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Patel N, Donahue C, Shenoy A, Patel A, El-Sherif N. Obstructive sleep apnea and arrhythmia: A systemic review. Int J Cardiol 2016; 228:967-970. [PMID: 27914359 DOI: 10.1016/j.ijcard.2016.11.137] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
There is a growing consensus in the scientific community that suggests a strong association between obstructive sleep apnea (OSA) and cardiovascular (CVD) conditions and events, including coronary artery disease, hypertension, arrhythmia, heart failure, and sudden cardiac death. We reviewed evidence on the relationship between OSA and arrhythmia. Our conclusion, based on our review of the literature, is that the evidence supports a strong link between OSA and cardiovascular mortality, which warrants treating OSA. Continuous positive airway pressure (CPAP) appears to reduce the CVD consequences of OSA. Future research is expected to clarify the benefits and optimal application of these treatment approaches.
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Affiliation(s)
- Nirav Patel
- Department of Medicine, SUNY Downstate, Brooklyn, NY, United States; Department of Cardiology, Brooklyn VA Center, Brooklyn, NY, United States; The Henry Low Heart Center, Hartford Hospital, Connecticut, United States.
| | | | - Abhishek Shenoy
- Department of Medicine, SUNY Downstate, Brooklyn, NY, United States
| | - Arpan Patel
- Windsor School of Medicine, St. Kitts, Saint Kitts and Nevis
| | - Nabil El-Sherif
- Department of Cardiology, Brooklyn VA Center, Brooklyn, NY, United States
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52
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Effects of adaptive servo-ventilation on ventricular arrhythmias in patients with stable congestive heart failure and sleep-disordered breathing. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0072-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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53
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Effekte einer adaptiven Servoventilation auf Herzrhythmusstörungen bei Patienten mit chronischer Herzinsuffizienz und schlafbezogenen Atmungsstörungen. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0059-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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54
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Alshaer H, Fernie GR, Tseng WH, Bradley TD. Comparison of in-laboratory and home diagnosis of sleep apnea using a cordless portable acoustic device. Sleep Med 2016; 22:91-96. [DOI: 10.1016/j.sleep.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/15/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
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55
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Wu X, Liu Z, Chang SC, Fu C, Li W, Jiang H, Jiang L, Li S. Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study. Respir Res 2016; 17:16. [PMID: 26879052 PMCID: PMC4754929 DOI: 10.1186/s12931-016-0333-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/09/2016] [Indexed: 11/22/2022] Open
Abstract
Background Nocturnal heart block often occurs in patients with obstructive sleep apnoea (OSA). It is more likely to be undiagnosed in heart block patients who are ignorant of the symptoms of sleep disorder. Berlin Questionnaire (BQ) is a highly reliable way to discover the risk factors of OSA, whereas the validity in sleep-related heart block patients is uncertain. We performed an observational study to address these issues and confirmed the potential protective effect of continuous positive airway pressure (CPAP). Methods Patients who were previously diagnosed with nocturnal heart block with R-R pauses exceeding 2 seconds were retrospective screened from the ECG centre of Zhongshan hospital. These recruited participants completed Berlin Questionnaire and underwent polysomnography synchronously with 24-hour Holter monitoring. A cross-sectional analysis was performed to confirm the association between nocturnal arrhythmia and OSA, as well as to assess the diagnostic accuracy of the BQ. Subsequently, subjects diagnosed with OSA (apnoea-hypopnoea index > 5) underwent 3 consecutive days of CPAP therapy. On the third day, patients repeated 24-hour Holter monitoring within the institution of CPAP. Results The symptoms of disruptive snoring and hypersomnolence in 72 enrolled patients were more related to the occurrence of nocturnal heart block (r = 0.306, 0.226, respectively, p = 0.015, 0.019) than syncope (r = 0.134, p = 0.282) and palpitations (r = 0.106, p = 0.119), which were prominent trait of our study population. The sensitivity, specificity, positive and negative predictive value of the BQ at a cut-off point of 5 of AHI for detecting OSA in heart block patients was 81.0 %, 44.4 %, 91.07 % and 25 %. Nocturnal heart block does not appear to occur exclusively in severe sleep apnoea. The frequent occurrence of arrhythmias in prominent oxygen desaturation supports the correlation between them. CPAP therapy resulted in significant decrease in the average number of episodes of heart block, from 148.58 ± 379.44 to 16.07 ± 58.52 (p < 0.05), same to the change of the longest RR pausing time (from 4.38 ± 2.95 s to 0.57 ± 1.05 s, p = 0.169) in 51 patients. The optimal therapy pressure to make the observed arrhythmia disappeared is 12 cm H2O. Conclusion Concerning high prevalence of OSA in heart block patients, BQ provided an economical and efficient screening method for OSA. For better management, CPAP therapy is feasible to prevent heart blocks avoiding unnecessary concomitant pacemaker implantation. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0333-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xu Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zilong Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Su Chi Chang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Cuiping Fu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wenjing Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hong Jiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200032, China.
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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56
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Linz D, Denner A, Illing S, Hohl M, Ukena C, Mahfoud F, Ewen S, Reil JC, Wirth K, Böhm M. Impact of obstructive and central apneas on ventricular repolarisation: lessons learned from studies in man and pigs. Clin Res Cardiol 2016; 105:639-647. [DOI: 10.1007/s00392-016-0961-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 01/18/2016] [Indexed: 11/24/2022]
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57
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Satake H, Sugimura K, Fukumoto Y, Fukuda K, Nakano M, Kondo M, Fukui S, Ogawa H, Shinozaki T, Shimokawa H. Effect of Respiratory Therapy on the Prognosis of Chronic Heart Failure Patients Complicated With Sleep-Disordered Breathing – A Pilot Efficacy Trial –. Circ J 2016; 80:130-8. [DOI: 10.1253/circj.cj-15-0702] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroyuki Satake
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Yoshihiro Fukumoto
- Department of Internal Medicine, Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Koji Fukuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Makoto Nakano
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masateru Kondo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Shigefumi Fukui
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiromasa Ogawa
- Department of Occupational Health, Tohoku University Graduate School of Medicine
| | - Tsuyoshi Shinozaki
- Division of Cardiology, National Hospital Organization Sendai Medical Center
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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58
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace 2015; 17:1601-87. [PMID: 26318695 DOI: 10.1093/europace/euv319] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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59
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Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, Elliott PM, Fitzsimons D, Hatala R, Hindricks G, Kirchhof P, Kjeldsen K, Kuck KH, Hernandez-Madrid A, Nikolaou N, Norekvål TM, Spaulding C, Van Veldhuisen DJ. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36:2793-2867. [PMID: 26320108 DOI: 10.1093/eurheartj/ehv316] [Citation(s) in RCA: 2530] [Impact Index Per Article: 281.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
MESH Headings
- Acute Disease
- Aged
- Anti-Arrhythmia Agents/therapeutic use
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/therapy
- Autopsy/methods
- Cardiac Resynchronization Therapy/methods
- Cardiomyopathies/complications
- Cardiomyopathies/therapy
- Cardiotonic Agents/therapeutic use
- Catheter Ablation/methods
- Child
- Coronary Artery Disease/complications
- Coronary Artery Disease/therapy
- Death, Sudden, Cardiac/prevention & control
- Defibrillators
- Drug Therapy, Combination
- Early Diagnosis
- Emergency Treatment/methods
- Female
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/therapy
- Heart Transplantation/methods
- Heart Valve Diseases/complications
- Heart Valve Diseases/therapy
- Humans
- Mental Disorders/complications
- Myocardial Infarction/complications
- Myocardial Infarction/therapy
- Myocarditis/complications
- Myocarditis/therapy
- Nervous System Diseases/complications
- Nervous System Diseases/therapy
- Out-of-Hospital Cardiac Arrest/therapy
- Pregnancy
- Pregnancy Complications, Cardiovascular/therapy
- Primary Prevention/methods
- Quality of Life
- Risk Assessment
- Sleep Apnea, Obstructive/complications
- Sleep Apnea, Obstructive/therapy
- Sports/physiology
- Stroke Volume/physiology
- Terminal Care/methods
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/therapy
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60
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Mansukhani MP, Wang S, Somers VK. Sleep, death, and the heart. Am J Physiol Heart Circ Physiol 2015; 309:H739-49. [PMID: 26188022 DOI: 10.1152/ajpheart.00285.2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/13/2015] [Indexed: 12/17/2022]
Abstract
Obstructive and central sleep apnea have been associated with increased risk of adverse cardiovascular events and mortality. Sympathetic dysregulation occurring as a result of the respiratory disturbance is thought to play a role in this increased risk. Sleep apnea increases the risk of arrhythmias, myocardial ischemia/infarction, stroke, and heart failure, all of which may increase mortality risk. A higher incidence of nocturnal arrhythmias, cardiac ischemia, and sudden death has been noted in subjects with sleep-disordered breathing (SDB). In this review, the association between SDB and each of these conditions is discussed, as well as the potential mechanisms underlying these risks and the effects of treatment of SDB. Particular emphasis is placed on the relationship between SDB and nocturnal atrial and ventricular arrhythmias, myocardial ischemia/infarction and sudden death.
