What is the remaining status of adaptive servo-ventilation? The results of a real-life multicenter study (OTRLASV-study)

Abstract Backgrounds As a consequence of the increased mortality observed in the SERVE-HF study, many questions concerning the safety and rational use of ASV in other indications emerged. The aim of this study was to describe the clinical characteristics of ASV-treated patients in real-life conditions. Methods The OTRLASV-study is a prospective, 5-centre study including patients who underwent ASV-treatment for at least 1 year. Patients were consecutively included in the study during the annual visit imposed for ASV-reimbursement renewal. Results 177/214 patients were analysed (87.57% male) with a median (IQ25–75) age of 71 (65–77) years, an ASV-treatment duration of 2.88 (1.76–4.96) years, an ASV-usage of 6.52 (5.13–7.65) hours/day, and 54.8% were previously treated via continuous positive airway pressure (CPAP). The median Epworth Scale Score decreased from 10 (6–13.5) to 6 (3–9) (p < 0.001) with ASV-therapy, the apnea-hypopnea-index decreased from 50 (38–62)/h to a residual device index of 1.9 (0.7–3.8)/h (p < 0.001). The majority of patients were classified in a Central-Sleep-Apnea group (CSA; 59.3%), whereas the remaining are divided into an Obstructive-Sleep-Apnea group (OSA; 20.3%) and a Treatment-Emergent-Central-Sleep-Apnea group (TECSA; 20.3%). The Left Ventricular Ejection Fraction (LVEF) was > 45% in 92.7% of patients. Associated comorbidities/etiologies were cardiac in nature for 75.7% of patients (neurological for 12.4%, renal for 4.5%, opioid-treatment for 3.4%). 9.6% had idiopathic central-sleep-apnea. 6.2% of the patients were hospitalized the year preceding the study for cardiological reasons. In the 6 months preceding inclusion, night monitoring (i.e. polygraphy or oximetry during ASV usage) was performed in 34.4% of patients, 25.9% of whom required a subsequent setting change. According to multivariable, logistic regression, the variables that were independently associated with poor adherence (ASV-usage ≤4 h in duration) were TECSA group versus CSA group (p = 0.010), a higher Epworth score (p = 0.019) and lack of a night monitoring in the last 6 months (p < 0.05). Conclusions In real-life conditions, ASV-treatment is often associated with high cardiac comorbidities and high compliance. Future research should assess how regular night monitoring may optimize devices settings and patient management. Trial registration The OTRLASV study is registered on ClinicalTrials.gov (Identifier: NCT02429986) on 1 April 2015.

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Patterns of adaptive servo-ventilation settings in a real-life multicenter study: pay attention to volume!

Respiratory Research ◽

10.1186/s12931-020-01509-7 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Dany Jaffuel ◽

Claudio Rabec ◽

Carole Philippe ◽

Jean-Pierre Mallet ◽

Marjolaine Georges ◽

...

Keyword(s):

Sleep Apnea ◽

Airway Pressure ◽

Real Life ◽

Central Sleep Apnea ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Negative Consequences ◽

