Nocturnal Rostral Fluid Shift

Yumino, Dai; Redolfi, Stefania; Ruttanaumpawan, Pimon; Su, Ming‐Yao; Smith, Stephanie Shintani; Newton, Gary E.; Mak, Susanna; Bradley, T. Douglas

doi:10.1161/circulationaha.109.902452

Cited by 397 publications

(159 citation statements)

References 43 publications

(57 reference statements)

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“…2009; Yumino et al. 2010); the APmean correlated with neck circumference, which has been noted before in healthy volunteers (Shiota et al. 2007).…”

Section: Discussionsupporting

confidence: 77%

“…Other researchers have speculated that not all lower leg fluid shifts to the tissues of the neck, and that some may be redistributed to other body compartments such as the abdomen and the thoracic cavity (Yumino et al. 2010; Kasai et al. 2012).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, therapeutic levels of CPAP have been shown to attenuate fluid shift in CHF patients with OSA (Yumino et al. 2010) and CPAP near to or at therapeutic levels are required for the holding pressure in the passive Pcrit technique. In order to allow as much overnight rostral fluid shift to occur as possible, we only supplied CPAP at holding pressures during the actual Pcrit measurements.…”

Section: Limitationsmentioning

confidence: 99%

“…In CHF patients with OSA, and CHF patients with central sleep apnea (CSA), an overnight decrease in leg fluid volume has been found to correlate with the AHI (Yumino et al. 2010). However, to the best of our knowledge, no measurements of pharyngeal collapsibility or pharyngeal caliber have been reported in CHF patients, nor have these measurement been made across the night.…”

Section: Introductionmentioning

confidence: 99%

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Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

et al. 2017

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The increased prevalence of obstructive sleep apnea (OSA) in congestive heart failure (CHF) may be associated with rostral fluid shift. We investigated the effect of overnight rostral fluid shift on pharyngeal collapsibility (Pcrit), pharyngeal caliber (APmean), and apnea‐hypopnea index (AHI) in CHF patients. Twenty‐three optimally treated systolic CHF patients were studied. Neck circumference was measured immediately prior to sleep in the evening and immediately after waking in the morning as a marker of rostral fluid shift. Pcrit was measured during sleep, early and late in the night. APmean was measured using acoustic reflection at the same times as neck circumference measurements. 15/23 CHF patients experienced an overnight increase in neck circumference; overall neck circumference significantly increased overnight (mean±SD, evening: 41.7 ± 3.2 cm; morning: 42.3 ± 3.1 cm; P = 0.03). Pcrit increased significantly overnight (early‐night: −3.8 ± 3.3 cmH2O; late‐night: −2.6 ± 3.0 cmH2O; P = 0.03) and APmean decreased (evening: 4.2 ± 1.3 cm2; morning: 3.7 ± 1.3 cm2; P = 0.006). The total AHI correlated with neck circumference (r = 0.4; P = 0.04) and Pcrit (r = 0.5; P = 0.01). APmean correlated with neck circumference (r = −0.47; P = 0.02). There was no significant change in AHI between the first and second half of the night (first‐half: 12.9 ± 12.4/h; second‐half: 13.7 ± 13.3/h; P = 0.6). Overnight rostral fluid shift was associated with increased pharyngeal collapsibility and decreased pharyngeal caliber during sleep in CHF patients. Rostral fluid shift may be an important mechanism of OSA in this patient group.

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“…2009; Yumino et al. 2010); the APmean correlated with neck circumference, which has been noted before in healthy volunteers (Shiota et al. 2007).…”

Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

et al. 2017

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“…A series of studies have demonstrated that in healthy males and in those with HF, there is significant fluid shift from the lower limbs during sleep, which corresponds to an increase in neck circumference. 59, 60 In HF patients, the degree of fluid shift from the legs appeared to correlate well with both increasing severity of OSA and CSA. While the change in OSA can be explained by increasing upper airway resistance due to neck oedema, 24 how fluid shifts affect CSA is less clear.…”

Section: Sleep Disordered Breathingmentioning

confidence: 95%

Heart Failure and the Lung

Kee

Naughton

2010

Circ J

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Heart failure (HF) is a highly prevalent disease that leads to significant morbidity and mortality. There is increasing evidence that the symptoms of HF are exacerbated by its deleterious effects on lung function. HF appears to cause airway obstruction acutely and leads to impaired gas diffusing capacity and pulmonary hypertension in the longer term. It is postulated that this is the result of recurrent episodes of elevated pulmonary capillary pressure leading to pulmonary oedema and pulmonary capillary stress fracture, which produces lung fibrosis. It is likely that impaired lung function impairs the functional status of HF patients and makes them more prone to central sleep apnoea. (Circ J 2010; 74: 2507 - 2516

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