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Affiliation(s)
- Meghna P Mansukhani
- Sleep Medicine, Affiliated Community Medical Centers, Willmar, Minnesota; and
| | - Shihan Wang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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61
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Grau N, Bazan V, Kallouchi M, Rodriguez D, Estirado C, Corral MI, Valls MT, Ramos P, Sanjuas C, Felez M, Valles E, Benito B, Gea J, Bruguera-Cortada J, Martí-Almor J. Long-term Impact of Continuous Positive Airway Pressure Therapy on Arrhythmia and Heart Rate Variability in Patients With Sleep Apnea. Arch Bronconeumol 2015; 52:17-23. [PMID: 25937252 DOI: 10.1016/j.arbres.2015.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/28/2015] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Autonomic dysfunction can alter heart rate variability and increase the incidence of arrhythmia. We analyzed the impact of continuous positive airway pressure (CPAP) on this pathophysiological phenomenon in patients with severe sleep apnea-hypopnea syndrome. METHODS Consecutive patients with recently diagnosed severe sleep apnea-hypopnea syndrome were prospectively considered for inclusion. Incidence of arrhythmia and heart rate variability (recorded on a 24-hour Holter monitoring device) were analyzed before starting CPAP therapy and 1 year thereafter. RESULTS A total of 26 patients were included in the study. CPAP was administered for 6.6 ± 1.8 hours during Holter monitoring. After starting CPAP, we observed a marginally significant reduction in mean HR (80 ± 9 to 77 ± 11 bpm, p=.05). CPAP was associated with partial modulation (only during waking hours) of r-MSSD (p=.047) and HF (p=.025) parasympathetic parameters and LF (p=.049) sympathetic modulation parameters. None of these parameters returned completely to normal levels (p<.001). The number of unsustained episodes of atrial tachycardia diminished (p=.024), but no clear effect on other arrhythmias was observed. CONCLUSIONS CPAP therapy only partially improves heart rate variability, and exclusively during waking hours, and reduces incidence of atrial tachycardia, both of which can influence cardiovascular morbidity and mortality in sleep apnea-hypopnea syndrome patients.
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Affiliation(s)
- Nuria Grau
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Victor Bazan
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Mohamed Kallouchi
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Diego Rodriguez
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Cristina Estirado
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Maria Isabel Corral
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Maria Teresa Valls
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pablo Ramos
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Carles Sanjuas
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Felez
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Ermengol Valles
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Begoña Benito
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Joaquim Gea
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jordi Bruguera-Cortada
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Julio Martí-Almor
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
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62
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Bitter T, Fox H, Gaddam S, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Cardiac Arrhythmias. Can J Cardiol 2015; 31:928-34. [PMID: 26037822 DOI: 10.1016/j.cjca.2015.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 02/07/2023] Open
Abstract
Over the past few years sleep-disordered breathing has been identified as an important factor in arrhythmogenesis and a potential target of therapy to prevent cardiac arrhythmias in selected patients. In this review we highlight the role of obstructive sleep apnea and Cheyne-Stokes respiration in the pathophysiology of arrhythmias, address their clinical effect in supraventricular and ventricular tachyarrhythmias, and in conduction disturbances, and address the role of current treatment options for sleep-disordered breathing in the primary and secondary prevention of arrhythmic events.
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Affiliation(s)
- Thomas Bitter
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Henrik Fox
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - SaiPrassad Gaddam
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
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63
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Heart Failure and Sleep Apnea. Can J Cardiol 2015; 31:898-908. [PMID: 26112300 DOI: 10.1016/j.cjca.2015.04.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/23/2015] [Accepted: 04/12/2015] [Indexed: 12/18/2022] Open
Abstract
Obstructive and central sleep apnea are far more common in heart failure patients than in the general population and their presence might contribute to the progression of heart failure by exposing the heart to intermittent hypoxia, increased preload and afterload, sympathetic nervous system activation, and vascular endothelial dysfunction. There is now substantial evidence that supports a role for fluid overload and nocturnal rostral fluid shift from the legs as unifying mechanisms in the pathogenesis of obstructive and central sleep apnea in heart failure patients, such that the predominant type of sleep apnea is related to the relative distribution of fluid from the leg to the neck and chest. Despite advances in therapies for heart failure, mortality rates remain high. Accordingly, the identification and treatment of sleep apnea in patients with heart failure might offer a novel therapeutic target to modulate this increased risk. In heart failure patients with obstructive or central sleep apnea, continuous positive airway pressure has been shown to improve cardiovascular function in short-term trials but this has not translated to improved mortality or reduced hospital admissions in long-term randomized trials. Other forms of positive airway pressure such as adaptive servoventilation have shown promising results in terms of attenuation of sleep apnea and improvement in cardiovascular function in short-term trials. Large scale, randomized trials are required to determine whether treating sleep apnea with various interventions can reduce morbidity and mortality.
