scholarly journals Therapeutic Strategies for Sleep Apnea in Hypertension and Heart Failure

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Akiko Noda ◽  
Seiko Miyata ◽  
Yoshinari Yasuda
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Sleep Apnea ◽  
Cardiac Function ◽  
Blood Pressure Reduction ◽  
Intrathoracic Pressure ◽  
Left Ventricular ◽  
Cpap Treatment ◽  
Negative Intrathoracic Pressure ◽  
Obstructive Sleep

Sleep-disordered breathing (SDB) causes hypoxemia, negative intrathoracic pressure, and frequent arousal, contributing to increased cardiovascular disease mortality and morbidity. Obstructive sleep apnea syndrome (OSAS) is linked to hypertension, ischemic heart disease, and cardiac arrhythmias. Successful continuous positive airway pressure (CPAP) treatment has a beneficial effect on hypertension and improves the survival rate of patients with cardiovascular disease. Thus, long-term compliance with CPAP treatment may result in substantial blood pressure reduction in patients with resistant hypertension suffering from OSAS. Central sleep apnea and Cheyne-Stokes respiration occur in 30–50% of patients with heart failure (HF). Intermittent hypoxemia, nocturnal surges in sympathetic activity, and increased left ventricular preload and afterload due to negative intrathoracic pressure all lead to impaired cardiac function and poor life prognosis. SDB-related HF has been considered the potential therapeutic target. CPAP, nocturnal O2therapy, and adaptive servoventilation minimize the effects of sleep apnea, thereby improving cardiac function, prognosis, and quality of life. Early diagnosis and treatment of SDB will yield better therapeutic outcomes for hypertension and HF.

Effects of CPAP treatment on cardiac structure and function in individuals with obstructive sleep apnea and cardiovascular disease: a prospective 6-month randomised control trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Franke ◽  
K.A Loffler ◽  
S.J Nicholls ◽  
C.S Anderson ◽  
B.R Cowan ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Function ◽  
Right Ventricular ◽  
Usual Care ◽  
Randomised Control Trial ◽  
Funding Source ◽  
Cpap Treatment ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnea (OSA) is associated with an increased risk of cardiovascular events. The influence of continuous positive airway pressure (CPAP) on cardiac function remains uncertain. Purpose To prospectively determine the effects of CPAP on cardiovascular function, as measured by cardiac magnetic resonance imaging (CMR) as a sub-study of the international SAVE trial (NCT00738179). Methods Participants with OSA and established cardiovascular disease were randomized to CPAP treatment plus usual cardiovascular care or Usual Care alone. Primary outcomes were defined as change in ventricular ejection fraction (EF) and stroke volume (SV) between baseline and 6-month follow-up both groups. Secondary outcomes included other ventricular parameters including volumes, mass, and strain, and atrial parameters. Results 140 participants were included; mean CPAP adherence in those allocated to receive the treatment was 4.31±2.45 hours per night. Most were male (91%) and had moderate-severe OSA with minimal daytime sleepiness. There were no significant differences in left or right ventricular EF between groups after 6 months of treatment. There was an 8.5 mL increase in LV SV (95% CI; [4.3–12.6], p<0.001) and a 7.7 mL increase in RV SV (95% CI; [3.4–12.0], p<0.001) in the CPAP group compared to Usual Care. CPAP also affected left and right ventricular EDV, RV strain, and atrial parameters. Conclusions In the first prospective CMR imaging study of patients with OSA and cardiovascular disease, CPAP treatment did not change EF after 6 months, but did have significant effects on other parameters of cardiac function. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Respironics Foundation; Australian National Health and Medical Research; New Zealand Health Research Council

scholarly journals CPAP treatment, glycemia and diabetes risk in obstructive sleep apnea and comorbid cardiovascular disease

2020 ◽  
Author(s):  
Kelly A. Loffler ◽  
Emma Heeley ◽  
Ruth Freed ◽  
Rosie Meng ◽  
Lia R. Bittencourt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Glycemic Control ◽  
Usual Care ◽  
Serum Glucose ◽  
Cpap Therapy ◽  
Cpap Treatment ◽  
Obstructive Sleep

