, or OSA‐CSA), the occurrence of periodic breathing (proportion of Cheyne‐Stokes respiration ≥20%), and blood gases were determined in 1557 HFrEF patients with confirmed SDB. OSA, OSA‐CSA, and CSA were found in 29%, 40%, and 31% of patients, respectively; 41% showed periodic breathing. Characteristics differed significantly among SDB groups and in those with versus without periodic breathing. There was a relationship between greater proportions of CSA and the presence of periodic breathing. Risk factors for having CSA rather than OSA were male sex, older age, presence of atrial fibrillation, lower ejection fraction, and lower awake carbon dioxide pressure (pco 2). Periodic breathing was more likely in men, patients with atrial fibrillation, older patients, and as left ventricular ejection fraction and awake pco 2 decreased, and less likely as body mass index increased and minimum oxygen saturation decreased.ConclusionsSchlaHF data show that there is wide interindividual variability in the SDB phenotype of HFrEF patients, suggesting that individualized management is appropriate.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01500759.

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Section: Methodsmentioning

confidence: 99%

“…Just 1 or 2 obstructed breaths at the end of an apnea did not change the classification to a central event. Obstructive versus central hypopneas were determined based on the presence/absence of inspiratory flow limitation and/or paradoxical abdominal/thoracic movements on respiratory inductance plethysmography if available 25, 26…”

Section: Methodsmentioning

confidence: 99%

Phenotyping of Sleep‐Disordered Breathing in Patients With Chronic Heart Failure With Reduced Ejection Fraction—the SchlaHF Registry

Arzt

Oldenburg

Graml

et al. 2017

JAHA

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“…The technology utilized in our study (intercostal EMG and impedance plethysmography) has a limited capacity to distinguish between obstructive and central hypopneas, and it is possible that some hypopneas may have been of central origin. An algorithm to assist in distinguishing central from obstructive hypopneas has been reported, 13 and this may be of use in future studies. The fact that all had significant obstructive apnea and those with central apnea were excluded should mitigate this possibility.…”

Section: Discussionmentioning

confidence: 99%

High Hypopnea/Apnea Ratio (HAR) in Extreme Obesity

Mathew

Castriotta

2014

Journal of Clinical Sleep Medicine

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Study Objectives:The study was performed to evaluate the hypothesis that the extremely obese manifest sleep disordered breathing with a preponderance of hypopneas and relative paucity of obstructive apneas. Methods: Retrospective review of 90 adults with obstructive sleep apnea-hypopnea syndrome (OSAHS) matched for age and gender, comparing two groups, Group A: body mass index (BMI) < 35, Group B: BMI ≥ 45. Exclusion criteria: age < 18 years, pregnancy, ≥ 5 central apneas/hour, BMI ≥ 35 < 45. Primary Outcome Measure: Hypopnea/apnea ratio (HAR); secondary measures: obstructive apnea-hypopnea index (AHI), obstructive and central apnea indices, hypopnea index (HI), oxygen saturation (SpO 2 ) nadir, end-tidal carbon dioxide tension (PetCO 2 ), and presence of obesity-hypoventilation syndrome (OHS). Statistical methods: t-test for independent samples; Mann-Whitney, linear regression with natural log transformation, and Kruskal-Wallis χ 2 . Descriptive statistics were expressed as interquartile range, median and mean ± standard deviation, p < 0.05 considered signifi cant.Results: Group A (n = 45): age = 50.6 ± 11.5 years, BMI = 28.9 ± 4 kg/m 2 ; Group B (n = 45): age = 47.4 ± 12.7 years, BMI = 54.5 ± 8 kg/m 2 . HAR was signifi cantly higher in Group B (38.8 ± 50.7) than Group A (10.6 ± 16.5), p = 0.0006, as was HI (28.7 ± 28.6 in B vs 12.6 ± 8.4 in A, p = 0.0005) and AHI (35.5 ± 33.8 vs 22 ± 23, p = 0.03), but not apnea index. HAR was signifi cantly higher in Group B regardless of race, gender, or presence of OHS. The BMI was the only signifi cant predictor of HAR (adjusted r 2 = 0.138; p = 0.002) in a linear regression model with natural log transformation of the HAR performed for age, gender, race, BMI, and PetCO 2 . Conclusion: Extremely obese patients manifest OSAHS with a preponderance of hypopneas. Keywords: Obesity, obstructive sleep apnea, hypopnea, obesity-hypoventilation syndrome, gender differences, sleepdisordered breathing, hypopnea/apnea ratio. Citation: Mathew R; Castriotta RJ. High hypopnea/apnea ratio (HAR) in extreme obesity. J Clin Sleep Med 2014;10(4):391-396.http://dx.doi.org/10.5664/jcsm.3612 S C I E N T I F I C I N V E S T I G A T I O N SO besity is one of the major risk factors for obstructive sleep apnea-hypopnea syndrome (OSAHS), 1 which may be defi ned as an apnea-hypopnea index (AHI) ≥ 5 apneas+ hypopneas/hour of sleep, accompanied by symptoms of excessive sleepiness, diffi culty sleeping, or non-refreshing sleep. The prevalence of obesity in the USA has increased by 33% during the last decade, with 40% of men and 55% of women aged 25 years or older being overweight or obese.2 OSAHS has a higher prevalence among obese subjects than among the general population.3 The prevalence of OSAHS (AHI ≥ 15) in obese (body mass index [BMI] ≥ 32-59 kg/m 2 ) adults is 32% 4 and is signifi cantly higher in men with morbid obesity (BMI ≥ 39 kg/ m 2 ) with 40% having an apnea index > 20 apneas/hour. 5 The prevalence of OSAHS among hospitalized patients has been reported to be 60% in the morbidly obese.6 Com...