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64
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Oldenburg O, Arzt M, Bitter T, Bonnemeier H, Edelmann F, Fietze I, Podszus T, Schäfer T, Schöbel C, Skobel E, Skowasch D, Penzel T, Nienaber C. Positionspapier „Schlafmedizin in der Kardiologie“. KARDIOLOGE 2015. [DOI: 10.1007/s12181-015-0654-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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65
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Shamsuzzaman A, Amin RS, van der Walt C, Davison DE, Okcay A, Pressman GS, Somers VK. Daytime cardiac repolarization in patients with obstructive sleep apnea. Sleep Breath 2015; 19:1135-40. [PMID: 25737301 DOI: 10.1007/s11325-015-1119-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 12/17/2014] [Accepted: 01/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Obstructive sleep apnea (OSA) has been implicated in complications of cardiovascular disease, including arrhythmias and sudden cardiac death (SCD). Prolonged QT interval is associated with arrhythmias and SCD in patients with cardiovascular disease and apparently healthy humans. Apneic episodes during sleep in OSA patients are associated with QT prolongation due to increased vagal activity, but it is not understood whether chronic QT prolongation persists during normoxic daytime wakefulness. METHODS To determine whether daytime QT intervals in OSA patients are prolonged compared to control subjects, we recruited 97 (76 male, 21 female) newly diagnosed patients with OSA [apnea-hypopnea index (AHI) ≥5 events/h] and 168 (100 male, 68 female) healthy volunteers (AHI <5 events/h) and measured daytime resting QT and RR intervals from the electrocardiograms to determine QT prolongation corrected for heart rate (QTc). RESULTS All subjects with OSA were older and heavier, with increased heart rate, significantly increased AHI and arousal index, and reduced oxygen saturation (SpO2) during sleep, and spent less time in sleep with >90 % SpO2 compared to respective controls. QTc in patients with OSA (410 ± 3.3 for male and 433 ± 5.6 for female) was significantly increased compared to respective control groups (399 ± 2.9 for male and 417 ± 2.9 for female), after adjustment for age and body mass index. CONCLUSIONS Our data show that OSA in either men or women is associated with a significant increase in resting daytime QTc. The propensity for ventricular arrhythmias in patients with OSA may be a result of abnormalities in resting cardiac repolarization.
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Affiliation(s)
- Abu Shamsuzzaman
- Cincinnati Children's Hospital Medical Center, MLC 2021 3333 Burnet Ave, Cincinnati, OH, 45229, USA. .,Mayo Clinic, Rochester, MN, USA.
| | - Raouf S Amin
- Cincinnati Children's Hospital Medical Center, MLC 2021 3333 Burnet Ave, Cincinnati, OH, 45229, USA
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66
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Omran H, Bitter T, Fox H, Horstkotte D, Oldenburg O. [Association of sleep-disordered breathing and malignant arrhythmias in patients with ischemic and dilated cardiomyopathy]. Herzschrittmacherther Elektrophysiol 2015; 26:27-31. [PMID: 25733315 DOI: 10.1007/s00399-015-0354-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 01/26/2015] [Indexed: 06/04/2023]
Abstract
Sleep-disordered breathing (SDB) has so far been a neglected comorbidity in patients with cardiac arrhythmias. Recently however, several studies have revealed a correlation between SDB and malignant ventricular arrhythmias. This review article is intended to provide the reader with an update on the pathophysiological association between SDB and ventricular arrhythmias, available clinical data, and therapeutic options.
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MESH Headings
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/therapy
- Cardiomyopathy, Dilated/diagnosis
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/therapy
- Comorbidity
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Humans
- Incidence
- Prevalence
- Risk Assessment/methods
- Risk Factors
- Sleep Apnea Syndromes/diagnosis
- Sleep Apnea Syndromes/mortality
- Sleep Apnea Syndromes/therapy
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Affiliation(s)
- Hazem Omran
- Klinik für Kardiologie, Herz- und Diabeteszentrum NRW Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Deutschland
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67
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Cicek D, Balcioğlu AS, Lakadamyali H, Müderrisoğlu H. Effects of Three Month Nasal Continuous Positive Airway Pressure Treatment on Electrocardiographic, Echocardiographic and Overnight Polysomnographic Parameters in Newly Diagnosed Moderate/Severe Obstructive Sleep Apnea Patients. Int Heart J 2015; 56:94-9. [DOI: 10.1536/ihj.14-085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Davran Cicek
- Department of Cardiology, Medical and Research Center of Alanya, Başkent University
| | | | - Hüseyin Lakadamyali
- Department of Chest Disease, Medical and Research Center of Alanya, Başkent University
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68
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Marcus NJ, Del Rio R, Schultz HD. Central role of carotid body chemoreceptors in disordered breathing and cardiorenal dysfunction in chronic heart failure. Front Physiol 2014; 5:438. [PMID: 25505417 PMCID: PMC4241833 DOI: 10.3389/fphys.2014.00438] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/27/2014] [Indexed: 11/13/2022] Open
Abstract
Oscillatory breathing (OB) patterns are observed in pre-term infants, patients with cardio-renal impairment, and in otherwise healthy humans exposed to high altitude. Enhanced carotid body (CB) chemoreflex sensitivity is common to all of these populations and is thought to contribute to these abnormal patterns by destabilizing the respiratory control system. OB patterns in chronic heart failure (CHF) patients are associated with greater levels of tonic and chemoreflex-evoked sympathetic nerve activity (SNA), which is associated with greater morbidity and poor prognosis. Enhanced chemoreflex drive may contribute to tonic elevations in SNA by strengthening the relationship between respiratory and sympathetic neural outflow. Elimination of CB afferents in experimental models of CHF has been shown to reduce OB, respiratory-sympathetic coupling, and renal SNA, and to improve autonomic balance in the heart. The CB chemoreceptors may play an important role in progression of CHF by contributing to respiratory instability and OB, which in turn further exacerbates tonic and chemoreflex-evoked increases in SNA to the heart and kidney.
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Affiliation(s)
- Noah J Marcus
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center Omaha, NE, USA
| | - Rodrigo Del Rio
- Laboratory of Cardiorespiratory Control, Center of Biomedical Research, Universidad Autónoma de Chile Santiago, Chile
| | - Harold D Schultz
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center Omaha, NE, USA
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69
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Abstract
The intersecting relationships of sleep disordered breathing (SDB), arrhythmogenic risk and chronic heart failure (HF) are complex and most likely multi-directional and synergistic. Autonomic dysfunction is a common pathophysiological feature of each of these entities. Intermittent hypoxia, hypercapnia, mechanical cardiac influences due to upper airway obstruction and rostral fluid shifts are SDB-specific mechanisms which may trigger, perpetuate and exacerbate HF and arrhythmogenesis. Specific pathophysiological mechanisms will vary according to the predominance of central as compared to obstructive sleep apnea. The risk of cardiac arrhythmias and HF attributable to SDB may be considerable given the high prevalence of SDB and its likely physiologic burden. The current review focuses on the data, which have accrued elucidating the specific contributory mechanisms of SDB in cardiac arrhythmias and HF, highlighting the clinical relevance and effects of standard SDB treatment on these outcomes, and describing the role of novel therapeutics.
