Central Sleep Apnea with Cheyne-Stokes Breathing in Heart Failure – From Research to Clinical Practice and Beyond

2018 ◽  
pp. 327-351 ◽  
Author(s):  
K. Terziyski ◽  
A. Draganova
Keyword(s):  
Heart Failure ◽  
Clinical Practice ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Cheyne Stokes Breathing

scholarly journals 1238 Central sleep apnea with Cheyne Stokes breathing in a pediatric patient with heart failure

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A472-A472
Author(s):  
Weston T Powell ◽  
Maida Chen ◽  
Erin MacKintosh
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Heart Transplantation ◽  
Dilated Cardiomyopathy ◽  
Acute Heart Failure ◽  
Pediatric Patient ◽  
Central Sleep Apnea ◽  
Supplemental Oxygen ◽  
Adult Patients ◽  
Cheyne Stokes Breathing

Abstract Introduction Central sleep apnea due to Cheyne-Stokes breathing (CSA-CSB) commonly occurs in adult patients with chronic heart failure, but has rarely been described in children. We describe a case of CSA-CSB in a pediatric patient with dilated cardiomyopathy and acute heart failure. Report of Case A 12-year-old is admitted to the intensive care unit in the setting of new diagnosis of dilated cardiomyopathy leading to acute systolic and diastolic heart failure requiring inotropic infusions. After admission she is noted to have self-resolving desaturations on continuous pulse oximetry while asleep. Sleep medicine is consulted for further evaluation. She has desaturations during naps and night-time sleep that are not associated with any snoring, congestion, cough, choking, or gagging. She underwent adenotonsillectomy 7 years prior. Her father has dilated cardiomyopathy. Current medications are spironolactone, furosemide, ranitidine, loratadine, enoxaparin, milrinone and epinephrine infusion. Physical exam reveals an obese girl with absent tonsils, clear breath sounds, and tachycardia. Cardiac MRI showed severely dilated left ventricle with global hypokinesia and depressed function (EF 7%). Polysomnography reveals AHI 24.2/hr, with oAHI 0/hr and cAHI 24.2/hr. No snoring, flow limitation, or thoracoabdominal paradox is seen. Cheyne-Stokes respiration is present leading to diagnosis of CSA-CSB. Supplemental oxygen is provided to blunt desaturations. While waiting for titration PSG she underwent placement of a left ventricular assist device and orthotopic heart transplantation. Following heart transplantation she had resolution of desaturations while asleep without supplemental oxygen; family declined repeat polysomnography. Conclusion Central sleep apnea with Cheyne-Stokes breathing is associated with increased mortality in adult patients with heart failure and provides important prognostic information if identified. The prevalence of central sleep apnea and its implications are unknown in pediatric patients and our case highlights the need to consider sleep disordered breathing as a cause of desaturations in patients with acute heart failure.

scholarly journals Identifying Predictors of Central Sleep Apnea/Cheyne-Stokes Breathing in Chronic Heart Failure: a Pathophysiological Approach

Folia Medica ◽  
2016 ◽  
Vol 58 (4) ◽  
pp. 225-233 ◽  
Author(s):  
Aneliya I. Draganova ◽  
Kiril V. Terziyski ◽  
Stefan S. Kostianev
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Chronic Heart Failure ◽  
Treatment Options ◽  
Central Sleep Apnea ◽  
Feedback Gain ◽  
Major Health Problem ◽  
Obstructive Sleep ◽  
Co Morbidity ◽  
Cheyne Stokes Breathing

AbstractChronic heart failure (CHF) is a major health problem associated with increased mortality, despite modern treatment options. Central sleep apnea (CSA)/Cheyne-Stokes breathing (CSB) is a common and yet largely under-diagnosed co-morbidity, adding significantly to the poor prognosis in CHF because of a number of acute and chronic effects, including intermittent hypoxia, sympathetic overactivation, disturbed sleep architecture and impaired physical tolerance. It is characterized by repetitive periods of crescendo-decrescendo ventilatory pattern, alternating with central apneas and hypopneas. The pathogenesis of CSA/CSB is based on the concept of loop gain, comprising three major components: controller gain, plant gain and feedback gain. Laboratory polysomnography, being the golden standard for diagnosing sleep-disordered breathing (SDB) at present, is a costly and highly specialized procedure unable to meet the vast diagnostic demand. Unlike obstructive sleep apnea, CSA/CSB has a low clinical profile. Therefore, a reliable predictive system is needed for identifying CHF patients who are most likely to suffer from CSA/CSB, optimizing polysomnography use. The candidate predictors should be standardized, easily accessible and low-priced in order to be applied in daily medical routine.The present review focuses on a pathophysiological approach to the selection of some predictors based on parameters reflecting the etiology, the pathogenesis and the consequences of CSA/CSB in CHF.