Ventricular Ejection Fraction ◽

Obstructive Sleep

Abstract Backgrounds To explain the excess cardiovascular mortality observed in the SERVE-HF study, it was hypothesized that the high-pressure ASV default settings used lead to inappropriate ventilation, cascading negative consequences (i.e. not only pro-arrythmogenic effects through metabolic/electrolyte abnormalities, but also lower cardiac output). The aims of this study are: i) to describe ASV-settings for long-term ASV-populations in real-life conditions; ii) to describe the associated minute-ventilations (MV) and therapeutic pressures for servo-controlled-flow versus servo-controlled-volume devices (ASV-F Philips®-devices versus ASV-V ResMed®-devices). Methods The OTRLASV-study is a cross-sectional, 5-centre study including patients who underwent ASV-treatment for at least 1 year. The eight participating clinicians were free to adjust ASV settings, which were compared among i) initial diagnosed sleep-disordered-breathing (SBD) groups (Obstructive-Sleep-Apnea (OSA), Central-Sleep-Apnea (CSA), Treatment-Emergent-Central-Sleep-Apnea (TECSA)), and ii) unsupervised groups (k-means clusters). To generate these clusters, baseline and follow-up variables were used (age, sex, body mass index (BMI), initial diagnosed Obstructive-Apnea-Index, initial diagnosed Central-Apnea-Index, Continuous-Positive-Airway-Pressure used before ASV treatment, presence of cardiopathy, and presence of a reduced left-ventricular-ejection-fraction (LVEF)). ASV-data were collected using the manufacturer’s software for 6 months. Results One hundred seventy-seven patients (87.57% male) were analysed with a median (IQ25–75) initial Apnea-Hypopnea-Index of 50 (38–62)/h, an ASV-treatment duration of 2.88 (1.76–4.96) years, 61.58% treated with an ASV-V. SDB groups did not differ in ASV settings, MV or therapeutic pressures. In contrast, the five generated k-means clusters did (generally described as follows: (C1) male-TECSA-cardiopathy, (C2) male-mostly-CSA-cardiopathy, (C3) male-mostly-TECSA-no cardiopathy, (C4) female-mostly-elevated BMI-TECSA-cardiopathy, (C5) male-mostly-OSA-low-LVEF). Of note, the male-mostly-OSA-low-LVEF-cluster-5 had significantly lower fixed end-expiratory-airway-pressure (EPAP) settings versus C1 (p = 0.029) and C4 (p = 0.007). Auto-EPAP usage was higher in the male-mostly-TECSA-no cardiopathy-cluster-3 versus C1 (p = 0.006) and C2 (p < 0.001). MV differences between ASV-F (p = 0.002) and ASV-V (p < 0.001) were not homogenously distributed across clusters, suggesting specific cluster and ASV-algorithm interactions. Individual ASV-data suggest that the hyperventilation risk is not related to the cluster nor the ASV-monitoring type. Conclusions Real-life ASV settings are associated with combinations of baseline and follow-up variables wherein cardiological variables remain clinically meaningful. At the patient level, a hyperventilation risk exists regardless of cluster or ASV-monitoring type, spotlighting a future role of MV-telemonitoring in the interest of patient-safety. Trial registration The OTRLASV study was registered on ClinicalTrials.gov (Identifier: NCT02429986). 1 April 2015.

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

Journal of Clinical Medicine ◽

10.3390/jcm9040989 ◽

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.

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

European Heart Journal ◽

10.1093/eurheartj/ehz746.0373 ◽

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.

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Characterization of dynamic left ventricular systolic and diastolic function in patients with obstructive sleep apnea syndrome with preserved left ventricular ejection fraction

10.1183/13993003.congress-2018.pa3326 ◽

2018 ◽

Author(s):

Angelo Canora ◽

Antonello D'Andrea ◽

Carmine Nicoletta ◽

Simona Sperlongano ◽

Giacomo Ghinassi ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sleep Apnea Syndrome ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Obstructive Sleep ◽

Apnea Syndrome ◽

Systolic And Diastolic Function

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Subclinical impairment of dynamic left ventricular systolic and diastolic function in patients with obstructive sleep apnea and preserved left ventricular ejection fraction

BMC Pulmonary Medicine ◽

10.1186/s12890-020-1099-9 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 2

Author(s):

Antonello D’Andrea ◽

Angelo Canora ◽

Simona Sperlongano ◽

Domenico Galati ◽

Serena Zanotta ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Diastolic Function ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Obstructive Sleep ◽

Systolic And Diastolic Function

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Resolution of Cheyne-Stokes Respiration after Treatment of Heart Failure with Sacubitril/Valsartan: A First Case Report

Cardiology ◽

10.1159/000455118 ◽

2017 ◽

Vol 137 (2) ◽

pp. 96-99 ◽

Cited By ~ 6

Author(s):