Objective: Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and DM risk in patients with cardiovascular disease (CVD) and OSA. <strong>Research Design and Methods: </strong>Blood, medical history, and personal data were collected in a <strong>substudy of 888 participants in the </strong>Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were r<strong>andomized</strong> to receive CPAP plus Usual Care, or Usual Care alone. Serum glucose and glycated hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) were measured at baseline, and six months, two- and four years, and incident diabetes diagnoses recorded. Results: Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA<sub>1c</sub> or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. Interaction testing suggested that women with diabetes did poorly in the Usual Care group while their counterparts on CPAP therapy remained stable. <strong>Conclusions</strong><b>:</b> Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.

scholarly journals Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

2020 ◽  
Vol 9 (4) ◽  
pp. 989
Author(s):  
Colin Suen ◽  
Jean Wong ◽  
Clodagh M. Ryan ◽  
Samuel Goh ◽  
Tiffany Got ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Scoping Review ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Hospital Outcomes ◽  
Ventricular Ejection Fraction ◽  
Obstructive Sleep

Background: Obstructive sleep apnea (OSA) is associated with long-term cardiovascular morbidity and is highly prevalent in patients with cardiovascular disease (CVD). The objectives of this scoping review were to determine the prevalence of OSA inpatients hospitalized for CVD and to map the range of in-hospital outcomes associated with OSA. Methods: We searched MEDLINE(R), Embase, and Cochrane Databases for articles published from 1946–2018. We included studies involving non-surgical adults with OSA or at high risk of OSA who were hospitalized for CVD. The outcomes were considered as in-hospital if they were collected from admission up to 30 days post-discharge from hospital. Results: After the screening of 4642 articles, 26 studies were included for qualitative synthesis. Eligible studies included patients presenting with acute coronary syndromes (n = 19), congestive heart failure (n = 6), or any cardiovascular disease (n = 1). The pooled prevalence of OSA in cardiac inpatients was 48% (95% CI: 42–53). The in-hospital outcomes reported were mortality (n = 4), length of stay (n = 8), left ventricular ejection fraction (n = 8), peak troponin (n = 7), peak B-type natriuretic peptide (n = 4), and composite cardiovascular complications (n = 2). Conclusions: OSA is highly prevalent in the cardiac inpatient population. The outcomes reported included mortality, cardiac function, cardiac biomarkers, and resource utilization. There are significant knowledge gaps regarding the effect of treatment and OSA severity on these outcomes. The findings from this review serve to inform further areas of research on the management of OSA among patients with CVD.

P5415Sleep disordered breathing in patients before and after heart transplantation: association with biomarkers and clinical parameters

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Medvedeva ◽  
L S Korostovtseva ◽  
M A Simonenko ◽  
Y V Sazonova ◽  
Y V Sviryaev
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Heart Transplantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Clinical Parameters ◽  
Ventricular Ejection Fraction ◽  
Obstructive Sleep ◽  
Before And After ◽  
Disordered Breathing

Abstract Background Sleep-disordered breathing (SDB) is highly frequent in patients with severe heart failure (HF). SDB, and predominantly central sleep apnea (CSA), may improve after recovery of cardiac function, but available data are limited and inconclusive, especially in patients who have undergone heart transplantation. The assessment of the severity of sleep apnea is mainly based on the apnea-hypopnea index (AHI), but this event-based parameter alone may not sufficiently reflect the complex pathophysiological mechanisms underlying SDB potentially contributing to adverse outcomes in patients with heart failure. Purpose To assess SDB in patients with severe HF before and after heart transplantation, their relationship with biomarkers and clinical parameters. Methods We included 117 patients (mean age 52.4±4.7 years) with HF NYHA class II-IV in the prospective cohort study, follow-up period was 5 years. The left ventricular ejection fraction (LVEF) was 28.05±9.57%. All patients underwent a comprehensive clinical examination, echocardiography, polysomnography (PSG, Embla N7000, Natus, USA). The plasma level of NT-proBNP, was analyzed by immunoassay (ELISA). The SPSS statistical software (version 23.0) was used. Results PSG showed the following types of SDB in the studied cohort: obstructive sleep apnoea (OSA) was diagnosed in 48 patients (41%), central - in 20 (17%), mixed - in 26 (22%). Among them mild SDB was diagnosed in 29 cases, moderate in 32 and severe in 33 patients. SDB was not found in 23 patients. The following correlations were identified: NT-proBNP and obstructive apnea index (OAI) (r=−0.44, p=0.007), NT-proBNP and sleep efficiency (r=−0.71, p=0.006), AHI and body mass index (BMI) (r=0.32, p=0.01), OAI and BMI index (r=0.34, p<0.001), desaturation index and BMI (r=0.43, p<0.001), average saturation oxygen and BMI (r=−0,6, p<0,001). Twenty-three patients underwent heart transplantation. According PSG-data 1 year after transplantation we observed decrease of central apnea index (CAI) (p=0,04). On the other hand, OAI increased (p=0,01) independently of the significant change in BMI (p=0,08). Conclusion We found very high rate of SDB (80%) in patients with severe HF, the predominant type was OSA. AHI, OAI and indicators of oxygen saturation correlate with BMI and biomarkers before heart transplantation. After 1 year after transplantation CAI decreased, assessment of the dynamics of obstructive sleep apnea requires further study.