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70
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Raghuram A, Clay R, Kumbam A, Tereshchenko LG, Khan A. A systematic review of the association between obstructive sleep apnea and ventricular arrhythmias. J Clin Sleep Med 2014; 10:1155-60. [PMID: 25317099 DOI: 10.5664/jcsm.4126] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 08/01/2014] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is an independent risk factor for sudden cardiac death. The aim of this review was to study the relationship between OSA and ventricular arrhythmias. METHODS PubMed, Medline, and Cochrane databases were searched with MESH headings to find studies linking OSA and ventricular arrhythmias including ventricular ectopy, ventricular tachycardia (VT), and ventricular fibrillation (VF). Studies were graded by a scoring system, and an attempt was made to pool data. RESULTS There were no matched cohort or case control studies to study the association between OSA and ventricular arrhythmias. Given data heterogeneity, pooling and meta-analysis of data were not possible. An attempt was made to judge the quality of evidence and present a systematic review. Patients with OSA were noted to have higher odds of ventricular ectopy, and were at a higher risk for ventricular arrhythmias. Associations included higher QTc dispersion and HR variability. We did not, however, find any clear evidence for a direct correlation between increased apnea hypopnea index and increased VT or VF. CONCLUSIONS Pooling and meta-analysis of studies linking OSA and ventricular arrhythmias were not possible due to heterogeneity of data. In a systemic review of studies, patients with OSA were noted to have higher odds of ventricular ectopy and arrhythmias. A single study showed that CPAP may help lower arrhythmogenicity; however, it was unclear if CPAP lowered the risk of VT. Further research should focus on studying the association of OSA and causes of sudden cardiac death, including ventricular arrhythmias.
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Affiliation(s)
| | - Ryan Clay
- Oregon Health & Science University, Portland OR
| | | | | | - Akram Khan
- Oregon Health & Science University, Portland OR
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71
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Aggarwal S, Nadeem R, Loomba RS, Nida M, Vieira D. The effects of continuous positive airways pressure therapy on cardiovascular end points in patients with sleep-disordered breathing and heart failure: a meta-analysis of randomized controlled trials. Clin Cardiol 2014; 37:57-65. [PMID: 24567977 DOI: 10.1002/clc.22201] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In patients with sleep-disordered breathing and heart failure, continuous positive airway pressure has been found to be associated with an improvement in cardiovascular end points. We conducted a systematic review of the current literature and a meta-analysis to pool data from 15 published randomized controlled trials. End points analyzed were left ventricular ejection fraction, diastolic blood pressure, systolic blood pressure, heart rate, and mortality. A fixed effects model was used for end points demonstrating homogeneity among included studies, whereas a random effects model was used for end points demonstrating heterogeneity among included studies. A significant improvement in left ventricular ejection fraction was noted with continuous positive airway pressure (mean difference, 5.05%; 95% confidence interval [CI]: 3.72 to 6.38), diastolic blood pressure (mean difference, −1.67; 95% CI: −3.09 to −0.25), and heart rate (mean difference, −5.92; 95% CI: −10.12 to−1.72). No significant changes in mortality (odds ratio, 0.63; 95% CI: 0.40 to 1.00) and systolic blood pressure were noted (mean difference, −6.35; 95% CI: −16.11 to 2.41). The analysis also revealed the need for additional studies to clarify the associations noted and the presence of publication bias with small studies with a paucity of small studies with negative results. In this meta-analysis, treatment with continuous positive airways pressure was associated with improvements in ejection fraction, diastolic blood pressure, and heart rate in patients with sleep-disordered breathing and congestive heart failure.
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72
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Padeletti M, Zacà V, Mondillo S, Jelic S. Sleep-disordered breathing increases the risk of arrhythmias. J Cardiovasc Med (Hagerstown) 2014; 15:411-6. [PMID: 24743686 PMCID: PMC4654124 DOI: 10.2459/jcm.0000000000000019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Sleep-disordered breathing (SDB) has been consistently associated with increased risk for cardiovascular diseases, including arrhythmias. The purpose of this review is to elucidate the several pathophysiologic pathways such as repetitive hypoxia and reoxygenation, increased oxidative stress, inflammation and sympathetic activation that may underlie the increased incidence of arrhythmias in SDB patients. We discuss in particular the incidence of ventricular arrhythmias, atrial fibrillation and bradyarrhythmias in SDB patients. In addition, we discuss the electrocardiographic alteration such as ST-T changes during apneic events and QT dispersion induced by SDB that may trigger complex ventricular arrhythmias and sudden cardiac death. Finally, we consider also the therapeutic interventions such as continuous positive airways pressure therapy, a standard treatment for SDB, that may reduce the incidence and recurrence of supraventricular and ventricular arrhythmias in patients with SDB.
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Affiliation(s)
| | - Valerio Zacà
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Sanja Jelic
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, New York, USA
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73
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Valenza MC, Baranchuk A, Valenza-Demet G, Muñoz-Casaubon T, Martin-Navajas JA, Healey J. Prevalence of risk factors for atrial fibrillation and stroke among 1210 patients with sleep disordered breathing. Int J Cardiol 2014; 174:73-6. [PMID: 24726170 DOI: 10.1016/j.ijcard.2014.03.156] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/13/2014] [Accepted: 03/22/2014] [Indexed: 01/22/2023]
Abstract
AIMS This study sought to identify the prevalence of risk factors for atrial fibrillation and stroke in a sleep apnea population. METHODS Study participants included 1210 consecutive adults who were referred with suspicion of sleep apnea. Statistical analysis was used to determine the relationship between sleep apnea syndrome and risk factors for atrial fibrillation and stroke. RESULTS Among 1210 enrolled patients, 65.8% had severe sleep apnea (Apnea/hypopnea Index--AHI>30), 25.2% had mild to moderate sleep apnea (AHI 5 to 30), and 8.8% had no sleep apnea (AHI<5). At baseline, the mean apnea-hypopnea index in patients with sleep apnea syndrome was 35. Compared to patients with an AHI<5, those with an AHI>30 were older (47.3±11.4 vs. 52.74±12.4, p<0.001) and had a higher body mass index (BMI) (30.7±7.3 vs. 33.83±10.1, p<0.001), a higher prevalence of hypertension (38 vs. 16%, p<0.001), and a higher CHADS2 (congestive heart failure, hypertension, age, diabetes and prior stroke) score (0.59±0.8 vs. 0.28±0.64, p<0.001). CONCLUSIONS Patients with severe sleep apnea have a higher prevalence of risk factors for atrial fibrillation and stroke when compared with subjects without sleep apnea.
