Shift in sleep apnoea type in heart failure patients in the CANPAP trial

Ryan, Clodagh M.; Floras, John S.; Logan, Alexander G.; Kimoff, R. John; Sériès, Frédéric; Morrison, Debra; Ferguson, Kathleen A.; Belenkie, Israel; Pfeifer, Michael; Fleetham, John A.; Hanly, Patrick J.; Smilovitch, Mark; Arzt, Michael; Bradley, T. Douglas

doi:10.1183/09031936.00070509

Cited by 59 publications

(31 citation statements)

References 22 publications

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“…14 -18 This is consistent with the observed inverse correlation between overnight change in LFV and mean PtcCO 2 and lowest SaO 2 during sleep. Our findings also help to explain why OSA and CSA can coexist in HF patients and why the predominant type can change over time, 8,9 possibly in relation to variations in the degree of fluid retention and overnight rostral fluid shift.…”

Section: Discussionmentioning

confidence: 67%

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Nocturnal Rostral Fluid Shift

Redolfi²,

et al. 2010

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Background-Obstructive sleep apnea (OSA) and central sleep apnea are common in patients with heart failure. We hypothesized that in such patients, severity of OSA is related to overnight rostral leg fluid displacement and increase in neck circumference, severity of central sleep apnea is related to overnight rostral fluid displacement and to sleep PCO 2 , and continuous positive airway pressure alleviates OSA in association with prevention of fluid accumulation in the neck. Methods and Results-In 57 patients with heart failure (ejection fraction Յ45%), we measured change in leg fluid volume and neck circumference before and after polysomnography, and we measured transcutaneous PCO 2 during polysomnography. Patients were divided into an obstructive-dominant group (Ն50% of apneas and hypopneas obstructive) and a central-dominant group (Ͼ50% of events central

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Section: Discussionmentioning

confidence: 67%

“…6,7 Despite their differing pathologies, patients with HF can have both types of sleep apnea, and the predominant type can shift from obstructive to central in association with a fall in PaCO 2 and an increase in circulation time, or vice versa. 8,9 These observations suggest that in HF, mechanisms for development of OSA and CSA may be linked.…”

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confidence: 93%

Nocturnal Rostral Fluid Shift

Redolfi²,

et al. 2010

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“…Many patients show a combination of different types of SDB breathing patterns that may change over the course of a night as well as over time 10. Although both OSA and CSA/CSR have been shown to be independent predictors of worse outcome in HF patients,11, 12, 13, 14, 15, 16 the different forms of SDB are likely to have different effects on the cardiovascular system 17.…”

Section: Introductionmentioning

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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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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“…A report from the recent clinical trial demonstrated a spontaneous conversion from predominantly CSA to OSA in 18% of a control group in association with a LVEF improvement. 5 Another study showed that improvement in cardiac function following cardiac transplantation in HF patients was accompanied by complete resolution of CSA or conversion to predominantly OSA. 2 The observations from both these reports, as well as our case, raise the possibility that, in patients with cardiac dysfunction, OSA and CSA may be part of the spectrum of periodic breathing, the pre-…”

Section: Discussionmentioning

confidence: 99%

Conversion from Predominant Central Sleep Apnea to Obstructive Sleep Apnea Following Valvuloplasty in a Patient with Mitral Regurgitation

Takahashi

Kasai

Dohi

et al. 2011

Journal of Clinical Sleep Medicine

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A few reports have shown that cardiac valve repair may improve central sleep apnea (CSA) in patients with valvular heart disease. It has been suggested that such improvements are associated with the improvement of cardiac function. We report the case of a 67-year-old man with mitral regurgitation, whose CSA converted to predominant obstructive sleep apnea following mitral valvuloplasty in association with a shortening of lung-to-fi nger circulation time. Keywords: Sleep apnea, mitral regurgitation, valvuloplasty Citation: Takahashi M; Kasai T; Dohi T; Maeno K; Kasagi S; Kawana F; Ishiwata S; Narui K. Conversion from predominant central sleep apnea to obstructive sleep apnea following valvuloplasty in a patient with mitral regurgitation.

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Shift in sleep apnoea type in heart failure patients in the CANPAP trial

Abstract: In patients with heart failure (HF), the predominant type of sleep apnoea can change over time in association with alterations in circulation time.

Cited by 59 publications

References 22 publications

Nocturnal Rostral Fluid Shift

Nocturnal Rostral Fluid Shift

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

Conversion from Predominant Central Sleep Apnea to Obstructive Sleep Apnea Following Valvuloplasty in a Patient with Mitral Regurgitation

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