scholarly journals CPAP treatment, glycemia and diabetes risk in obstructive sleep apnea and comorbid cardiovascular disease

2020 ◽  
Author(s):  
Kelly A. Loffler ◽  
Emma Heeley ◽  
Ruth Freed ◽  
Rosie Meng ◽  
Lia R. Bittencourt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Glycemic Control ◽  
Usual Care ◽  
Serum Glucose ◽  
Cpap Therapy ◽  
Cpap Treatment ◽  
Obstructive Sleep

Objective: Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and DM risk in patients with cardiovascular disease (CVD) and OSA. <strong>Research Design and Methods: </strong>Blood, medical history, and personal data were collected in a <strong>substudy of 888 participants in the </strong>Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were r<strong>andomized</strong> to receive CPAP plus Usual Care, or Usual Care alone. Serum glucose and glycated hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) were measured at baseline, and six months, two- and four years, and incident diabetes diagnoses recorded. Results: Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA<sub>1c</sub> or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. Interaction testing suggested that women with diabetes did poorly in the Usual Care group while their counterparts on CPAP therapy remained stable. <strong>Conclusions</strong><b>:</b> Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.

scholarly journals CPAP treatment, glycemia and diabetes risk in obstructive sleep apnea and comorbid cardiovascular disease

2020 ◽  
Author(s):  
Kelly A. Loffler ◽  
Emma Heeley ◽  
Ruth Freed ◽  
Rosie Meng ◽  
Lia R. Bittencourt ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Glycemic Control ◽  
Usual Care ◽  
Serum Glucose ◽  
Cpap Therapy ◽  
Cpap Treatment ◽  
Obstructive Sleep

Objective: Despite evidence of a relationship between obstructive sleep apnea (OSA), metabolic dysregulation and diabetes mellitus (DM), it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and DM risk in patients with cardiovascular disease (CVD) and OSA. <strong>Research Design and Methods: </strong>Blood, medical history, and personal data were collected in a <strong>substudy of 888 participants in the </strong>Sleep Apnea Cardiovascular Endpoints (SAVE) trial in which patients with OSA and stable CVD were r<strong>andomized</strong> to receive CPAP plus Usual Care, or Usual Care alone. Serum glucose and glycated hemoglobin A<sub>1c</sub> (HbA<sub>1c</sub>) were measured at baseline, and six months, two- and four years, and incident diabetes diagnoses recorded. Results: Median follow-up was 4.3 years. In those with pre-existing DM (n=274), there was no significant difference between CPAP and Usual Care groups in serum glucose, HbA<sub>1c</sub> or anti-diabetic medications during follow-up. There were also no significant between-group differences in participants with pre-diabetes (n=452), nor in new diagnoses of DM. Interaction testing suggested that women with diabetes did poorly in the Usual Care group while their counterparts on CPAP therapy remained stable. <strong>Conclusions</strong><b>:</b> Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affected glycemic control in those with diabetes or pre-diabetes, or DM risk over standard of care treatment. The potential differential effect according to sex deserves further investigation.

scholarly journals Association of Obstructive Sleep Apnea Indicators with Heart Failure