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Affiliation(s)
| | - Adrian Baranchuk
- Division of Cardiology (Arrhythmia Service), Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
| | | | - Tomás Muñoz-Casaubon
- Sleep Laboratory, Department of Pulmonology, San Cecilio Hospital, Granada, Spain
| | | | - Jeff Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
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75
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Perioperative Risk Modification in Patients with Obstructive Sleep Apnea. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-013-0043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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76
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Haack KKV, Marcus NJ, Del Rio R, Zucker IH, Schultz HD. Simvastatin treatment attenuates increased respiratory variability and apnea/hypopnea index in rats with chronic heart failure. Hypertension 2014; 63:1041-9. [PMID: 24516105 DOI: 10.1161/hypertensionaha.113.02535] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cheyne-Stokes respiration and cardiac arrhythmias are associated with increased morbidity and mortality in patients with chronic heart failure (CHF). Enhanced carotid body chemoreflex (CBC) sensitivity is associated with these abnormalities in CHF. Reduced carotid body (CB) nitric oxide and nitric oxide synthase (NOS) levels play an important role in the enhanced CBC. In other disease models, Simvastatin (statin) treatment increases endothelial NOS, in part, by increasing Krüppel-like Factor 2 expression. We hypothesized that statin treatment would ameliorate enhanced CBC sensitivity as well as increased respiratory variability, apnea/hypopnea index, and arrhythmia index, in a rodent model of CHF. Resting breathing pattern, cardiac rhythm, and the ventilatory and CB chemoreceptor afferent responses to hypoxia were assessed in rats with CHF induced by coronary ligation. CHF was associated with enhanced ventilatory and CB afferent responses to hypoxia as well as increased respiratory variability, apnea/hypopnea index, and arrhythmia index. Statin treatment prevented the increases in CBC sensitivity and the concomitant increases in respiratory variability, apnea/hypopnea index, and arrhythmia index. Krüppel-like Factor 2 and endothelial NOS protein were decreased in the CB and nucleus tractus solitarii of CHF animals, and statin treatment increased the expression of these proteins. Our findings demonstrate that the increased CBC sensitivity, respiratory instability, and cardiac arrhythmias observed in CHF are ameliorated by statin treatment and suggest that statins may be an effective treatment for Cheyne-Stokes respiration and arrhythmias in patient populations with high chemoreflex sensitivity.
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Affiliation(s)
- Karla K V Haack
- Department of Cellular and Integrative Physiology, 985850 Nebraska Medical Center, Omaha, NE 68198.
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77
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Chan KH, Wilcox I. Obstructive sleep apnea: novel trigger and potential therapeutic target for cardiac arrhythmias. Expert Rev Cardiovasc Ther 2014; 8:981-94. [DOI: 10.1586/erc.10.80] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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78
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Hamilton GS, Naughton MT. Impact of obstructive sleep apnoea on diabetes and cardiovascular disease. Med J Aust 2013; 199:S27-30. [PMID: 24138362 DOI: 10.5694/mja13.10579] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/24/2013] [Indexed: 12/17/2022]
Abstract
Obstructive sleep apnoea (OSA) is a potential cause of systemic hypertension in young and middle-aged people, and treatment helps reduce blood pressure in some patients. Severe OSA (apnoea-hypopnoea index [AHI] > 30/h) is strongly associated with increased mortality, stroke and cardiovascular disease in middle-aged populations. The cardiovascular risk from moderate OSA (AHI, 15-30/h) is uncertain, particularly if the oxygen desaturation index is low, although the data suggest an increased risk for stroke (particularly in men). There is no evidence of increased cardiovascular risk from mild OSA (AHI < 15/h). In the elderly, the cardiovascular risks of OSA are uncertain, although there is a likelihood of increased risk of stroke. Current, ongoing randomised controlled trials will inform whether OSA is a reversible cardiovascular risk factor within the next 5 years. Patients with cardiovascular disease, stroke, diabetes, obesity or poorly controlled hypertension are at high risk of OSA and should be questioned for symptoms of OSA, which, if present, may warrant further investigation and treatment. Weight loss has an unpredictable effect on OSA severity, but is independently beneficial for symptoms and metabolic health in OSA patients and is recommended for all overweight and obese OSA patients.
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79
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Effects of CPAP treatment interruption due to disasters: patients with sleep-disordered breathing in the Great East Japan Earthquake and tsunami area. Prehosp Disaster Med 2013; 28:547-55. [PMID: 24300523 DOI: 10.1017/s1049023x13008959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The 2011 Great East Japan Earthquake caused major disruptions in the provision of health care, including that for patients with sleep-disordered breathing (SDB) using a nasal continuous positive airway pressure (nCPAP) device. This study investigated the ability of SDB patients to continue using the nCPAP device in the weeks immediately following the earthquake, whether inability to use the nCPAP device led to symptom relapse, and measures that should be taken to prevent disruptions in nCPAP therapy during future disasters. Hypothesis If nCPAP devices cannot be used during disasters, SDB patients' health will be affected negatively. METHODS Within 14 days of the disaster, 1,047 SDB patients completed a questionnaire that collected data regarding ability to use, duration of inability to use, and reasons for inability to use the nCPAP device; symptom relapse while unable to use the nCPAP device; ability to use the nCPAP device use at evacuation sites; and recommendations for improvement of the nCPAP device. RESULTS Of the 1,047 patients, 966 (92.3%) had been unable to use the nCPAP device in the days immediately following the earthquake. The most common reason for inability to use the nCPAP device was power failure, followed by anxiety about sleeping at night due to fear of aftershocks, involvement in disaster-relief activities, loss of the nasal CPAP device, and fear of being unable to wake up in case of an emergency. Among the 966 patients, 242 (25.1%) had experienced relapse of symptoms, the most common of which was excessive daytime sleepiness (EDS), followed by insomnia, headache, irritability, and chest pain. CONCLUSION Developing strategies for the continuation of nCPAP therapy during disasters is important for providing healthy sleeping environments for SDB patients in emergency situations.
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Marcus NJ, Del Rio R, Schultz EP, Xia XH, Schultz HD. Carotid body denervation improves autonomic and cardiac function and attenuates disordered breathing in congestive heart failure. J Physiol 2013; 592:391-408. [PMID: 24247985 DOI: 10.1113/jphysiol.2013.266221] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In congestive heart failure (CHF), carotid body (CB) chemoreceptor activity is enhanced and is associated with oscillatory (Cheyne-Stokes) breathing patterns, increased sympathetic nerve activity (SNA) and increased arrhythmia incidence. We hypothesized that denervation of the CB (CBD) chemoreceptors would reduce SNA, reduce apnoea and arrhythmia incidence and improve ventricular function in pacing-induced CHF rabbits. Resting breathing, renal SNA (RSNA) and arrhythmia incidence were measured in three groups of animals: (1) sham CHF/sham-CBD (sham-sham); (2) CHF/sham-CBD (CHF-sham); and (3) CHF/CBD (CHF-CBD). Chemoreflex sensitivity was measured as the RSNA and minute ventilatory (VE) responses to hypoxia and hypercapnia. Respiratory pattern was measured by plethysmography and quantified by an apnoea-hypopnoea index, respiratory rate variability index and the coefficient of variation of tidal volume. Sympatho-respiratory coupling (SRC) was assessed using power spectral analysis and the magnitude of the peak coherence function between tidal volume and RSNA frequency spectra. Arrhythmia incidence and low frequency/high frequency ratio of heart rate variability were assessed using ECG and blood pressure waveforms, respectively. RSNA and VE responses to hypoxia were augmented in CHF-sham and abolished in CHF-CBD animals. Resting RSNA was greater in CHF-sham compared to sham-sham animals (43 ± 5% max vs. 23 ± 2% max, P < 0.05), and this increase was not found in CHF-CBD animals (25 ± 1% max, P < 0.05 vs. CHF-sham). Low frequency/high frequency heart rate variability ratio was similarly increased in CHF and reduced by CBD (P < 0.05). Respiratory rate variability index, coefficient of variation of tidal volume and apnoea-hypopnoea index were increased in CHF-sham animals and reduced in CHF-CBD animals (P < 0.05). SRC (peak coherence) was increased in CHF-sham animals (sham-sham 0.49 ± 0.05; CHF-sham 0.79 ± 0.06), and was attenuated in CHF-CBD animals (0.59 ± 0.05) (P < 0.05 for all comparisons). Arrhythmia incidence was increased in CHF-sham and reduced in CHF-CBD animals (213 ± 58 events h(-1) CHF, 108 ± 48 events h(-1) CHF-CBD, P < 0.05). Furthermore, ventricular systolic (3.8 ± 0.7 vs. 6.3 ± 0.5 ml, P < 0.05) and diastolic (6.3 ± 1.0 vs. 9.1 ± 0.5 ml, P < 0.05) volumes were reduced, and ejection fraction preserved (41 ± 5% vs. 54 ± 2% reduction from pre-pace, P < 0.05) in CHF-CBD compared to CHF-sham rabbits. Similar patterns of changes were observed longitudinally within the CHF-CBD group before and after CBD. In conclusion, CBD is effective in reducing RSNA, SRC and arrhythmia incidence, while improving breathing stability and cardiac function in pacing-induced CHF rabbits.
