Mobile Health for Central Sleep Apnea Screening Among Patients With Stable Heart Failure: Single-Cohort, Open, Prospective Trial (Preprint)

BACKGROUND Polysomnography is the gold standard for detection of central sleep apnea in patients with stable heart failure. However, this procedure is costly, time consuming, and a burden to the patient and therefore unsuitable as a screening method. An electronic health (eHealth) app to measure overnight oximetry may be an acceptable screening alternative, as it can be automatically analyzed and is less burdensome to patients. OBJECTIVE This study aimed to assess whether overnight pulse oximetry using a smartphone-compatible oximeter can be used to detect central sleep apnea in a population with stable heart failure. METHODS A total of 26 patients with stable heart failure underwent one night of both a polygraph examination and overnight saturation using a smartphone-compatible oximeter. The primary endpoint was agreement between the oxygen desaturation index (ODI) above or below 15 on the smartphone-compatible oximeter and the diagnosis of the polygraph. RESULTS The median age of patients was 66.4 (interquartile range, 62-71) years and 92% were men. The median body mass index was 27.1 (interquartile range, 24.4-30.8) kg/m2. Two patients were excluded due to incomplete data, and two other patients were excluded because they could not use a smartphone. Seven patients had central sleep apnea, and 6 patients had obstructive sleep apnea. Of the 7 (of 22, 32%) patients with central sleep apnea that were included in the analysis, 3 (13%) had an ODI≥15. Of all patients without central sleep apnea, 8 (36%) had an ODI<15. The McNemar test yielded a P value of .55. CONCLUSIONS Oxygen desaturation measured by this smartphone-compatible oximeter is a weak predictor of central sleep apnea in patients with stable heart failure.

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393 Comparison of Oxygenation Abnormalities Between Obstructive Sleep Apnea and Central Sleep Apnea

SLEEP ◽

10.1093/sleep/zsab072.392 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A156-A157

Author(s):

Sikawat Thanaviratananich ◽

Hao Cheng ◽

Maria Pino ◽

Krishna Sundar

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Demographic Data ◽

Central Sleep Apnea ◽

Nrem Sleep ◽

Rate Of Change ◽

Apnea Hypopnea Index ◽

P Value ◽

Obstructive Sleep ◽

Cheyne Stokes Breathing

Abstract Introduction The apnea-hypopnea index (AHI) is used as a generic index to quantify both central sleep apnea (CSA) and obstructive sleep apnea (OSA) syndromes. Patterns of oxygenation abnormalities seen in CSA and OSA may be key to understanding differing clinical impacts of these disorders. Oxygen desaturation and resaturation slopes and durations in OSA and CSA were compared between OSA and CSA patients. Methods Polysomnographic data of patients aged 18 years or older with diagnosis of OSA and CSA, at University of Iowa Hospitals and Clinics, were analyzed and demographic data were collected. Oximetric changes during hypopneas and apneas were studied for desaturation/resaturation durations and desaturation/resaturation slopes. Desaturation and resaturation slopes were calculated as rate of change in oxygen saturation (ΔSpO2/Δtime). Comparison of hypoxemia-based parameters between patients with OSA and CSA was performed using unpaired t-test. Results 32 patients with OSA with median AHI of 15.4 (IQR 5.1 to 30.55) and median ODI of 15.47 (IQR 9.50 to 29.33) were compared to 15 patients with CSA with a median AHI of 20.4 (IQR 12.6 to 47.8) and median ODI of 27.56 (IQR 17.99 to 29.57). The mean number of desaturation and resaturation events was not significantly different between patients with OSA and CSA (OSA - 106.81±87.93; CSA - 130.67±76.88 with a p-value 0.1472). 4/15 CSA patients had Cheyne-Stokes breathing, 2/15 had treatment emergent central sleep apnea, 1/15 had methadone-associated CSA and for 8/15, no etiologies for CSA were found. Mean desaturation durations was significantly longer in OSA (20.84 s ± 5.67) compared to CSA (15.94 s ± 4.54) (p=0.0053) and consequently the desaturation slopes were steeper in CSA than OSA (-0.35%/sec ±0.180 vs. -0.243 ± 0.073; p=0.0064). The resaturation duration was not significantly longer in OSA (9.76 s ± 2.02) than CSA (9.057 s ± 2.17) (p=0.2857). Differences between desaturation duration and slopes between CSA and OSA persisted during REM and NREM sleep, and in supine sleep. Conclusion As compared to OSA, patients with CSA have different patterns of desaturations and resaturations with lesser hypoxic burden with CSA. This may have implications on the clinical outcomes seen between these two disorders. Support (if any):

