A 53-year-old man with history of central sleep apnea and congestive heart failure

Abstract Introduction: Sleep breathing disorders occur in 45% of patients with heart failure, with 36%-50% manifesting Cheyne-Stokes respiration with central sleep apnea and 12% exhibiting obstructive sleep apnea. Several studies have shown that sleep pathophysiology may negatively affect the cardiovascular system and that cardiac dysfunction alters sleep and respiration. Objective: The aim of this study was to examine oxyhemoglobin desaturation during sleep in patients with congestive heart failure (CHF) using overnight pulse oximetry. Methods: Overnight pulse oximetry was conducted in the patients' homes with wrist pulse oximeters and finger probes that were placed around the forefingers of 15 patients with CHF and ejection fractions less than 50%, who were classified as New York Heart Association functional classes II and III. Results: The patients were divided into two groups. The first group consisted of seven patients with oxyhemoglobin desaturation indices of over 5 events/h, and the second group contained eight patients with oxyhemoglobin desaturation indices of 5 or less events/h. Student's t-tests did not show any significant differences between the groups. The patients' body mass indices correlated positively with the total desaturation episodes and desaturation time less than 90% and correlated negatively with the arterial oxygen saturation nadir. Conclusion: Pulse oximetry monitoring during sleep can be used to detect sleep breathing disorders in stable patients with CHF.

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Coexistence Of Central Sleep Apnea And Periodic Breathing Pattern In Patients With Congestive Heart Failure And Obstructive Sleep Apnea

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6706 ◽

2012 ◽

Author(s):

Michael Arzt ◽

Gerhard Weinreich ◽

Olaf Oldenburg ◽

Andrea Graml ◽

Helmut Teschler ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Breathing Pattern ◽

Central Sleep Apnea ◽

Periodic Breathing ◽

Obstructive Sleep

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Abstract 17143: Obstructive and Central Sleep Apnea and Risk of Incident Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.17143 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Patricia Tung ◽

Yamini S Levitzky ◽

Rui Wang ◽

Stuart F Quan ◽

Daniel J Gottlieb ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Health Study ◽

Apnea Hypopnea Index ◽

Community Based ◽

Obstructive Sleep ◽

History Of

INTRODUCTION: Prior studies have documented a higher prevalence of atrial fibrillation (AF) in those with obstructive sleep apnea (OSA). OSA has been associated with AF recurrence following cardioversion and ablation, and with prevalent and incident AF in cross-sectional and retrospective studies. Central sleep apnea (CSA) also has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have evaluated the association of CSA with AF in population studies. METHODS: We assessed the association of OSA and CSA with incident AF among 3,420 subjects without a history of AF in the Sleep Heart Health Study (SHHS), a prospective, community-based study designed to evaluate the cardiovascular consequences of sleep disordered breathing. Subjects underwent overnight polysomnography at baseline and were followed over time for the development of incident AF, documented at any time after baseline polysomnogram until the end of follow-up. OSA was defined as an obstructive apnea-hypopnea index ≥ 5 and CSA was defined as a central apnea index ≥ 5. RESULTS: At baseline, the sample include 1499 men (44.4%) with a mean age of 62.4 (±10.9); 1569 (45.9%) subjects met criteria for mild to severe OSA and 54 (1.6%) for CSA. Over a mean follow-up of 8.2 years, 382 cases of incident AF were identified. The prevalence of both OSA and CSA was higher among those who developed AF compared to those who did not (OSA 49% vs 44%, p=0.001 and CSA 5% vs 1.2%, p=0.001). After adjustment for multiple AF risk factors, CSA was associated with an approximately 2-fold increased odds of incident AF (RR=2.38, 95% CI, 1.15-4.94; p = 0.02). The association persisted after exclusion of 258 subjects with a history of heart failure (RR=2.78, 95% CI, 1.28-6.04; p = 0.01). We did not find a significant association of OSA with incident AF (Table). CONCLUSION: In our prospective, community-based cohort baseline CSA was associated with incident AF.

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Peripheral and Central Ventilatory Responses in Central Sleep Apnea with and without Congestive Heart Failure

American Journal of Respiratory and Critical Care Medicine ◽

10.1164/ajrccm.162.6.2002024 ◽

2000 ◽

Vol 162 (6) ◽

pp. 2194-2200 ◽

Cited By ~ 192

Author(s):

PETER SOLIN ◽

TEANAU ROEBUCK ◽

DAVID P. JOHNS ◽

E. HAYDN WALTERS ◽

MATTHEW T. NAUGHTON

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Ventilatory Responses

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Dynamic ventilatory response to CO2 in congestive heart failure patients with and without central sleep apnea

Journal of Applied Physiology ◽

10.1152/jappl.2001.91.1.408 ◽

2001 ◽

Vol 91 (1) ◽

pp. 408-416 ◽

Cited By ~ 30

Author(s):

Zbigniew L. Topor ◽

Linda Johannson ◽

Jerzy Kasprzyk ◽

John E. Remmers

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Response Duration ◽

Open Loop ◽

Loop Gain ◽

Loop Dynamics ◽

Dynamic Gain ◽

Ventilatory Response To Co2

Nonobstructive (i.e., central) sleep apnea is a major cause of sleep-disordered breathing in patients with stable congestive heart failure (CHF). Although central sleep apnea (CSA) is prevalent in this population, occurring in 40–50% of patients, its pathogenesis is poorly understood. Dynamic loop gain and delay of the chemoreflex response to CO2 was measured during wakefulness in CHF patients with and without CSA by use of a pseudorandom binary CO2 stimulus method. Use of a hyperoxic background minimized responses derived from peripheral chemoreceptors. The closed-loop and open-loop gain, estimated from the impulse response, was three times greater in patients with nocturnal CSA ( n = 9) than in non-CSA patients ( n = 9). Loop dynamics, estimated by the 95% response duration time, did not differ between the two groups of patients. We speculate that an increase in dynamic gain of the central chemoreflex response to CO2 contributes to the genesis of CSA in patients with CHF.

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