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Affiliation(s)
- Noah J Marcus
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198-5850, USA.
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81
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Simms T, Brijbassi M, Montemurro LT, Bradley TD. Differential timing of arousals in obstructive and central sleep apnea in patients with heart failure. J Clin Sleep Med 2013; 9:773-9. [PMID: 23946707 PMCID: PMC3716668 DOI: 10.5664/jcsm.2918] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
STUDY OBJECTIVES In obstructive sleep apnea (OSA), arousals generally occur at apnea termination and help restore airflow. However, timing of arousals in central sleep apnea (CSA) has not been objectively quantified, and since arousals can persist even when CSA is alleviated, may not play the same defensive role as they do in OSA. We hypothesized that arousals following central events would occur longer after event termination than following obstructive events and would be related to circulation time. METHODS We examined polysomnograms from 20 patients with heart failure (HF) (left ventricular ejection fraction ≤ 45%): 10 with OSA and 10 with CSA (apneahypopnea index ≥ 15). Twenty central or obstructive apneas or hypopneas were analyzed in each patient. RESULTS Compared to the OSA group in whom arousals generally occurred at obstructive event termination, in the CSA group they occurred longer after central event termination (0.9 ± 1.1 versus 8.0 ± 4.1 s, p < 0.0001), but before peak hyperpnea. Time from arousal to peak hyperpnea did not differ between groups (4.3 ± 1.1 vs 4.8 ± 1.6 s, p = 0.416). Unlike the OSA group, latency from apnea termination to arousal correlated with circulation time in the CSA group (r = 0.793, p = 0.006). CONCLUSIONS In HF patients with CSA, apnea-to-arousal latency is longer than in those with OSA, and arousals usually follow resumption of airflow. These observations provide evidence that arousals are less likely to act as a protective mechanism to facilitate resumption of airflow following apneas in CSA than in OSA.
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Affiliation(s)
- Taryn Simms
- Sleep Research Laboratories of the University Health Network Toronto Rehabilitation Institute and Toronto General Hospital, Toronto, ON, Canada
| | - Melissa Brijbassi
- Sleep Research Laboratories of the University Health Network Toronto Rehabilitation Institute and Toronto General Hospital, Toronto, ON, Canada
| | - Luigi Taranto Montemurro
- Sleep Research Laboratories of the University Health Network Toronto Rehabilitation Institute and Toronto General Hospital, Toronto, ON, Canada
| | - T. Douglas Bradley
- Sleep Research Laboratories of the University Health Network Toronto Rehabilitation Institute and Toronto General Hospital, Toronto, ON, Canada
- Centre for Sleep Medicine and Circadian Biology of the University of Toronto, Toronto, ON, Canada
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Suppressive effects of adaptive servo-ventilation on ventricular premature complexes with attenuation of sympathetic nervous activity in heart failure patients with sleep-disordered breathing. Heart Vessels 2013; 29:470-7. [DOI: 10.1007/s00380-013-0394-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 06/27/2013] [Indexed: 12/22/2022]
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83
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Durán-Cantolla J, Martínez-Null C, Santaolalla CE. Tratamiento del síndrome de apneas-hipoapneas del sueño (SAHS) con dispositivos mecánicos generadores de presión postiva. CPAP, APAP y ventilación servoasistida. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70174-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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84
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Portable recording for detecting sleep disorder breathing in patients under the care of a heart failure clinic. Clin Res Cardiol 2013; 102:535-42. [DOI: 10.1007/s00392-013-0563-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 04/03/2013] [Indexed: 10/27/2022]
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85
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Yagishita-Tagawa Y, Yumino D, Takagi A, Serizawa N, Hagiwara N. Association between sleep apnea and overnight hemodynamic changes in hospitalized heart failure patients with and without paroxysmal nocturnal dyspnea. J Cardiol 2013; 61:348-53. [PMID: 23507270 DOI: 10.1016/j.jjcc.2012.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/04/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paroxysmal nocturnal dyspnea (PND) is a common symptom for patients with acute decompensated heart failure (ADHF). Some symptoms of PND are similar to those of sleep apnea (SA) which might be associated with overnight worsening hemodynamics in failing hearts. However, the association between PND, SA, and overnight change in hemodynamics in patients with heart failure remains uncertain. METHODS We studied 28 consecutive patients with reduced ejection fraction who were hospitalized with ADHF. Plasma atrial natriuretic peptide (ANP) levels were measured before and after overnight sleep study. PND was defined as having an episode of PND prior to hospitalization for ADHF. RESULTS Ten (36%) patients had a history of PND. Respiratory disturbance index (the frequency and severity of sleep apnea) was an independent factor associated with a history of PND (odds ratio 1.24, 95% confidence interval 1.05-1.47, p=0.011). In those without PND, plasma ANP levels decreased from before sleep to after waking, whereas in those with PND it increased (p=0.011). In addition, overnight change in plasma ANP levels was independently associated with respiratory disturbance index (p=0.035). CONCLUSION These results thus suggest that in patients with ADHF, SA might be a predisposing cause of PND in association with overnight worsening hemodynamics.