Central Sleep Apnea in Heart Failure

2009 ◽  
Vol 6 (2) ◽  
pp. 72-78 ◽  
Author(s):  
Rami Khayat ◽  
Andrew Pederzoli ◽  
William Abraham ◽  
◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Central Sleep Apnea

P-54 Efficacy of Adaptive-Servo Ventilation for Cheyne Stokes Respiration with Central Sleep Apnea Among Patients with Heart Failure

2009 ◽  
Vol 4 ◽  
pp. S67
Author(s):  
Shingo Nakagawa ◽  
Yoshiko Nakagawa ◽  
Keisuke Ishimaru ◽  
Haruo Nakagawa ◽  
Takatoshi Kasai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Adaptive Servo Ventilation ◽  
Patients With Heart Failure

Impact of sleeping position on central sleep apnea/Cheyne–Stokes respiration in patients with heart failure

2010 ◽  
Vol 11 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Shuji Joho ◽  
Yoshitaka Oda ◽  
Tadakazu Hirai ◽  
Hiroshi Inoue
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Sleeping Position ◽  
Patients With Heart Failure

833 Evolution of sleep disordered breathing types in heart failure

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A324-A325
Author(s):  
Pratibha Anne ◽  
Rupa Koothirezhi ◽  
Ugorji Okorie ◽  
Minh Tam Ho ◽  
Brittany Monceaux ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Left Ventricular Assist Device ◽  
Ventricular Assist Device ◽  
Central Sleep Apnea ◽  
Sleep Apnoea ◽  
Left Ventricular ◽  
Assist Device ◽  
Ventricular Assist ◽  
Left Ventricular Assist

Abstract Introduction Central sleep apnea is commonly seen in patients with heart failure. Here we present a case demonstrating shifting of predominant apneic events from central to obstructive type after placement of left ventricular assist device (LVAD) in end stage heart failure patient. Report of case(s) Case Presentation: 66 year-old African American male has past medical history of chronic congestive heart failure diabetes, hypertension, paroxysmal atrial fibrillation, anemia, hypothyroidism, chronic kidney disease and sleep apnea. Prior to his LVAD placement, his left ventricular ejection fraction (EF) was <10%. Patient was diagnosed with central sleep apnea with AHI of 58 (with 92% of apneic events being central events), oxygen nadir of 74%. Subsequently, patient had LVAD placed for symptomatic heart failure and repeat polysomnogram repeated at six month demonstrated an improved AHI of 45.8 with predominantly obstructive and mixed apneic events, with only 12.5% being central events. Conclusion This case report highlights not only the improvement of the sleep apnea in CHF treated with LVAD but also shows the shift of apneic events from predominantly central to obstructive type post LVAD. Support (if any) 1. Henein MY, Westaby S, Poole-Wilson PA, Cowie MR, Simonds AK. Resolution of central sleep apnoea following implantation of a left ventricular assist device. Int J Cardiol. 2010 Feb 4;138(3):317–9. PMID: 18752859. 2. Köhnlein T, Welte T, Tan LB, Elliott MW. Central sleep apnoea syndrome in patients with chronic heart disease: a critical review of the current literature. Thorax. 2002 Jun;57(6):547–54. PMID: 12037232 3. Monda C, Scala O, Paolillo S, Savarese G, Cecere M, D’Amore C, Parente A, Musella F, Mosca S, Filardi PP. Apnee notturne e scompenso cardiaco: fisiopatologia, diagnosi e terapia [Sleep apnea and heart failure: pathophysiology, diagnosis and therapy]. G Ital Cardiol (Rome). 2010 Nov;11(11):815–22. Italian. PMID: 21348318.

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