Influence of Pulmonary Capillary Wedge Pressure on Central Apnea in Heart Failure

Abstract

Background-Recent studies suggest that acute pulmonary congestion induces hyperventilation and that hyperventilationrelated hypocapnia leads to ventilatory control instability and central sleep apnea. Whether chronic pulmonary congestion due to congestive heart failure (CHF) is associated with central apnea is unknown. We hypothesized that CHF patients with central apnea would have greater pulmonary capillary wedge pressure (PCWP) than patients without central apnea and that PCWP would correlate with central apnea severity. Methods and Results-Seventy-five stable CHF patients underwent right heart catheterization and, on the basis of overnight sleep studies, were divided into central apnea (nϭ33)

Sleep Apnea and Cardiovascular Disease

“…171 Compared with heart failure patients with OSA, those with CSA may be more likely to be male and older and to have a lower BMI 47,334 and a higher pulmonary capillary wedge pressure. 340 Little is known about risk factors for CSA in persons without heart failure, and data on the prevalence and characteristics of CSA in other types of cardiovascular disease are sparse.…”

“…The introduction of angiotensin-converting enzyme inhibition can lower the AHI and reduce the nocturnal desaturation of patients with mild to moderate heart failure. 354 Diuresis with a reduction in cardiac filling pressure also has been shown to reduce the severity of CSA, 340 but in some patients, the resulting metabolic alkalosis may promote CSA by narrowing the difference between ambient PaCO 2 and the PaCO 2 threshold for apnea. 355,356 ␤-Adrenergic blockade, which counters excess sympathetic activation and may modulate ventilatory responses in heart failure, 18 has been reported to decrease AHI in patients with CSA.…”

Central Sleep Apnea in Left Ventricular Dysfunction

“…In patients with overt heart failure, CSA correlated with pulmonary capillary wedge pressure, as measured by invasive 22 and noninvasive 23,24 approaches. In our present study of patients with LV dysfunction without overt heart failure, the presence and severity of CSA was not associated with increased ventricular impairment or hemodynamic indices of increased filling pressure (Figure 2).…”

“…27 This tendency to hyperventilate has been attributed in part to the afferent stimulation from pulmonary venous congestion. 22 However, CSA-CSR does not always occur in patients with severely compromised hemodynamic and pulmonary congestion. 28 Indeed, an enhanced ventilatory chemoreflex response to CO 2 may play a crucial role in the development of CSA-CSR in heart failure.…”

Impact of sacubitril–valsartan combination in patients with chronic heart failure and sleep apnoea syndrome: the ENTRESTO‐SAS study design

“…Two preliminary studies have reported that ACE inhibitors could improve SDB in CHF 15, 16. To the best of our knowledge, the effect of sacubitril–valsartan on SDB has never been investigated in a prospective study despite the fact that this drug combination has the potential to correct SDB in CHF patients.…”