Henrik Fox ◽

Thomas Bitter ◽

Dieter Horstkotte ◽

Olaf Oldenburg

Keyword(s):

Heart Failure ◽

Central Sleep Apnea ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Apnea Hypopnea Index ◽

Ventricular Ejection Fraction ◽

First Case ◽

Neprilysin Inhibitor ◽

Patients With Heart Failure ◽

Angiotensin Receptor Neprilysin Inhibitor

Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure (HF), and is known to be associated with a worse prognosis. The severity of central sleep apnea is thought to mirror cardiac dysfunction. The novel angiotensin receptor-neprilysin inhibitor (ARNi) sacubitril has been shown to improve HF, but a relationship between treatment with ARNi and the severity of SDB has not yet been investigated. We report the case of a 71-year-old male with HF and SDB. Treatment with sacubitril/valsartan was associated with improved cardiac function, as shown by a reduction in the level of N-terminal prohormone of brain natriuretic peptide from 3,249 to 1,720 pg/mL, and an improvement in left-ventricular ejection fraction from 30 to 35%. This was accompanied by a marked reduction in the apnea-hypopnea index (from 41 to 19/h). To the best of our knowledge, this is the first case to document parallel improvements in HF and SDB after the initiation of ARNi treatment.

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Association of Obstructive Sleep Apnea Indicators with Heart Failure

Proceedings of IMPRS ◽

10.18060/24837 ◽

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.

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Association of C1q/TNF-Related Protein-9 (CTRP9) Level with Obstructive Sleep Apnea in Patients with Coronary Artery Disease

Mediators of Inflammation ◽

10.1155/2020/7281391 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Zexuan Li ◽

Yunhui Du ◽

Lixin Jia ◽

Jingyao Fan ◽

Ruifeng Guo ◽

...

Keyword(s):

Coronary Artery Disease ◽

Obstructive Sleep Apnea ◽

Coronary Artery ◽

Sleep Apnea ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Related Protein ◽

Ventricular Ejection Fraction ◽

Obstructive Sleep ◽

Artery Disease

Background. Obstructive sleep apnea (OSA) is closely related to the incidence and progression of coronary artery disease (CAD), and the mechanisms linking OSA and CAD are multifactorial. C1q/TNF-related protein-9 (CTRP9) is a novel adipokine that protects the heart against ischemic injury and ameliorates cardiac remodeling. We aimed to ascertain the clinical relevance of CTRP9 with OSA prevalence in patients with CAD. Methods. From August 2016 to March 2019, consecutive eligible patients with CAD (n=154; angina pectoris, n=88; acute myocardial infarction [AMI], n=66) underwent cardiorespiratory polygraphy. OSA was defined as an apnea-hypopnea index (AHI) ≥15 events·h−1. Plasma CTRP9 concentrations were measured by ELISA method. Results. Moderate/severe OSA was present in 89 patients (57.8%). CTRP9 levels were significantly decreased in the moderate/severe OSA group than in the no/mild OSA group (4.7 [4.1-5.2] ng/mL vs. 4.9 [4.4-6.0] ng/mL, P=0.003). The difference between groups was only observed in patients with AMI (3.0 [2.3-4.9] vs. 4.5 [3.2-7.9], P=0.009). Correlation analysis showed that CTRP9 levels were negatively correlated with AHI (r=−0.238, P=0.003) and oxygen desaturation index (r=−0.234, P=0.004) and positively correlated with left ventricular ejection fraction (r=0.251, P=0.004) in all subjects. Multivariate analysis showed that male gender (OR 3.099, 95% CI 1.029-9.330, P=0.044), BMI (OR 1.148, 95% CI 1.040-1.268, P=0.006), and CTRP9 levels (OR 0.726, 95% CI 0.592-0.890, P=0.002) were independently associated with the prevalence of moderate/severe OSA. Conclusions. Plasma CTRP9 levels were independently related to the prevalence of moderate/severe OSA in patients with CAD, suggesting that CTRP9 might play a role in the pathogenesis of CAD exacerbated by OSA.

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