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Nocturnal oxyhemoglobin desaturation during sleep in congestive heart failure patients

Fisioterapia em Movimento ◽

10.1590/1980-5918.029.003.ao18 ◽

2016 ◽

Vol 29 (3) ◽

pp. 597-606

Author(s):

Jéssica Julioti Urbano ◽

Lilian Nanami Uchiyama ◽

Anderson Soares Silva ◽

Roger André Oliveira Peixoto ◽

Sergio Roberto Nacif ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Sleep Apnea ◽

Pulse Oximetry ◽

Arterial Oxygen Saturation ◽

Central Sleep Apnea ◽

Arterial Oxygen ◽

Sleep Breathing Disorders ◽

Breathing Disorders ◽

Obstructive Sleep

Abstract Introduction: Sleep breathing disorders occur in 45% of patients with heart failure, with 36%-50% manifesting Cheyne-Stokes respiration with central sleep apnea and 12% exhibiting obstructive sleep apnea. Several studies have shown that sleep pathophysiology may negatively affect the cardiovascular system and that cardiac dysfunction alters sleep and respiration. Objective: The aim of this study was to examine oxyhemoglobin desaturation during sleep in patients with congestive heart failure (CHF) using overnight pulse oximetry. Methods: Overnight pulse oximetry was conducted in the patients' homes with wrist pulse oximeters and finger probes that were placed around the forefingers of 15 patients with CHF and ejection fractions less than 50%, who were classified as New York Heart Association functional classes II and III. Results: The patients were divided into two groups. The first group consisted of seven patients with oxyhemoglobin desaturation indices of over 5 events/h, and the second group contained eight patients with oxyhemoglobin desaturation indices of 5 or less events/h. Student's t-tests did not show any significant differences between the groups. The patients' body mass indices correlated positively with the total desaturation episodes and desaturation time less than 90% and correlated negatively with the arterial oxygen saturation nadir. Conclusion: Pulse oximetry monitoring during sleep can be used to detect sleep breathing disorders in stable patients with CHF.

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Coexistence Of Central Sleep Apnea And Periodic Breathing Pattern In Patients With Congestive Heart Failure And Obstructive Sleep Apnea

10.1164/ajrccm-conference.2012.185.1_meetingabstracts.a6706 ◽

2012 ◽

Author(s):

Michael Arzt ◽

Gerhard Weinreich ◽

Olaf Oldenburg ◽

Andrea Graml ◽

Helmut Teschler ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Breathing Pattern ◽

Central Sleep Apnea ◽

Periodic Breathing ◽

Obstructive Sleep

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Sleep-related breathing disorders in patients with heart failure: classification, epidemiology and pathophysiology. Part I

Russian Journal of Cardiology ◽

10.15829/1560-4071-2021-4386 ◽

2021 ◽

Vol 26 (2S) ◽

pp. 4386

Author(s):

K. S. Krupichka ◽

M. V. Agaltsov ◽

R. P. Myasnikov ◽

O. M. Drapkina

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Periodic Breathing ◽

Healthy Person ◽

Underlying Disease ◽

Sleep Related Breathing Disorders ◽

Breathing Disorders ◽

Obstructive Sleep ◽

High Prevalence

The problem of heart failure (HF) is one of the central problems in modern cardiology due to its high prevalence among the population and high mortality. In turn, sleep-related breathing disorders (SRBD) are widespread in patients with HF and are associated with both the progression of the underlying disease and a decrease in the quality of life. For the first time, periodic breathing, as one of the types of sleep breathing disorders, was described in patients with HF.Further study of the issue showed a high prevalence of other types of SRBD among patients with HF The article discusses the physiology of sleep breathing monitoring in a healthy person and the pathophysiology of SRBD. The pathogenesis of central sleep apnea and its relationship with HF are discussed in detail. In addition, the mechanisms of the adverse effect of obstructive sleep apnea and HF are highlighted.