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“…In spite of the implementation of additional criteria, such as flattening, snoring, paradoxical effort movements, arousal position relative to hypopnoeas and associated sleep stage (REM/non-REM), to distinguish between obstructive and central respiratory events [22], some misclassification may have biased the results with respect to the type of sleep apnoea.…”

Section: Sleep-related Disorders S Buchner Et Almentioning

confidence: 99%

“…In addition, hypopnoeas were classified as obstructive if there was out-of-phase motion of the ribcage and abdomen, or if airflow limitation was present. In order to achieve optimal distinction between obstructive and central hypopnoeas without using an oesophageal balloon, we used additional criteria, such as flattening, snoring, paradoxical effort movements, arousal position relative to hypopnoeas and associated sleep stage (rapid eye movement (REM)/non-REM) [22]. CSA was defined as .50% central apnoeas and hypopnoeas of all apnoeas and hypopnoeas.…”

Section: Patientsmentioning

confidence: 99%

Natural course of sleep-disordered breathing after acute myocardial infarction

et al. 2012

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The aim of this study was to test whether an improvement of left ventricular ejection fraction (EF) in the early phase after acute myocardial infarction is associated with a reduction of the severity of central and obstructive sleep apnoea.40 consecutive patients with acute myocardial infarction underwent polysomnography and cardiovascular magnetic resonance imaging within 5 days and 12 weeks after the event to assess sleep apnoea and cardiac function. We stratified the sample in patients who improved their left ventricular EF within 12 weeks by o5% (improved EF group, DEF 9¡1%, n516) and in those who did not (unchanged EF group, DEF -1¡1%, n524).Prevalence of sleep apnoea (o15 apnoea and hypopnoea events?h -1 ) within f5 days after myocardial infarction was 55%. Apnoea and hypopnoea events?h -1 were significantly more reduced in the improved EF group compared with the unchanged EF group (-10¡3 versus 1¡3 events?h -1 ; p50.036). This reduction was based on a significant alleviation of obstructive events (-7¡2 versus 4¡3 events?h -1 ; p50.009), while the reduction of central events was similar between groups (p50.906).An improvement of cardiac function early after myocardial infarction is associated with an alleviation of sleep apnoea. This finding suggests that re-evaluation of treatment indication for sleep apnoea is needed when a change in cardiac function occurs.

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Evaluation of a Noninvasive Algorithm for Differentiation of Obstructive and Central Hypopneas

Abstract: Randerath WJ; Treml M; Priegnitz C; Stieglitz S; Hagmeyer L; Morgenstern C. Evaluation of a noninvasive algorithm for differentiation of obstructive and central hypopneas. SLEEP 2013;36(3):363-368.

Cited by 75 publications

References 29 publications

Phenotyping of Sleep‐Disordered Breathing in Patients With Chronic Heart Failure With Reduced Ejection Fraction—the SchlaHF Registry

Phenotyping of Sleep‐Disordered Breathing in Patients With Chronic Heart Failure With Reduced Ejection Fraction—the SchlaHF Registry

High Hypopnea/Apnea Ratio (HAR) in Extreme Obesity

Natural course of sleep-disordered breathing after acute myocardial infarction

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