scholarly journals Interaction Between Arousals and Ventilation During Cheyne-Stokes Respiration in Heart Failure Patients: Insights From Breath-by-Breath Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Gian Domenico Pinna ◽  
Elena Robbi ◽  
Claudio Bruschi ◽  
Maria Teresa La Rovere ◽  
Roberto Maestri
Keyword(s):  
Heart Failure ◽  
Sleep Stage ◽  
Central Sleep Apnea ◽  
Apnea Hypopnea Index ◽  
Central Apnea ◽  
Heart Failure Patients ◽  
Median Increase ◽  
Confounding Variables ◽  
Patients With Heart Failure ◽  
The Relationship

Study Objectives: Arousals from sleep during the hyperpneic phases of Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) in patients with heart failure are thought to cause ventilatory overshoot and a consequent longer apnea, thereby sustaining and exacerbating ventilatory instability. However, data supporting this model are lacking. We investigated the relationship between arousals, hyperpnea and post-hyperpnea apnea length during CSR-CSA.Methods: Breath-by-breath changes in ventilation associated with the occurrence of arousal were evaluated in 18 heart failure patients with CSR-CSA, apnea-hypopnea index ≥15/h and central apnea index ≥5/h. The change in apnea length associated with the presence of arousal during the previous hyperpnea was also evaluated. Potential confounding variables (chemical drive, sleep stage) were controlled for.Results: Arousals were associated with a large increase in ventilation at the beginning of the hyperpnea (+76 ± 35%, p < 0.0001), that rapidly declined during its crescendo phase. Around peak hyperpnea, the change in ventilation was −8 ± 26% (p = 0.14). The presence of arousal during the hyperpnea was associated with a median increase in the length of the subsequent apnea of +4.6% (Q1, Q2: −0.7%, 20.5%; range: −8.5%, 36.2%) (p = 0.021). The incidence of arousals occurring at the beginning of hyperpnea and mean ventilation in the region around its peak were independent predictors of the change in apnea length (p = 0.004 and p = 0.015, respectively; R2 = 0.78).Conclusions: Arousals from sleep during CSR-CSA in heart failure patients are associated with a rapidly decreasing ventilatory overshoot at the beginning of the hyperpnea, followed by a tendency toward a slight ventilatory undershoot around its peak. On average, arousals are also associated with a modest increase in post-hyperpnea apnea length; however, large increases in apnea length (>20%) occur in about a quarter of the patients.

scholarly journals 0602 Daytime Sleepiness in Heart Failure with Preserved Versus Reduced Ejection Fraction

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A230-A230
Author(s):  
S G Schütz ◽  
A Nguyen-Phan ◽  
M Konerman ◽  
S Hummel ◽  
R D Chervin
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Daytime Sleepiness ◽  
Diastolic Heart Failure ◽  
Apnea Hypopnea Index ◽  
Central Apnea ◽  
Reduced Ejection Fraction ◽  
Significant Difference ◽  
Patients With Heart Failure

Abstract Introduction Sleep apnea is common in patients with heart failure, though often not associated with significant daytime sleepiness in heart failure with reduced ejection fraction (HFrEF). The clinical presentation of sleep apnea in patients who have heart failure with borderline or preserved ejections fraction (HFbEF and HFpEF, respectively) is not well characterized. Methods Eighty patients with heart failure were identified retrospectively in data from University of Michigan Sleep Disorders Laboratories. Heart failure was categorized as heart failure with reduced ejection fraction (HFrEF)/systolic heart failure, heart failure with borderline ejection fraction (HFbEF) or heart failure with preserved ejection fraction (HFpEF)/diastolic heart failure. Clinical information and Epworth Sleepiness Scale (ESS) scores were extracted from medical records. A subset of subjects underwent a diagnostic polysomnogram. ANOVA was used to compare clinical characteristics in subjects with different heart failure types. Results ESS scores trended higher in 49 subjects with HFpEF (ESS mean 10.9±4.7 [sd]) compared to 9 with HFbEF (ESS 8.0±3.4) and 22 with HFrEF (ESS 8.4±5.0) (p=0.058). Among the 40 subjects who underwent diagnostic polysomnography, no statistically significant difference emerged in apnea-hypopnea index between subjects with HFpEF, HFbEF, and HFrEF (p=0.43). No significant differences emerged for the central apnea index (p=0.16), despite magnitudes of discrepancy that suggested a larger sample size might show different results CAI in participants with HFrEF showed a mean of 9.0±14.6/h, compared to 0.1±0.1/h in HFbEF and 3.1±6.3/h in HFpEF. Conclusion Among these patients with HFpEF, HFbEF, and HFrEF, subjects with HFpEF showed a trend towards increased subjective daytime sleepiness, though overall apnea and central apnea severity did not differ between groups. Further examination of clinical phenotypes in larger cohorts may help guide care in heterogeneous heart failure populations. Support National Institutes of Health grant NS107158

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 Acetazolamide Therapy in Patients with Heart Failure: A Meta-Analysis