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Faheem Handoo ◽  
Yuyao Liu ◽  
Sonja G. Schütz ◽  
Ronald D. Chervin ◽  
Ivo D. Dinov
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Previous Stroke ◽  
Obstructive Sleep ◽  
Increased Risk

Background: Obstructive sleep apnea (OSA) occurs when the airway is repeatedly blocked during sleep, resulting in frequent brief awakenings throughout the night. OSA has been found to increase the risk of many cardiovascular diseases, especially heart failure (HF). HF with reduced, preserved, and borderline ejection fraction (HFrEF, HFpEF, and HFbEF) are three subtypes common in OSA patients. The aim of this study is to further explore the relationship between OSA and HF and the influence of specific OSA measures. Methods: Electronic medical data was collected from health histories, echocardiograms, and polysomnography studies. Observations were sorted into three categories based on left ventricular ejection fraction: HFpEF (n=334), HFrEF (n=77), and HFbEF (n=37). Multinomial logistic regression was then conducted to determine the relative risk of HFpEF and HFrEF from each variable as compared to the baseline HFbEF. Results: Pacemaker presence, previous stroke, BMI, and a measure of left ventricular dysfunction (LVD), called relative wall thickness, all raised the risk of HFpEF compared to HFbEF, while another LVD measure, left ventricular end-systolic dimension, reduced it. These factors also increased risk for HFrEF, except for previous stroke and pacemaker presence, which were not significant. Relevant OSA metrices included average blood oxygen saturation and three measures of sleep apnea severity, named central apnea index, hypopnea index per hour, and the Epworth Sleepiness Scale (ESS). These all decreased relative HFpEF risk, other than ESS, which raised it. Conclusions: As was expected, several standard HF predictors increased the risk of both types of HF. Surprisingly, few OSA indices had the same effect. This suggests that targeting specific OSA markers may not be effective in treating patients with any of these HF types. Future work could involve the influence of OSA and its indices on mortality, or the responses of these indicators to treatment, both topics with limited previous findings.

Abstract 13636: Derivation and Validation of a Clinical Prediction Rule for Sleep Disordered Breathing in Patients With Cardiovascular Disease

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Takashi Miyazaki ◽  
Sunao Kojima ◽  
Kunihiko Matsui ◽  
Shuichi Kamijikkoku ◽  
Seiji Hokimoto ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Prediction Rule ◽  
Pathophysiological Mechanism ◽  
Cpap Treatment ◽  
Obstructive Sleep ◽  
The Difference ◽  
Independent Parameters ◽  
Disordered Breathing

Introduction: There is a growing demand for polysomnography (PSG) indispensable for the diagnosis of sleep apnea which is associated with the development of cardiovascular disease. Hypothesis: We assessed the hypothesis that a prediction rule without PSG could identify obstructive sleep apnea (OSA) patients in which the continuous positive airway pressure (CPAP) treatment was recommended. Methods: Consecutive 326 cardiovascular disease patients simultaneously underwent a full-night PSG and a digital-installed built-in memory pulse-oximeter. A logistic regression-based prediction rule was developed in patients at university hospital (n=278) and validated in patients at community hospital (n=48). Results: In the derivation group, apnea-hypopnea index (AHI) was correlated with 3% oxygen desaturation index (ODI) (r=0.94, P<0.0001) and 223 patients were diagnosed as sleep disordered breathing (SDB) (AHI >=5). Four independent parameters were identified to distinguish between OSA (n=161) and central sleep apnea patients (n=62): pulse pressure, left atrial diameter, minimum oxygen saturation and B-type natriuretic peptide levels. The observed probability of OSA, by calculated score, was comparable between derivation and validation groups (Figure 1). The model-based rule was well calibrated (Hosmer-Lemeshow χ2=4.23) and demonstrated good discrimination in the derivation group. Discriminatory ability was also reasonable in the validation group and the difference between these groups was limited (Figure 2). Provided that cutoff levels of 3%ODI and 4 independent parameters were entirely satisfied, positive predictive value was 100% in both groups for the diagnosis of OSA necessary for CPAP treatment. Conclusions: A prediction rule for the type of sleep apnea without PSG can quantify the difference of pathophysiological mechanism in SDB patients. This index may be useful in detecting eligible candidates for CPAP in cardiovascular disease patients.

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