scholarly journals Sleep-disordered Breathing in Heart Failure – Current State of the Art

2015 ◽  
Vol 1 (1) ◽  
pp. 16
Author(s):  
Martin R Cowie ◽  
Holger Woehrle ◽  
Olaf Oldenburg ◽  
Thibaud Damy ◽  
Peter van der Meer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Sleep Disordered Breathing ◽  
Healthcare Utilisation ◽  
Sleep Apnoea ◽  
Prognostic Impact ◽  
Current State ◽  
Obstructive Sleep ◽  
Disordered Breathing

Sleep-disordered breathing (SDB), either obstructive sleep apnoea (OSA) or central sleep apnoea (CSA)/Cheyne-Stokes respiration (CSR) and often a combination of the two, is highly prevalent in patients with heart failure (HF), is associated with reduced functional capacity and quality of life, and has a negative prognostic impact. European HF guidelines identify that sleep apnoea is of concern in patients with HF. Continuous positive airway pressure is the treatment of choice for OSA, and adaptive servoventilation (ASV) appears to be the most consistently effective therapy for CSA/CSR while also being able to treat concomitant obstructive events. There is a growing body of evidence that treating SDB in patients with HF, particularly using ASV for CSA/CSR, improves functional outcomes such as HF symptoms, cardiac function, cardiac disease markers, exercise tolerance and quality of life. However, conflicting results have been reported on ‘hard’ outcomes such as mortality and healthcare utilisation, and the influence of effectively treating SDB, including CSA/CSR, remains to be determined in randomised clinical trials. Two such trials (SERVE-HF and ADVENT-HF) in chronic stable HF and another in post-acute decompensated HF (CAT-HF) are currently underway.

Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy

2010 ◽  
Vol 125 (2) ◽  
pp. 193-198 ◽  
Author(s):  
S M Powell ◽  
M Tremlett ◽  
D A Bosman
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Life Assessment ◽  
Effect Sizes ◽  
Obstructive Sleep ◽  
Disordered Breathing

AbstractObjective:To assess the quality of life of UK children with sleep-disordered breathing undergoing adenotonsillectomy, by using the Obstructive Sleep Apnoea 18 questionnaire and determining score changes and effect sizes.Design:Prospective, longitudinal study.Setting:The otolaryngology department of a university teaching hospital in Northern England.Participants:Twenty-eight children for whom adenotonsillectomy was planned as treatment for sleep-disordered breathing, and who had either a clinical history consistent with obstructive sleep apnoea or a polysomnographic diagnosis.Main outcome measure:The Obstructive Sleep Apnoea 18 questionnaire, a previously validated, disease-specific quality of life assessment tool; changes in questionnaire scores and effect sizes were assessed.Methods:The Obstructive Sleep Apnoea 18 questionnaire was administered to each child's parent pre-operatively, then again at the follow-up appointment. Questionnaire scores ranged from 1 to 7. Score changes were analysed using the paired t-test; effect sizes were calculated using 95 per cent confidence intervals.Results:Complete data were obtained for 22 children (mean age, 61 months). Ten had undergone pre-operative polysomnography. Twenty-one children underwent adenotonsillectomy (one underwent tonsillectomy). Median follow up was eight weeks (interquartile range, six to 11 weeks). Following surgery, the overall mean score improvement was 2.6 (p < 0.0001) and the mean effect size 2.4 (95 per cent confidence interval 1.9 to 2.8). There were significant improvements in each of the individual questionnaire domains, i.e. sleep disturbance (mean score change 3.9, p < 0.0001), physical suffering (2.2, p < 0.0001), emotional distress (2.0, p = 0.0001), daytime problems (1.8, p = 0.0001) and caregiver concerns (2.6, p < 0.0001).Conclusion:In these children with sleep-disordered breathing treated by adenotonsillectomy, Obstructive Sleep Apnoea 18 questionnaire results indicated significantly improved mean score changes and effect sizes across all questionnaire domains, comparing pre- and post-operative data.

scholarly journals Long-term Impact of Adenotonsillectomy on the Quality of Life of Children with Sleep-disordered breathing

2020 ◽  
Author(s):  
Juliana Alves Sousa Caixeta ◽  
Jessica Caixeta Silva Sampaio ◽  
Vanessa Vaz Costa ◽  
Isadora Milhomem Bruno da Silveira ◽  
Carolina Ribeiro Fernandes de Oliveira ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Disordered Breathing ◽  
Long Term Effects ◽  
Obstructive Sleep ◽  
Long Term Impact ◽  
Disordered Breathing

Abstract Introduction Adenotonsillectomy is the first-line treatment for obstructive sleep apnea secondary to adenotonsillar hypertrophy in children. The physical benefits of this surgery are well known as well as its impact on the quality of life (QoL), mainly according to short-term evaluations. However, the long-term effects of this surgery are still unclear. Objective To evaluate the long-term impact of adenotonsillectomy on the QoL of children with sleep-disordered breathing (SDB). Method This was a prospective non-controlled study. Children between 3 and 13 years of age with symptoms of SDB for whom adenotonsillectomy had been indicated were included. Children with comorbities were excluded. Quality of life was evaluated using the obstructive sleep apnea questionnaire (OSA-18), which was completed prior to, 10 days, 6 months, 12 months and, at least, 18 months after the procedure. For statistical analysis, p-values lower than 0.05 were defined as statistically significant. Results A total of 31 patients were enrolled in the study. The average age was 5.2 years, and 16 patients were male. The OSA-18 scores improved after the procedure in all domains, and this result was maintained until the last evaluation, done 22 ± 3 months after the procedure. Improvement in each domain was not superior to achieved in other domains. No correlation was found between tonsil or adenoid size and OSA-18 scores. Conclusion This is the largest prospective study that evaluated the long-term effects of the surgery on the QoL of children with SDB using the OSA-18. Our results show adenotonsillectomy has a positive impact in children's QoL.