2019 ◽  
Vol 8 (3) ◽  
pp. 349 ◽  
Author(s):  
Janewit Wongboonsin ◽  
Charat Thongprayoon ◽  
Tarun Bathini ◽  
Patompong Ungprasert ◽  
Narothama Aeddula ◽  
...  
Keyword(s):  
Heart Failure ◽  
Meta Analysis ◽  
Central Sleep Apnea ◽  
Mean Difference ◽  
Apnea Hypopnea Index ◽  
Serum Bicarbonate ◽  
Acid Base Balance ◽  
Study Results ◽  
Patients With Heart Failure ◽  
Base Balance

Background and objectives: Fluid overload and central sleep apnea are highly prevalent in patients with heart failure (HF). We performed this meta-analysis to assess the effects of acetazolamide therapy on acid/base balance and apnea indexes. Methods: A literature search was conducted using EMBASE, MEDLINE, and Cochrane Database from inception through 18 November 2017 to identify studies evaluating the use of acetazolamide in HF. Study results were analyzed using a random effects model. The protocol for this systematic review is registered with PROSPERO (International Prospective Register of Systematic Reviews; no. CRD42017065401). Results: Nine studies (three randomized controlled trials and six cohort studies) with a total of 229 HF patients were enrolled. After acetazolamide treatment, there were significant decreases in serum pH (mean difference (MD) of −0.04 (95% CI, −0.06 to −0.02)), pCO2 (MD of −2.06 mmHg (95% CI, −3.60 to −0.53 mmHg)), and serum bicarbonate levels (MD of −6.42 mmol/L (95% CI, −10.05 to −2.79 mmol/L)). When compared to a placebo, acetazolamide significantly increased natriuresis (standardized mean difference (SMD) of 0.67 (95% CI, 0.08 to 1.27)), and decreased the apnea-hypopnea index (AHI) (SMD of −1.06 (95% CI, −1.75 to −0.36)) and central apnea index (CAI) (SMD of −1.10 (95% CI, −1.80 to −0.40)). Egger’s regression asymmetry tests revealed no publication bias with p = 0.20, 0.75 and 0.59 for analysis of the changes in pH, pCO2, and serum bicarbonate levels with use of acetazolamide in HF patients. Conclusion: Our study demonstrates significant reduction in serum pH, increase in natriuresis, and improvements in apnea indexes with use of acetazolamide among HF patients.

P-54 Efficacy of Adaptive-Servo Ventilation for Cheyne Stokes Respiration with Central Sleep Apnea Among Patients with Heart Failure

2009 ◽  
Vol 4 ◽  
pp. S67
Author(s):  
Shingo Nakagawa ◽  
Yoshiko Nakagawa ◽  
Keisuke Ishimaru ◽  
Haruo Nakagawa ◽  
Takatoshi Kasai ◽  
...  
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Adaptive Servo Ventilation ◽  
Patients With Heart Failure

Impact of sleeping position on central sleep apnea/Cheyne–Stokes respiration in patients with heart failure

2010 ◽  
Vol 11 (2) ◽  
pp. 143-148 ◽  
Author(s):  
Shuji Joho ◽  
Yoshitaka Oda ◽  
Tadakazu Hirai ◽  
Hiroshi Inoue
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Central Sleep Apnea ◽  
Sleeping Position ◽  
Patients With Heart Failure

P2263Prognostic impact of perceived social isolation in patients with heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Ikeda ◽  
K Iwatsu ◽  
K Matsumura ◽  
H Ashikawa ◽  
K Takabayashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Social Isolation ◽  
Roc Curve ◽  
Negative Impact ◽  
Roc Curve Analysis ◽  
Rehospitalization Rate ◽  
Kaplan Meier ◽  
Patients With Heart Failure ◽  
Perceived Social Isolation ◽  
The Relationship

Abstract Background Perceived social isolation (SI), the subjective sense of feelings of loneliness or isolation, has a negative impact on health outcomes, particularly in older adults. Although SI may also contribute to poor prognosis in patients with HF, evidence on the relationship between SI and outcomes in patients with HF is limited. Purpose The aim of this study was to investigate the relationship between SI and hospital readmission in patients with HF. Methods This study was a single center prospective cohort study. We consecutively enrolled 203 patients (mean age 72.9±11.7) who admitted for acute HF or exacerbation of chronic HF. At hospital discharge, we assessed perceived SI by using Lubben Social Network Scale - 6 (LSNS-6). Lower scores in LSNS-6 represents greater SI. Study outcome was rehospitalization for worsening HF within 180 days after discharge. We selected the optimal cutoff point of LSNS-6 that predict a worse outcome by the receiver operating characteristic (ROC) curve analysis. We investigate the association between SI and 180-days HF rehospitalization by using Cox proportional-hazard models, controlling for potential confounding factors. Results During follow up, A total of 40events (19.7%) were observed. The optimal cut-off point of LSNS-6 score was 17 points (the area under the ROC curve: 0.62, p<0.05, sensitivity: 82.5%, specificity 42.4%). Kaplan-Meier survival curves showed that those patients with greater SI (LSNS-6≤17) presented significantly higher HF rehospitalization rate (Figure). After adjusting for several pre-existing prognostic factors, LSNS-6≤17 was independently associated with HF rehospitalization (hazard ratio2.15,95% confidence interval 1.00–4.89). Conclusion The present study shows that SI is a independent predictor of HF rehospitalization in patients with HF. Assessing SI in the clinical practice with a brief screening tool may help identify patients with heart failure at greater risk of rehospitalization.

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