1144 Central Sleep Apnea in a Pediatric Patient With Acute Heart Failure

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.

Download Full-text

A Case Report: Adaptive Servo Ventilation for a Patient with Acute Heart Failure and Central Sleep Apnea

International Journal of Anesthetics and Anesthesiology ◽

10.23937/2377-4630/1410055 ◽

2017 ◽

Vol 4 (1) ◽

Author(s):

Chol Kim

Keyword(s):

Heart Failure ◽

Case Report ◽

Sleep Apnea ◽

Acute Heart Failure ◽

Central Sleep Apnea ◽

Adaptive Servo Ventilation

Download Full-text

Central Sleep Apnea in Heart Failure

US Cardiology Review ◽

10.15420/usc.2009.6.2.72 ◽

2009 ◽

Vol 6 (2) ◽

pp. 72-78 ◽

Cited By ~ 1

Author(s):

Rami Khayat ◽

Andrew Pederzoli ◽

William Abraham ◽

◽

...

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Central Sleep Apnea

Download Full-text

Faculty Opinions recommendation of Leptin deficiency promotes central sleep apnea in patients with heart failure.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718106749.793487683 ◽

2013 ◽

Author(s):

Teofilo Lee-Chiong

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Leptin Deficiency ◽

Patients With Heart Failure

Download Full-text

Efficacy of adaptive-servo ventilation (HEART PAP™) for an elderly patient with chronic heart failure who had Cheyne–Stokes respiration with central sleep apnea

Journal of Cardiology Cases ◽

10.1016/j.jccase.2009.06.001 ◽

2010 ◽

Vol 1 (1) ◽

pp. e12-e16 ◽

Cited By ~ 1

Author(s):

Yasuhiro Usui ◽

Yoshifumi Takata ◽

Kihiro Asano ◽

Yuki Hashimura ◽

Kota Kato ◽

...

Keyword(s):

Heart Failure ◽

Elderly Patient ◽

Sleep Apnea ◽

Chronic Heart Failure ◽

Central Sleep Apnea ◽

Adaptive Servo Ventilation

Download Full-text

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

CVD Prevention and Control ◽

10.1016/s1875-4570(09)60246-1 ◽

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

Download Full-text

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

Sleep Medicine ◽

10.1016/j.sleep.2009.05.014 ◽

2010 ◽

Vol 11 (2) ◽

pp. 143-148 ◽

Cited By ~ 29

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

Download Full-text

833 Evolution of sleep disordered breathing types in heart failure

SLEEP ◽

10.1093/sleep/zsab072.830 ◽

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.

Download Full-text