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Alshaer H, Fernie GR, Maki E, Bradley TD. Validation of an automated algorithm for detecting apneas and hypopneas by acoustic analysis of breath sounds. Sleep Med 2013; 14:562-71. [PMID: 23453251 DOI: 10.1016/j.sleep.2012.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 12/10/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common and is associated with increased risk for cardiovascular disease. However, most patients remain undiagnosed due to lack of access to sleep laboratories. We therefore tested the validity of a single-channel monitoring setup that captures and analyzes breath sounds (BSs) to detect SDB. METHODS BS were recorded from 50 patients undergoing simultaneous polysomnography (PSG). Using custom-designed automatic software, BS were subjected to a set of pattern recognition rules to identify apneas and hypopneas from which the acoustic apnea-hypopnea index (AHI-a) was calculated. Apneas and hypopneas from PSG were scored blindly by three technicians according to two criteria; one relying solely on the drop of the respiratory signal by >90% for an apnea and by 50% to 90% for a hypopnea (TV50 criteria), and another that also required a desaturation or an arousal for a hypopnea (American Association of Sleep Medicine [AASM] criteria). PSG AHI (AHI-p) was calculated for each technician according to both criteria. RESULTS There was no significant difference between AHI-p scores according to TV50 and AASM criteria. AHI-a was strongly correlated with AHI-p according to both TV50 (R=94%) and AASM criteria (R=93%). Bland-Altman plot analysis revealed that 98% and 92% of AHI-a fell within the limits of agreement for AHI-p according to TV50 and AASM criteria, respectively. Based on a diagnostic cutoff of AHI-p≥10 for SDB, overall accuracy of AHI-a reached 88% and negative predictive value reached 100%. CONCLUSION Acoustic analysis of BS is a reliable method for quantifying AHI and diagnosing SDB compared to simultaneous PSG.
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Affiliation(s)
- Hisham Alshaer
- University Health Network Toronto Rehabilitation Institute, iDAPT - Intelligent Design for Adaptation, Participation and Technology, Canada.
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88
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Alshaer H, Levchenko A, Bradley TD, Pong S, Tseng WH, Fernie GR. A system for portable sleep apnea diagnosis using an embedded data capturing module. J Clin Monit Comput 2013; 27:303-11. [DOI: 10.1007/s10877-013-9435-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
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89
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Szaboova E, Holoubek D, Tomori Z, Szabo P, Donic V, Stancak B. Severity of nocturnal cardiac arrhythmias correlates with intensity of sleep apnea in men. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 755:155-68. [PMID: 22826063 DOI: 10.1007/978-94-007-4546-9_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Various cardiac arrhythmias frequently occur in patients with sleep apnea, but complex analysis of the relationship between their severity and the probable arrhythmogenic risk factors is conflicting. The question is what cardiovascular risk factors and how strongly they are associated with the severity of cardiac arrhythmias in sleep apnea. Adult males (33 with and 16 without sleep apnea), matched for cardiovascular co-morbidity were studied by polysomnography with simultaneous ECG monitoring. Arrhythmia severity was evaluated for each subject by a special 7-degree scoring system. Laboratory, clinical, echocardiographic, carotid ultrasonographic, ambulatory blood pressure, and baroreflex sensitivity values were also assessed. Moderate sleep apnea patients had benign, but more exaggerated cardiac arrhythmias than control subjects (2.53 ± 2.49 vs. 1.13 ± 1.64 degrees of cumulative severity, p < 0.05). We confirmed strong correlations between the arrhythmia severity and known arrhythmogenic risk factors (left ventricular ejection fraction and dimensions, right ventricular diameter, baroreflex sensitivity, carotid intima-media thickness, age, previous myocardial infarction, and also apnea-hypopnea index). In multivariate modelling only the apnea-hypopnea index indicating the sleep apnea intensity remained highly significantly correlated with the cumulative arrhythmia severity (beta = 0.548, p < 0.005). In conclusion, sleep apnea modifying cardiovascular risk factors and structures or functions provoked various nocturnal arrhythmias. The proposed scoring system allowed a complex analysis of the contribution of various triggers to arrhythmogenesis and confirmed the apnea-hypopnea index as an independent risk for nocturnal cardiac arrhythmia severity in sleep apnea.
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Affiliation(s)
- E Szaboova
- Faculty of Medicine, PJ Safarik University, Kosice, Slovakia.
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Affiliation(s)
- Takatoshi Kasai
- Sleep Research Laboratory, Centre for Sleep Health and Research, and Department of Medicine of the University Health Network Toronto Rehabilitation Institute, Ontario, Canada
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91
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Sahadevan J, Srinivasan D. Treatment of obstructive sleep apnea in patients with cardiac arrhythmias. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:520-8. [PMID: 22923098 DOI: 10.1007/s11936-012-0201-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing that is prevalent in the population and frequently under diagnosed. Usually presenting with respiratory symptoms, the most significant consequences of OSA are cardiovascular, including arrhythmias. The pathophysiology of OSA through multiple mechanisms may promote bradyarrhythmias, atrial fibrillation, premature ventricular complexes, ventricular arrhythmias, and sudden death. These mechanisms may acutely trigger nocturnal arrhythmias and may chronically affect electrical and structural myocardial changes, causing arrhythmias. Numerous epidemiological data have identified an increased risk for atrial fibrillation, ventricular fibrillation and sudden death in subjects with OSA. Diagnosis of OSA should be considered in patients with arrhythmias. However, not all patients with arrhythmias need to undergo formal testing for sleep apnea. Patients who are observed to have nocturnal arrhythmias should be considered for evaluation for possible OSA. Also, if the arrhythmia is refractory to standard therapy and if other clinical indicators of OSA are also present, there should be a low threshold for pursuing the diagnosis of sleep apnea. The principal therapy for OSA is continuous positive airway pressure (CPAP). Currently, there are limited data to support the efficacy of CPAP for arrhythmia prevention or treatment. Randomized trials are necessary to determine the efficacy of OSA treatment on arrhythmia prevention.
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Affiliation(s)
- Jayakumar Sahadevan
- Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, Cleveland, OH, USA,
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92
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Bitter T, Körber B, Horstkotte D, Oldenburg O. [Sleep-disordered breathing and cardiac arrhythmias]. Herzschrittmacherther Elektrophysiol 2012; 23:22-6. [PMID: 22351149 DOI: 10.1007/s00399-011-0164-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sleep-disordered breathing (SDB) is an important comorbidity in patients with cardiac arrhythmias. Previous studies confirmed associations between supraventricular and ventricular arrhythmias and SDB. In heart failure patients, SDB was also found independently associated with a shorter event-free survival to the occurrence of malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapy. In obstructive sleep apnea, repetitive hypoxemia, mechanical stress (wall tension), arousals from sleep, and activation of the sympathetic nervous system promote cardiac arrhythmias. Pathophysiological concepts for the link between Cheyne-Stokes respiration and malignant arrhythmias are not fully understood and require further research. In addition, large-scale, randomized, controlled trials are awaited to prove whether adequate treatment of SDB is associated with a risk reduction for the occurrence of arrhythmias, in general, and malignant ventricular arrhythmias, in particular, in these patients.
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Affiliation(s)
- T Bitter
- Klinik für Kardiologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Deutschland.
