Sleep apnoea in heart failure: To treat or not to treat?

Naughton, Matthew T.; Kee, Kirk

doi:10.1111/resp.12964

Cited by 44 publications

(38 citation statements)

References 93 publications

(168 reference statements)

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“…41 Central sleep apnea occurs in the absence of significant upper airway obstruction, commonly reflecting exaggerated respiratory chemosensitivity associated with cardiac dysfunction and pulmonary congestion. 42 CSA-CSR is associated with sleep fragmentation and sympathetic nervous system activation that chronically could be deleterious to the failing heart. Indeed, previous investigations suggest that CSA-CSR is a strong independent marker of mortality in patients with heart failure.…”

Section: Treatment Of Central Apnea In Heart Failure Patients With Cementioning

confidence: 99%

“…43 Thus, suppression of central sleep apneas is suggested as a physiologically appropriate target for the treatment of patients with heart failure. This treatment can be considered at two levels: 42 The first approach is to aggressively treat the heart failure, a major contributor if not the cause of CSA-CSR. Optimizing heart failure with guideline-based medications, as well as coronary revascularization and cardiac resynchronization therapy in selected patients, may improve CSA-CSR.…”

Section: Treatment Of Central Apnea In Heart Failure Patients With Cementioning

confidence: 99%

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Sleep Apnea and Cardiovascular Disease

et al. 2017

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Emerging research highlights the complex inter-relationships between sleep disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patients presenting to cardiology clinics have a high prevalence of obstructive (OSA) and central sleep apnea associated with Cheyne-Stokes Respiration (CSA-CSR). Multiple mechanisms have been identified by which sleep disturbances adversely affect cardiovascular structure and function. Epidemiological research indicates that OSA is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke and atrial fibrillation. CSA-CSR predicts incident heart failure and atrial fibrillation; among patients with heart failure, CSA-CSR strongly predicts mortality. Thus, a strong literature provides the mechanistic and empirical bases for considering OSA and CSA-CSR as potentially modifiable risk factors for cardiovascular disease. Data from small trials provide evidence that treatment of OSA with continuous positive airway pressure (CPAP) not only improves patient-reported outcomes such as sleepiness, quality of life and mood, but also improves intermediate cardiovascular endpoints such as blood pressure, cardiac ejection fraction, vascular parameters and arrhythmias. However, data from large scale randomized controlled trials do not currently support a role for positive pressure therapies for reducing cardiovascular mortality. The results of two recent large randomized controlled trials, published in 2015 and 2016, raise questions on the effectiveness of pressure therapies in reducing clinical endpoints, although one supported the beneficial effect of CPAP on quality of life, mood, and work absenteeism. This review provides a contextual framework for interpreting the results of recent studies, key clinical messages, and suggestions for future sleep and cardiovascular research, which include further consideration of individual risk factors, use of existing and new multi-modality therapies which also address adherence, and implementation of trials that are sufficiently powered to target endpoints and to support subgroup analyses. These goals may best be addressed through strengthening collaboration among cardiology, sleep medicine and clinical trial communities.

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Section: Treatment Of Central Apnea In Heart Failure Patients With Cementioning

confidence: 99%

Section: Treatment Of Central Apnea In Heart Failure Patients With Cementioning

confidence: 99%

Sleep Apnea and Cardiovascular Disease

et al. 2017

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“…This trend will represent an opportunity for the sleep field, for example treatment of OSA, which reduces perioperative complications, at least in some individuals . Similarly, addressing sleep disorders in congestive heart failure, diabetes, COPD and accelerated cognitive decline may serve to improve the wellbeing of these patients from the standpoint of quality of care and health outcomes …”

Section: Value‐based Purchasing and Quality Improvementmentioning

confidence: 99%

Update in respiratory sleep disorders: Epilogue to a modern review series

2017

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“…Central apnea/hypopnea assuming the pattern of Cheyne Stokes breathing (CSB) is an independent risk condition for mortality in patients with chronic heart failure with a prevalence similar to obstructive sleep apnea or hypopnea (OSA) reaching 30% [1–3]. CSB has also been described in patients who have experienced cerebrovascular accidents and among those with end-stage renal disease [4].…”

Section: Introductionmentioning

confidence: 99%

Monitoring mandibular movements to detect Cheyne-Stokes Breathing

Martinot

Borel

Le-Dong³

et al. 2017

Respir Res

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BackgroundThe patterns of mandibular movements (MM) during sleep can be used to identify increased respiratory effort periodic large-amplitude MM (LPM), and cortical arousals associated with “sharp” large-amplitude MM (SPM). We hypothesized that Cheyne Stokes breathing (CSB) may be identified by periodic abnormal MM patterns. The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard.The present study aims to evaluate prospectively the concordance between CSB detected by periodic MM and polysomnography (PSG) as gold-standard.MethodsIn 573 consecutive patients attending an in-laboratory PSG for suspected sleep disordered breathing (SDB), MM signals were acquired using magnetometry and scored manually while blinded from the PSG signal. Data analysis aimed to verify the concordance between the CSB identified by PSG and the presence of LPM or SPM. The data were randomly divided into training and validation sets (985 5-min segments/set) and concordance was evaluated using 2 classification models.ResultsIn PSG, 22 patients (mean age ± SD: 65.9 ± 15.0 with a sex ratio M/F of 17/5) had CSB (mean central apnea hourly indice ± SD: 17.5 ± 6.2) from a total of 573 patients with suspected SDB. When tested on independent subset, the classification of CSB based on LPM and SPM is highly accurate (Balanced-accuracy = 0.922, sensitivity = 0.922, specificity = 0.921 and error-rate = 0.078). Logistic models based odds-ratios for CSB in presence of SPM or LPM were 172.43 (95% CI: 88.23–365.04; p < 0.001) and 186.79 (95% CI: 100.48–379.93; p < 0.001), respectively.ConclusionCSB in patients with sleep disordered breathing could be accurately identified by a simple magnetometer device recording mandibular movements.

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Sleep apnoea in heart failure: To treat or not to treat?

Cited by 44 publications

References 93 publications

Sleep Apnea and Cardiovascular Disease

Sleep Apnea and Cardiovascular Disease

Update in respiratory sleep disorders: Epilogue to a modern review series

Monitoring mandibular movements to detect Cheyne-Stokes Breathing

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