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Obstructive sleep apnea versus central sleep apnea: prognosis in systolic heart failure

Cardiovascular Diagnosis and Therapy ◽

10.21037/cdt.2020.03.02 ◽

2020 ◽

Vol 10 (3) ◽

pp. 396-404

Author(s):

Arild Hetland ◽

Maria Vistnes ◽

Kristina H. Haugaa ◽

Kristian Hovde Liland ◽

Margareth Olseng ◽

...

Keyword(s):

Heart Failure ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Systolic Heart Failure ◽

Central Sleep Apnea ◽

Obstructive Sleep

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Abstract 17143: Obstructive and Central Sleep Apnea and Risk of Incident Atrial Fibrillation

Circulation ◽

10.1161/circ.130.suppl_2.17143 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Patricia Tung ◽

Yamini S Levitzky ◽

Rui Wang ◽

Stuart F Quan ◽

Daniel J Gottlieb ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Sleep Apnea ◽

Central Sleep Apnea ◽

Health Study ◽

Apnea Hypopnea Index ◽

Community Based ◽

Obstructive Sleep ◽

History Of

INTRODUCTION: Prior studies have documented a higher prevalence of atrial fibrillation (AF) in those with obstructive sleep apnea (OSA). OSA has been associated with AF recurrence following cardioversion and ablation, and with prevalent and incident AF in cross-sectional and retrospective studies. Central sleep apnea (CSA) also has been associated with AF in patients with heart failure. However, data from prospective cohorts are sparse and few studies have evaluated the association of CSA with AF in population studies. METHODS: We assessed the association of OSA and CSA with incident AF among 3,420 subjects without a history of AF in the Sleep Heart Health Study (SHHS), a prospective, community-based study designed to evaluate the cardiovascular consequences of sleep disordered breathing. Subjects underwent overnight polysomnography at baseline and were followed over time for the development of incident AF, documented at any time after baseline polysomnogram until the end of follow-up. OSA was defined as an obstructive apnea-hypopnea index ≥ 5 and CSA was defined as a central apnea index ≥ 5. RESULTS: At baseline, the sample include 1499 men (44.4%) with a mean age of 62.4 (±10.9); 1569 (45.9%) subjects met criteria for mild to severe OSA and 54 (1.6%) for CSA. Over a mean follow-up of 8.2 years, 382 cases of incident AF were identified. The prevalence of both OSA and CSA was higher among those who developed AF compared to those who did not (OSA 49% vs 44%, p=0.001 and CSA 5% vs 1.2%, p=0.001). After adjustment for multiple AF risk factors, CSA was associated with an approximately 2-fold increased odds of incident AF (RR=2.38, 95% CI, 1.15-4.94; p = 0.02). The association persisted after exclusion of 258 subjects with a history of heart failure (RR=2.78, 95% CI, 1.28-6.04; p = 0.01). We did not find a significant association of OSA with incident AF (Table). CONCLUSION: In our prospective, community-based cohort baseline CSA was associated with incident AF.

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Abstract 2360: Central Sleep Apnea with Nocturnal Hypoxia Promotes Increased Circulating Erythropoietin in Heart Failure

Circulation ◽

10.1161/circ.118.suppl_18.s_709-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Andrew D Calvin ◽