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93
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Javaheri S, Shukla R, Wexler L. Association of smoking, sleep apnea, and plasma alkalosis with nocturnal ventricular arrhythmias in men with systolic heart failure. Chest 2012; 141:1449-1456. [PMID: 22172636 PMCID: PMC4694179 DOI: 10.1378/chest.11-1724] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 11/01/2011] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Excess sudden death due to ventricular tachyarrhythmias remains a major mode of mortality in patients with systolic heart failure. The aim of this study was to determine the association of nocturnal ventricular arrhythmias in patients with low ejection fraction heart failure. We incorporated a large number of known pathophysiologic triggers to identify potential targets for therapy to reduce the persistently high incidence of sudden death in this population despite contemporary treatment. METHODS Eighty-six ambulatory male patients with stable low (≤ 45%) ejection fraction heart failure underwent full-night attendant polysomnography and simultaneous Holter recordings. Patients were divided into groups according to the presence or absence of couplets (paired premature ventricular excitations) and ventricular tachycardia (VT) (at least three consecutive premature ventricular excitations) during sleep. RESULTS In multiple regression analysis, four variables (current smoking status, increased number of arousals, plasma alkalinity, and old age) were associated with VT and two variables (apnea-hypopnea index and low right ventricular ejection fraction) were associated with couplets during sleep. CONCLUSIONS We speculate that cessation of smoking, effective treatment of sleep apnea, and plasma alkalosis could collectively decrease the incidence of nocturnal ventricular tachyarrhythmias and the consequent risk of sudden death, which remains high despite the use of β blockades.
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Affiliation(s)
- Shahrokh Javaheri
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Veterans Affairs Medical Center, Cincinnati, OH.
| | - Rakesh Shukla
- Departments of Medicine and Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Laura Wexler
- Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Veterans Affairs Medical Center, Cincinnati, OH
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Jaffe LM, Kjekshus J, Gottlieb SS. Importance and management of chronic sleep apnoea in cardiology. Eur Heart J 2012; 34:809-15. [PMID: 22427382 DOI: 10.1093/eurheartj/ehs046] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Sleep apnoea is a common, yet underestimated, chronic disorder with a major impact on morbidity and mortality in the general population. It is quickly becoming recognized as an independent risk factor for cardiovascular impairment. Hypertension, coronary artery disease, diabetes, cardiovascular rhythm and conduction abnormalities, cerebrovascular disease, and heart failure have all been linked to this syndrome. This review will explore the critical connection between sleep apnoea and chronic cardiovascular diseases while highlighting established and emerging diagnostic and treatment strategies.
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Affiliation(s)
- Leeor M Jaffe
- School of Medicine, University of Maryland, 22 S Greene St, Baltimore, MD 21201, USA
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Walia H, Strohl KP, Mehra R. Effect of continuous positive airway pressure on an atrial arrhythmia in a patient with mild obstructive sleep apnea. J Clin Sleep Med 2012; 7:397-8. [PMID: 21897777 DOI: 10.5664/jcsm.1200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cardiac arrhythmias have been reported in up to half of individuals with obstructive sleep apnea (OSA) and have been proposed to be one of the factors contributing to their increased mortality. Several studies have demonstrated evidence of an association between OSA and a number of cardiac arrhythmias. The mechanisms of arrhythmogenesis in OSA may be due to enhanced vagal output triggered by a combination of apnea and hypoxemia. This case demonstrates a dose-dependent reduction in atrial ectopy with increasing continuous positive airway pressure (CPAP) in the setting of mild sleep apnea.
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Affiliation(s)
- Harneet Walia
- Department of Family Medicine, University Hospitals Case Medical Center, Cleveland, OH 4410, USA.
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Koehler U, Apelt S, Cassel W, Hildebrandt O, Nell C, Ranft S, Grimm W. [Sleep disordered breathing and nonsustained ventricular tachycardia in patients with chronic heart failure]. Wien Klin Wochenschr 2011; 124:63-8. [PMID: 22080939 DOI: 10.1007/s00508-011-0083-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 10/01/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND Patients with chronic heart failure (CHF) have a high incidence of sleep disordered breathing (SDB). It is assumed that patients with the combination of CHF and SDB have more ventricular couplets and nonsustained ventricular tachycardia (NSVT) than patients without SDB. METHODS In 63 patients, 49 men and 14 women with chronic heart failure (EF < 45%), all-night polysomnography and long-term-ECG were performed. Mean age was 59 ± 15 years, mean BMI 27 ± 5 kg/m(2). 56% had an ischemic, 44% a nonischemic heart disease. 51% had heart insufficiency classification NYHA III. RESULTS 42 of the 63 patients (67%) had sleep disordered breathing (SDB) with an AHI ≥5/h. In 24 patients (38%) SDB was central, in 18 (29%) obstructive. More patients with SDB than patients without SDB had NSVT (50% vs. 19%). Nocturnal frequency of NSVT in patients with SDB was about twice as high as the rate observed during daytime (0.48/h vs. 0.21/h). In patients without SDB there was no relevant difference between day and night (0.23/h vs. 0.21/h). AHI correlated with NSVT (r = 0.329, p < 0.01). Day/night comparison of couplets was 2.3/h vs. 1.9/h in SDB patients and 2.0/h vs. 1.6/h in patients without SDB. CONCLUSIONS Patients with chronic heart failure have a high prevalence of SDB. The combination of CHF and SDB predisposes for nocturnal malignant ventricular arrhythmias.
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Affiliation(s)
- Ulrich Koehler
- Klinik für Innere Medizin, SP Pneumologie, Intensiv- und Schlafmedizin, Philipps-Universität Marburg, Marburg, Germany.
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Sleep disordered breathing in patients with heart failure: pathophysiology and management. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2011; 13:506-16. [PMID: 21894522 DOI: 10.1007/s11936-011-0145-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OPINION STATEMENT Sleep disordered breathing (SDB) is common in heart failure patients across the range of ejection fractions and is associated with adverse prognosis. Although effective pharmacologic and device-based treatment of heart failure may reduce the frequency or severity of SDB, heart failure treatment alone may not be adequate to restore normal breathing during sleep. Continuous positive airway pressure (CPAP) is the major treatment for SDB in heart failure, especially if obstructive rather than central sleep apnea (CSA) predominates. Adequate suppression of CSA by PAP is associated with a heart transplant-free survival benefit, although randomized trials are ongoing. Bilevel PAP (BPAP) may be as effective as CPAP in treating SDB and may be preferable over CPAP in patients who experience expiratory pressure discomfort. Adaptive (or auto) servo-ventilation (ASV), which adjusts the PAP depending on the patient's airflow or tidal volume, may be useful in congestive heart failure patients if CPAP is ineffective. Other therapies that have been proposed for SDB in congestive heart failure include nocturnal oxygen, CO(2) administration (by adding dead space), theophylline, and acetazolamide; most of which have not been systematically studied in outcome-based prospective randomized trials.
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Poupard L, Mathieu M, Goldman M, Chouchou F, Roche F. Multi-modal ECG Holter system for sleep-disordered breathing screening. Sleep Breath 2011; 16:685-93. [DOI: 10.1007/s11325-011-0558-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 05/06/2011] [Accepted: 07/06/2011] [Indexed: 11/27/2022]
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Abstract
OPINION STATEMENT Obstructive sleep apnea is a highly prevalent disease that often goes undetected for many years before diagnosis. Although most patients seek treatment to improve symptoms of daytime sleepiness, a growing body of literature suggests that treatment may also modulate cardiovascular risk. This article summarizes the current literature regarding the associations between sleep-disordered breathing and adverse cardiovascular outcomes and reviews the lesser body of data demonstrating the cardiovascular benefits of therapy.
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