scholarly journals Monitoring for sleep-disordered breathing in heart failure

2019 ◽  
Vol 21 (Supplement_M) ◽  
pp. M36-M39
Author(s):  
Andrew J Stewart Coats
Keyword(s):  
Heart Failure ◽  
Nerve Stimulation ◽  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Alternative Therapies ◽  
Positive Pressure ◽  
Phrenic Nerve Stimulation ◽  
Sleep Study ◽  
Obstructive Sleep ◽  
Disordered Breathing

Abstract Sleep-disordered breathing (SDB) is extremely common in heart failure (HF) and it carries with it adverse symptoms and impaired survival. Sleep-disordered breathing has two main types; obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), which can overlap. The differentiation between CSA and OSA is important and is recommended in recent HF guidelines, by recommending a formal sleep study. The reason is that for OSA the main therapy is a positive pressure airway mask, whereas for patients with HFrEF and CSA this mask therapy actually increases cardiovascular mortality, and therefore alternative therapies are required, such as implantable phrenic nerve stimulation to improve sleep and related daytime symptoms attributable to the CSA. This article discusses the detection, screening, and monitoring of SDB in HF patients.

Effect of Adenotonsillectomy on Endothelin-1 and C-Reactive Protein Levels in Children with Sleep-Disordered Breathing

2011 ◽  
Vol 145 (6) ◽  
pp. 1030-1035 ◽  
Author(s):  
Arzu Tatlıpınar ◽  
Burak Çimen ◽  
Dursun Duman ◽  
Erkan Esen ◽  
Sema Köksal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sleep Disordered Breathing ◽  
Case Series ◽  
C Reactive Protein ◽  
Tertiary Referral Center ◽  
Endothelin 1 ◽  
Reactive Protein ◽  
Obstructive Sleep ◽  
Disordered Breathing

Objective. This study aimed to evaluate the influence of adenotonsillectomy on the plasma concentration of endothelin-1 (ET-1) and C-reactive protein (CRP) in children with sleep-disordered breathing (SDB). The relationship between quality of life and ET-1 levels was also evaluated. Setting. Tertiary referral center. Study Design. Before-and-after case series. Methods. Fasting blood samples for ET-1 and high-sensitivity CRP were drawn preoperatively in all patients and at 3 to 4 months postoperatively. The Obstructive Sleep Apnea–18 (OSA-18) survey and Brouilette symptom score were completed by each child’s parents during the same time periods. Results. The mean ET-1 level decreased from 3.51 ± 0.93 fmol/mL to 2.67 ± 0.69 fmol/mL postoperatively ( P < .01). OSA-18 survey scores and Brouilette symptom scores also decreased in the postoperative period ( P < .01). When comparing moderate and severe cases to mild cases according to Brouilette scores, ET-1 levels were significantly higher in moderate and severe cases ( P < .01). There was a significant correlation between ET-1 and the OSA-18 survey scale ( r = 0.442; P = .001). Although CRP levels decreased from 0.63 ± 1.19 mg/dL to 0.31 ± 0.23 mg/dL postoperatively, this was not statistically significant. Conclusion. Adenotonsillectomy effectively lowered plasma ET-1 levels in children with SDB and thus may have reduced their related risk for cardiovascular disease. In addition, adenotonsillectomy improved quality of life in this group.

scholarly journals Sleep-Disordered Breathing in Patients with Heart Failure: New Trends in Therapy

2013 ◽  
Vol 2013 ◽  
pp. 1-10 ◽  
Author(s):  
Anna Kazimierczak ◽  
Paweł Krzesiński ◽  
Krystian Krzyżanowski ◽  
Grzegorz Gielerak
Keyword(s):  
Heart Failure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Clinical Manifestations ◽  
Sleep Apnoea ◽  
Favourable Effect ◽  
Bilevel Positive Airway Pressure ◽  
Obstructive Sleep ◽  
Disordered Breathing

Heart failure (HF) is a growing health problem which paradoxically results from the advances in the treatment of etiologically related diseases (especially coronary artery disease). HF is commonly accompanied by sleep-disordered breathing (SDB), which may directly exacerbate the clinical manifestations of cardiovascular disease and confers a poorer prognosis. Obstructive sleep apnoea predominates in mild forms while central sleep apnoea in more severe forms of heart failure. Identification of SDB in patients with HF is important, as its effective treatment may result in notable clinical benefits to the patients. Continuous positive airway pressure (CPAP) is the gold standard in the management of SDB. The treatments for central breathing disorders include CPAP, bilevel positive airway pressure (BPAP), and adaptive servoventilation (ASV), with the latter being the most modern method of treatment for the Cheyne-Stokes respiration and involving ventilation support with a variable synchronisation dependent on changes in airflow through the respiratory tract and on the patient’s respiratory rate. ASV exerts the most favourable effect on long-term prognosis. In this paper, we review the current state of knowledge on the diagnosis and treatment of SDB with a particular emphasis on the latest methods of treatment.

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