scholarly journals Evaluation of the Apnea-Hypopnea Index Determined by Adaptive Servo-Ventilation Devices in Patients With Heart Failure and Sleep-Disordered Breathing

2021 ◽  
Vol 8 ◽  
Author(s):  
Satomi Imanari ◽  
Yasuhiro Tomita ◽  
Satoshi Kasagi ◽  
Fusae Kawana ◽  
Yuka Kimura ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Disordered Breathing ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Apnea Hypopnea Index ◽  
Adaptive Servo Ventilation ◽  
Respiratory Events ◽  
Patients With Heart Failure ◽  
Modest Correlation ◽  
Disordered Breathing

Introduction: Adaptive servo-ventilation (ASV) devices are designed to suppress central respiratory events, and therefore effective for sleep-disordered breathing (SDB) in patients with heart failure (HF) and provide information about their residual respiratory events. However, whether the apnea-hypopnea index (AHI), determined by the ASV device AutoSet CS (ASC), correlates with the AHI calculated by polysomnography (PSG) in patients with HF and SDB remains to be evaluated.Methods: Consecutive patients with SDB titrated on ASC were included in the study. We assessed the correlation between AHI determined by manual scoring during PSG (AHI-PSG) and that determined by the ASC device (AHI-ASC) during an overnight session.Results: Thirty patients with HF and SDB (age, 68.8 ± 15.4 years; two women; left ventricular ejection fraction, 53.8 ± 17.9%) were included. The median AHI in the diagnostic study was 28.4 events/h, including both obstructive and central respiratory events. During the titration, ASC markedly suppressed the respiratory events (AHI-PSG, 3.3 events/h), while the median AHI-ASC was 12.8 events/h. We identified a modest correlation between AHI-PSG and AHI-ASC (r = 0.36, p = 0.048). The Brand-Altman plot indicated that the ASC device overestimated the AHI, and a moderate agreement was observed with PSG.Conclusions: There was only a modest correlation between AHI-PSG and AHI-ASC. The discrepancy may be explained by either the central respiratory events that occur during wakefulness or the other differences between PSG and ASC in the detected respiratory events. Therefore, clinicians should consider this divergence when assessing residual respiratory events using ASC.

Abstract 11556: Association of Sleep Disordered Breathing and ECG R-Wave to Radial Artery Pulse Delay: The MESA Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Younghoon Kwon ◽  
David R Jacobs ◽  
Pamela L Lutsey ◽  
Peter Hannan ◽  
Julio A Chirinos ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Radial Artery ◽  
Sleep Disordered Breathing ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Apnea Hypopnea Index ◽  
Sleep Study ◽  
Ventricular Ejection Fraction ◽  
Pulse Delay ◽  
Disordered Breathing

Background: Arterial stiffness is a well-recognized predictor of cardiovascular disease (CVD). ECG R-wave to Radial artery pulse delay (RRD) is a novel hemodynamic index in which arterial stiffness is an important component (shorter delay = Higher arterial stiffness) and is obtainable from a single tonometric measurement at the radial artery with simultaneous ECG. Sleep disordered breathing (SDB) has emerged as a risk factor for CVD. The aim of the study was to determine the association of SDB with RRD. Methods: Multi-Ethnic Study of Atherosclerosis participants in 2010-2012 without overt CVD who underwent a sleep study, radial artery tonometry and cardiac MRI were eligible for this cross-sectional analysis (N = 1173, Mean [SD] age: 67.8 ± 8.8, Women: 55.4%). Independent associations between SDB indices including apnea hypopnea index (AHI) and oxygen (O2) desaturation index (ODI: events with more than 4% O2 desaturation), and RRD (transit time in msec) were examined. Model was constructed to adjust for isovolumetric contraction time, another component of RRD, by including measures of contractility and preload (left ventricular ejection fraction (LVEF) and left ventricular end diastolic volume (LVEDV) respectively). Results: Median [IQR] of AHI and ODI were 7.9/hr [2.9- 18.0] and 7.5/hr [3.0- 17.5] respectively. Adjusting for transit path length, demographic factors, BMI and CVD risk factors, both AHI and ODI were inversely associated with RRD (β= -50.3 msec per SD, p = 0.09 and β= -0.60.2 msec per SD, p = 0.04 respectively). In gender stratified analyses given presence of significant interaction, measures of SDB were predictive of RRD only in men. No significant associations were found with key nocturnal hypoxemia indices including mean O2 saturation (SpO2), percent time with SpO2less than 90 % and minimum SpO2. Men, older age, Asian race, high blood pressure, LVEF and LVEDV were also inversely associated with RRD. Conclusion: SDB was associated with shorter RRD implying higher arterial stiffness in men only. These findings suggest the importance of apnea related dynamic change in SpO2 (intermittent hypoxia and reoxygenation) in its potential link to arterial stiffness and also highlights effect modification by gender in the association between the two.

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

Cardiology ◽  
2017 ◽  
Vol 137 (2) ◽  
pp. 96-99 ◽  
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.

scholarly journals Association Between Sleep Disordered Breathing and Left Ventricular Function

2020 ◽  
Vol 13 (5) ◽  
Author(s):  
Rachel P. Ogilvie ◽  
Michael V. Genuardi ◽  
Jared W. Magnani ◽  
Susan Redline ◽  
Martha L. Daviglus ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Sleep Disordered Breathing ◽  
Survey Design ◽  
Systolic Function ◽  
Epidemiological Studies ◽  
Left Ventricular ◽  
Health Study ◽  
Apnea Hypopnea Index ◽  
Disordered Breathing

Background: Prior studies have found that sleep-disordered breathing (SDB) is common among those with left ventricular (LV) dysfunction and heart failure. Few epidemiological studies have examined this association, especially in US Hispanic/Latinos, who may be at elevated risk of SDB and heart failure. Methods: We examined associations between SDB and LV diastolic and systolic function using data from 1506 adults aged 18 to 64 years in the Hispanic Community Health Study/Study of Latinos ECHO-SOL Ancillary Study (2011–2014). Home sleep testing was used to measure the apnea-hypopnea index, a measure of SDB severity. Echocardiography was performed a median of 2.1 years later to quantify LV diastolic function, systolic function, and structure. Multivariable linear regression was used to model the association between apnea-hypopnea index and echocardiographic measures while accounting for the complex survey design, demographics, body mass, and time between sleep and echocardiographic measurements. Results: Each 10-unit increase in apnea-hypopnea index was associated with 0.2 (95% CI, 0.1–0.3) lower E′, 0.3 (0.1–0.5) greater E/E′ ratio, and 1.07-fold (1.03–1.11) higher prevalence of diastolic dysfunction as well as 1.3 (0.3–2.4) g/m 2 greater LV mass index. These associations persisted after adjustment for hypertension and diabetes mellitus. In contrast, no association was identified between SDB severity and subclinical markers of LV systolic function. Conclusions: Greater SDB severity was associated with LV hypertrophy and subclinical markers of LV diastolic dysfunction. These findings suggest SDB in Hispanic/Latino men and women may contribute to the burden of heart failure in this population.

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