Impact of untreated sleep apnea on prognosis of patients with congestive heart failure

Luo, Qin; Zhang, Hongliang; Tao, Xincao; Zhao, Zhihui; Yang, Yuejin; Liu, Zhihong

doi:10.1016/j.ijcard.2009.03.050

Cited by 29 publications

(14 citation statements)

References 13 publications

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“…Most studies recruited outpatients from heart failure clinics, but some included hospitalized patients and the severity of heart failure, assessed either by echocardiography or clinically, varied widely. The apnea-hypopnea index (AHI) that defined sleep apnea ranged from 15 to 5 cycles per hour and, accordingly, the prevalence varied from 47 to 82% and from 21 to 66% for sleep-disordered breathing and CSR in patients with CHF, respectively [2,3,11,12,13,14,15,16,17,18,19,20,21] (fig. 2).…”

Section: Prevalence and Importance Of Chf And Csrmentioning

confidence: 99%

“…For example, the estimated mortality of a patient with a left atrial area of 55 cm 2 and 40 cycles per hour of CSR was more than 4 times higher than the mortality of a patient with a similar left atrial area but no CSR. Table 1 summarizes the most recent studies on the impact of CSR on survival in patients with heart failure who were treated with all current standard cardiac medications [5,19,21,43,44,45,46]. The outcome was either death or cardiac transplantation.…”

Section: Prognosis Of Patients With Csr and Chfmentioning

confidence: 99%

“…The outcome was either death or cardiac transplantation. The majority of studies found an increased mortality with a hazard ratio of 2.1–5.7 for CSR with only two exceptions [19,21]. Patients and methods varied between studies, which may explain the different outcomes.…”

Section: Prognosis Of Patients With Csr and Chfmentioning

confidence: 99%

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Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Brack¹,

Randerath

Bloch

2011

Respiration

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Cheyne-Stokes respiration (CSR) is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment.

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Section: Prevalence and Importance Of Chf And Csrmentioning

confidence: 99%

Section: Prognosis Of Patients With Csr and Chfmentioning

confidence: 99%

See 1 more Smart Citation

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Brack¹,

Randerath

Bloch

2011

Respiration

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“…In contrast, other cohort studies, after controlling for common confounding factors in younger patients with CSA and congestive heart failure [22] or CSA and stroke [12] did not observe higher mortality rates in comparison to those with no-SDB. However, in latter cohorts followed for up to 10 years, some CSA patients continued with CPAP therapy at home for up to five years.…”

Section: Mortalitymentioning

confidence: 62%

Morbidity and Predicted Mortality in Older Adults with Central Sleep Apnea

S¹,

Dauphinot

Gooneratne³

et al. 2013

J Sleep Disorders Ther

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Brief SummaryCurrent knowledge/study rationale Sleep-Disordered Breathing (SDB) in general and Central Sleep Apnea (CSA) in particular are known to increase with advancing age. The information concerning the morbidity and mortality associated with CSA in older populations is scarce and inconsistent. It is not known if CSA-related mortality is greater than Obstructive Sleep Apnea (OSA) related mortality in the elderly. Study impactOur study using a prognostic mortality risk index demonstrates that CSA diagnosed by full polysomnography is a major and independent risk factor for mortality in older adults. Untreated CSA compared with OSA is also significantly associated with stroke and hypertension. IntroductionThe prevalence of Sleep-Disordered Breathing (SDB), defined as an Apnea-Hypopnea index (AHI) of 15 or greater, is 23% in the community-dwelling older over the age of 70 [1]. Central Sleep Apnea (CSA), a form of SDB, can affect more than one third of these elderly patients with SDB [1]. The prevalence, severity and costs of CSA will likely escalate as the older adult population increases in number and lives longer.CSA is characterized on the polysomnogram by recurrent cessation of respiration during sleep with no associated ventilatory effort. In contrast obstructive sleep apnea (OSA) is defined as repetitive episodes of upper airway obstruction with ongoing respiratory efforts [2]. In OSA patients the repetitive upper airway collapse occurs during sleep because negative pressure generated during inspiration is not effectively counteracted by splinting by pharyngeal dilators, especially when narrowing occurs as a result of excessive soft tissue (e.g. obesity, loss of soft tissue elasticity related to age) or vulnerable craniofacial anatomy (e.g. edentulous older adults). In both cases, the Continuous Positive Airway Pressure (CPAP) is the most widely used treatment even in older adults. Furthermore, bilevel positive airway pressure (BiPAP) in a spontaneous-timed mode and Adaptive Servo-Ventilation (ASV) which generates positive airway pressure with variable pressure in response to a patient's expiration are increasingly recommended in order to ameliorate central respiratory events related to chronic heart failure. AbstractObjectives: To assess cardiovascular morbidity and prognostic mortality risk in older patients with CSA in comparison to those with OSA and without any SDB (apnea-hypopnea index <15/hour).Background: Sleep-Disordered Breathing (SDB), including both Central Sleep Apnea (CSA) and Obstructive Sleep Apnea (OSA), is a prevalent condition in older adults. In contrast to OSA, the information concerning the morbidity and mortality associated with CSA is scarce and inconsistent.

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“…The role of cardiac dysfunctions can also be considered as a possible determinant of sleep-disordered breathing but there are studies suggesting a role of SRBD, in particular of changes in intrathoracic pressure associated with hypoxia, in determining alterations in left and right ventricular mechanics [17].…”

Section: Srbd and Hypertensionmentioning

confidence: 99%