Virend K Somers ◽

Jennifer M Miller ◽

David P Steensma ◽

Lyle J Olson

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Nyha Class ◽

Arterial Oxygen Saturation ◽

Central Sleep Apnea ◽

Arterial Oxygen ◽

Apnea Hypopnea Index ◽

Simple Linear Regression ◽

Class Iii ◽

Obstructive Sleep

Central sleep apnea (CSA) with nocturnal hypoxia is frequent in heart failure (HF). Hypoxia causes increased circulating erythropoietin (EPO) in healthy normals. EPO promotes increased vasoconstriction and exogenous EPO administration is associated with adverse cardiovascular events. No prior studies have related EPO concentration to apnea or hypoxia due to CSA. EPO is elevated in HF patients with nocturnal hypoxia due to CSA. Ambulatory, non-anemic HF patients (n = 29) with LVEF < 45% and healthy controls (n = 18) underwent polysomnography (PSG). Subjects with obstructive sleep apnea (OSA) were excluded. CSA was defined as apnea-hypopnea index (AHI) ≥ 15. Hypoxia was quantified as the proportion of sleep with arterial oxygen saturation < 90% (T90%). Blood for EPO was drawn post-PSG. Other clinical characteristics were summarized from the medical record. HF subjects and controls were similar age (54 vs 60 y, p = 0.09). CSA was present in 14 HF subjects; 13 were men compared to 8 of 15 without CSA (p = 0.04). HF subjects had 42% higher mean EPO than controls (p < 0.01) despite similar hemoglobin (13.9 vs 14.0 g/dL, p = 0.8). NYHA class III–IV HF subjects had 42% higher mean EPO than class I–II HF subjects (p = 0.05, figure ). EPO concentration was correlated with severity of nocturnal hypoxia by simple linear regression (r = 0.4; p = 0.02). By multivariate analysis, elevated EPO was associated with NYHA class III–IV HF and elevated AHI (p = 0.01 and 0.03, respectively; r = 0.6) after adjusting for age, gender, LVEF, renal function and hemoglobin. Nocturnal hypoxia due to CSA promotes increased endogenous EPO concentration in HF patients.

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Sleep disorders in patients with acute and exacerbated chronic heart failure

Bulgarian Cardiology ◽

10.3897/bgcardio.26.e55814 ◽

2020 ◽

Vol 26 (4) ◽

pp. 5-11

Author(s):

Petar Kalaydzhiev ◽

Desislava Somleva ◽

Elena Kinova ◽

Assen Goudev

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Chronic Heart Failure ◽

Sleep Disorders ◽

High Frequency ◽

Central Sleep Apnea ◽

The Other ◽

Cpap Therapy ◽

Obstructive Sleep ◽

Patients With Heart Failure

Heart failure is often accompanied by sleep disorders. CPAP therapy has proven in the treatment of obstructive sleep apnea, but the benefits associated with comorbid patients and patients with heart failure is still under research. On the other hand, central sleep apnea is also with high frequency in these patients and more difficult to treat. The aim of the current publication is to make a brief review of acute and exacerbated chronic heart failure in patients with sleep disorders - frequency, severity, and types to treat.

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Identifying Predictors of Central Sleep Apnea/Cheyne-Stokes Breathing in Chronic Heart Failure: a Pathophysiological Approach

Folia Medica ◽

10.1515/folmed-2016-0037 ◽

2016 ◽

Vol 58 (4) ◽

pp. 225-233 ◽

Cited By ~ 1

Author(s):

Aneliya I. Draganova ◽

Kiril V. Terziyski ◽

Stefan S. Kostianev

Keyword(s):

Heart Failure ◽

Sleep Apnea ◽

Chronic Heart Failure ◽

Treatment Options ◽

Central Sleep Apnea ◽

Feedback Gain ◽

Major Health Problem ◽

Obstructive Sleep ◽

Co Morbidity ◽

Cheyne Stokes Breathing

AbstractChronic heart failure (CHF) is a major health problem associated with increased mortality, despite modern treatment options. Central sleep apnea (CSA)/Cheyne-Stokes breathing (CSB) is a common and yet largely under-diagnosed co-morbidity, adding significantly to the poor prognosis in CHF because of a number of acute and chronic effects, including intermittent hypoxia, sympathetic overactivation, disturbed sleep architecture and impaired physical tolerance. It is characterized by repetitive periods of crescendo-decrescendo ventilatory pattern, alternating with central apneas and hypopneas. The pathogenesis of CSA/CSB is based on the concept of loop gain, comprising three major components: controller gain, plant gain and feedback gain. Laboratory polysomnography, being the golden standard for diagnosing sleep-disordered breathing (SDB) at present, is a costly and highly specialized procedure unable to meet the vast diagnostic demand. Unlike obstructive sleep apnea, CSA/CSB has a low clinical profile. Therefore, a reliable predictive system is needed for identifying CHF patients who are most likely to suffer from CSA/CSB, optimizing polysomnography use. The candidate predictors should be standardized, easily accessible and low-priced in order to be applied in daily medical routine.The present review focuses on a pathophysiological approach to the selection of some predictors based on parameters reflecting the etiology, the pathogenesis and the consequences of CSA/CSB in CHF.

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