scholarly journals Sleep-Disordered Breathing In Heart Failure

2015 ◽  
Vol 10 (2) ◽  
pp. 89 ◽  
Author(s):  
Simon G Pearse ◽  
Martin R Cowie ◽  
Rakesh Sharma ◽  
Ali Vazir ◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Disordered Breathing ◽  
Cardiovascular Effects ◽  
Intrathoracic Pressure ◽  
Sleep Apnoea ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Obstructive Sleep ◽  
Regulation Of Breathing ◽  
Disordered Breathing

Sleep-disordered breathing affects over half of patients with heart failure (HF) and is associated with a poor prognosis. It is an under-diagnosed condition and may be a missed therapeutic target. Obstructive sleep apnoea is caused by collapse of the pharynx, exacerbated by rostral fluid shift during sleep. The consequent negative intrathoracic pressure, hypoxaemia, sympathetic nervous system activation and arousals have deleterious cardiovascular effects. Treatment with continuous positive airway pressure may confer symptomatic and prognostic benefit in this group. In central sleep apnoea, the abnormality is with regulation of breathing in the brainstem, often causing a waxing-waning Cheyne Stokes respiration pattern. Non-invasive ventilation has not been shown to improve prognosis in these patients and the recently published SERVE-HF trial found increased mortality in those treated with adaptive servoventilation. The management of sleep-disordered breathing in patients with HF is evolving rapidly with significant implications for clinicians involved in their care.

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.

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.

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.

scholarly journals Apnoea–hypopnoea indices determined via continuous positive airway pressure (AHI-CPAPflow) versus those determined by polysomnography (AHI-PSGgold): a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e044499
Author(s):  
Fanny Bertelli ◽  
Carey Meredith Suehs ◽  
Jean Pierre Mallet ◽  
Marie Caroline Rotty ◽  
Jean Louis Pepin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Sleep Disordered Breathing ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Sleep Apnoea ◽  
Obstructive Sleep ◽  
The Impact ◽  
Disordered Breathing

Introduction To date, continuous positive airway pressure (CPAP) remains the cornerstone of obstructive sleep apnoea treatment. CPAP data describing residual sleep-disordered breathing events (ie, the CPAP-measured apnoea–hypopnoea indices (AHI-CPAPflow)) is difficult to interpret because it is an entirely different metric than the polysomnography (PSG) measured AHI gold standard (AHI-PSGgold). Moreover, manufacturer definitions for apnoea and hypopnoea are not only different from those recommended for PSG scoring, but also different between manufacturers. In the context of CPAP initiation and widespread telemedicine at home to facilitate sleep apnoea care, there is a need for concrete evidence that AHI-CPAPflow can be used as a surrogate for AHI-PSGgold. Methods and analysis No published systematic review and meta-analysis (SRMA) has compared the accuracy of AHI-CPAPflow against AHI-PSGgold and the primary objective of this study is therefore to do so using published data. The secondary objectives are to similarly evaluate other sleep disordered breathing indices and to perform subgroup analyses focusing on the inclusion/exclusion of central apnoea patients, body mass index levels, CPAP device brands, pressure titration modes, use of a predetermined and fixed pressure level or not, and the impact of a 4% PSG desaturation criteria versus 3% PSG on accuracy. The Preferred Reporting Items for SRMA protocols statement guided study design. Randomised controlled trials and observational studies of adult patients (≥18 years old) treated by a CPAP device will be included. The CPAP intervention and PSG comparator must be performed synchronously. PSGs must be scored manually and follow the American Academy of Sleep Medicine guidelines (2007 AASM criteria or more recent). To assess the risk of bias in each study, the Quality Assessment of Diagnostic Accuracy Studies 2 tool will be used. Ethics and dissemination This protocol received ethics committee approval on 16 July 2020 (IRB_MTP_2020_07_2020000404) and results will be disseminated via peer-reviewed publications. PROSPERO/Trial registration numbers CRD42020159914/NCT04526366; Pre-results

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 MinimallyInvasive Radiofrequency Surgery in Sleep-Disordered Breathing

Healthcare ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 97
Author(s):  
Ankit Patel ◽  
Bhik Kotecha
Keyword(s):  
Sleep Disordered Breathing ◽  
Sleep Apnoea ◽  
Long Term Outcomes ◽  
Sustained Improvement ◽  
Radiofrequency Surgery ◽  
Obstructive Sleep ◽  
Good Quality Research ◽  
Disordered Breathing

Sleep-disordered breathing encompasses a spectrum of conditions ranging from simple snoring to obstructive sleep apnoea (OSA). Radiofrequency surgery represents a relatively new technique available to surgeons involved in managing this condition. Its principal advantage relates to its minimally invasive nature resulting in a reduced morbidity when compared to traditional sleep surgery. The presence of good-quality research evaluating the long-term outcomes is currently scarce, although the short-term data is promising. Careful patient selection appears to be paramount in obtaining a sustained improvement. The role of radiofrequency surgery in sleep-disordered breathing has been reviewed.

Sleep disordered breathing

2007 ◽  
pp. 253-256
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Disordered Breathing ◽  
Face Mask ◽  
Sleep Apnoea ◽  
Respiratory Medicine ◽  
Respiratory Support ◽  
Obstructive Sleep ◽  
Disordered Breathing

Sleep disordered breathing 254 Sleep disordered breathing is a relatively new area of respiratory medicine. It encompasses two broad and sometimes overlapping groups: the first and largest is obstructive sleep apnoea (OSA), and the second is the nocturnal hypoventilatory disorders. Both require nocturnal respiratory support, usually via a nasal or face mask, although sometimes via a tracheostomy. The on-call acute physician will be consulted about patients who have sleep disordered breathing and hence should be aware of the diagnoses and the therapies....

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