Haemodynamic effects of nasal continuous positive airway pressure in severe congestive heart failure

Liston, Richard; Deegan, Paul; McCreery, Christopher P.; Costello, Renee; Maurer, B.; McNicholas, WT

doi:10.1183/09031936.95.08030430

Cited by 54 publications

(43 citation statements)

References 24 publications

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“…Atrial fibrillation (AF) has been shown to occur frequently in CHF patients with CSR-CSA [115,127]. It has been evidenced that AF represents a predictive factor for CSR-CSA and also a risk factor for decreasing cardiac output when treating these subjects with CPAP [128]. LEUNG et al [129] showed a markedly increased prevalence of AF among patients with idiopathic CSA in the absence of CHF.…”

Section: Consequencesmentioning

confidence: 99%

Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives

Lévy¹,

Pépin²,

Arnaud³

et al. 2008

European Respiratory Journal

168

111

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There are three major types of sleep-disordered breathing (SDB) with respect to prevalence and health consequences, i.e. obstructive sleep apnoea syndrome (OSAS), CheyneStokes respiration and central sleep apnoea (CSR-CSA) in chronic heart failure, and obesity hypoventilation syndrome (OHS). In all three conditions, hypoxia appears to affect body functioning in different ways. Most of the molecular and cellular mechanisms that occur in response to SDB-related hypoxia remain unknown.In OSAS, an inflammatory cascade mainly dependent upon intermittent hypoxia has been described. There is a strong interaction between haemodynamic and inflammatory changes in promoting vascular remodelling. Moreover, during OSAS, most organ, tissue or functional impairment is related to the severity of nocturnal hypoxia. CSR-CSA occurring during heart failure is primarily a consequence of cardiac impairment. CSR-CSA has deleterious consequences for cardiac prognosis and mortality since it favours sympathetic activation, ventricular ectopy and atrial fibrillation. Although correction of CSR-CSA seems to be critical, there is a need to establish therapy guidelines in large randomised controlled trials.Finally, OHS is a growing health concern, owing to the worldwide obesity epidemic and OHS morbidities. The pathophysiology of OHS remains largely unknown. However, resistance to leptin, obesity and severe nocturnal hypoxia lead to insulin resistance and endothelial dysfunction. In addition, several adipokines may be triggered by hypoxia and explain, at least in part, OHS morbidity and mortality.Overall, chronic intermittent hypoxia appears to have specific genomic effects that differ notably from continuous hypoxia. Further research is required to fully elucidate the molecular and cellular mechanisms.

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Section: Consequencesmentioning

confidence: 99%

Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives

Lévy¹,

Pépin²,

Arnaud³

et al. 2008

European Respiratory Journal

168

111

View full text Add to dashboard Cite

show abstract

“…43,44 Conversely, it has also been reported that cardiac output may be reduced in some patients with severe congestive heart failure and that no effect is evident with CPAP in control subjects. 45,46 Renal blood flow and function have also been reported to decrease with increasing CPAP air pressure. 47 Until further information is available concerning the effects of CPAP on renal and cardiac function, it is difficult to make recommendations; however, CPAP is currently the most effective treatment for OSA, and the issues highlighted by this small number of studies are likely to be applicable only in patients with significant comorbidities.…”

Section: Confirmation Of Initial Diagnosismentioning

confidence: 99%

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

Culpepper¹,

Roth²

2009

Prim. Care Companion J. Clin. Psychiatry

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Objective: This review aims to impart information regarding recognition of obstructive sleep apnea (OSA) and associated excessive sleepiness (ES) in the primary care setting in order to provide optimal care to patients with this common but serious condition. This review will also discuss the prevalence and treatment of depression in patients with OSA.Data Sources: A MEDLINE search of articles published between 1990 and 2008 was conducted using the search terms obstructive sleep apnea AND excessive sleepiness, obstructive sleep apnea AND depression, and obstructive sleep apnea AND primary care. Searches were limited to articles in English concerned with adult patients.Study Selection: In total, 239 articles were identified. Articles concerning other sleep disorders and forms of apnea were excluded. The reference lists of identified articles were searched manually to find additional articles of interest.Data Synthesis: Primary care physicians can aid in the diagnosis of OSA and associated ES by being vigilant for lifestyle and physical risk factors associated with this condition. In addition, primary care physicians should maintain a high level of clinical suspicion when presented with illnesses that are commonly comorbid with OSA, such as psychiatric disorders and depression, in particular. Conversely, assessment of patients with OSA for common comorbidities may also improve a patient's prognosis and quality of life.Conclusions: Primary care physicians play a vital role in recognizing OSA and ES. These clinicians are crucial in supporting their patients during treatment by ensuring that they have clear, concise information regarding available therapies and the correct application and maintenance of prescribed devices.

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“…Further exclusion criteria were myocardial infarction within 6 months of study entry, severe ventricular arrhythmia, atrial fibrillation [16], cardiac valve replacement, current smoking, known or a strong clinical suspicion of obstructive sleep apnoea (w10 obstructive apnoeas per hour of sleep or w10% of all detected apnoeas being obstructive in nature), diabetes mellitus, and (suspicion of) alcohol or drug abuse. Patients with any noncardiologic medication that would have a possible influence on the control of breathing (e.g.…”

Section: Subjectsmentioning

confidence: 99%

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

Köhnlein¹,

Welte²,

Tan³

et al. 2002

European Respiratory Journal

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Patients with chronic congestive cardiac failure (CCF) frequently suffer from central sleep apnoea syndrome (CSAS). Continuous positive airway pressure (CPAP) has been suggested as a treatment. The authors hypothesised that bilevel ventilation might be easier to initiate and superior to CPAP at correcting the sleeprelated abnormality of breathing in patients with CCF.After excluding those with a history suggestive of obstructive sleep apnoea, 35 patients with CCF (left ventricular ejection fraction v35%) were screened with overnight oximetry and the diagnosis of CSAS was established with polysomnography in 18. Two 14-day cycles of CPAP (0.85 kPa (8.5 mbar)) or bilevel ventilation (0.85/0.3 kPa (8.5/3 mbar)) in random order, were compared in a crossover study.Sixteen patients (13 males), mean age 62.0 ¡ 7.4 yrs completed the study. The pretreatment apnoea/hypopnoea index of 26.7¡10.7 was significantly reduced by CPAP and bilevel ventilation to 7.7¡5.6 and 6.5¡6.6, respectively. The arousal index fell from 31.1¡10.0 per hour of sleep to 15.7¡5.4 and 16.4¡6.9, respectively. Significant and equal improvements with CPAP and bilevel ventilation were found for sleep quality, daytime fatigue, circulation time and New York Heart Association class.The authors conclude that continuous positive airway pressure and bilevel ventilation equally and effectively improve Cheyne-Stokes respiration in patients with congestive cardiac failure. Eur Respir J 2002; 20: 934-941.

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Haemodynamic effects of nasal continuous positive airway pressure in severe congestive heart failure

Cited by 54 publications

References 24 publications

Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives

Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives

Recognizing and Managing Obstructive Sleep Apnea in Primary Care

Assisted ventilation for heart failure patients with Cheyne-Stokes respiration

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