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Vyas A, Desai R, Ghadge N, Bansal P, Chintalapalli Patta HV, Raval M, Jain A, Gupta T, Patel H, Kondur A, Lavie CJ. Impact of obstructive sleep apnoea on cardiovascular outcomes and mortality in young adults with congenital heart anomalies: insights from the national inpatient sample (2019). Cardiol Young 2024:1-5. [PMID: 38439634 DOI: 10.1017/s1047951124000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
BACKGROUND Obstructive sleep apnoea is a common sleep disorder, and adult congenital heart disease (CHD) is also a significant burden on the population. Early diagnosis and treatment are important for improving quality of life and reducing the risk of health complications. The limited research on obstructive sleep apnoea and adult CHD highlights the need for further investigation into the relationship between these two conditions and the mechanisms underlying this relationship. METHOD We used NIS 2019 database to identify adult CHD admissions aged 18-44 years and assess the impact of obstructive sleep apnoea on all-cause mortality, dysrhythmia, and stroke. A propensity-matched cohort of individuals with and without obstructive sleep apnoea was obtained, and the outcomes were assessed using multivariable analysis and compared in terms of resource utilisation. RESULTS Of the 41,950 young adult CHD admissions, 6.3% (n = 2630) had obstructive sleep apnoea. The obstructive sleep apnoea+ (n = 2590) and obstructive sleep apnoea- (n = 2590) cohorts were comparable in terms of median age (35 years) and were predominantly male (63.1% versus 62.5%). The obstructive sleep apnoea+ cohort had a higher frequency of risk factors like chronic obstructive pulmonary disease, hypothyroidism, and prior venous thromboembolism than the obstructive sleep apnoea cohort. We found significant association of obstructive sleep apnoea with dysrhythmia (adjusted odds ratio 2.99, 95% confidence interval 2.13-4.19, p < 0.001), but no significant impact on the risk of all-cause mortality or stroke. The obstructive sleep apnoea+ cohort also had higher transfers to short-term facilities, prolonged stays, and higher charges (p < 0.001). CONCLUSION Our study provides important insights into relationship between obstructive sleep apnoea and adult CHD and highlights the need for further investigation into the impact of obstructive sleep apnoea on individuals with adult CHD.
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Affiliation(s)
- Ankit Vyas
- Department of Vascular Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | | | | | - Prerna Bansal
- Department of Medicine, Rural Medical College, Pravara Institute of Medical Sciences, Loni, MH, India
| | | | - Maharshi Raval
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Akhil Jain
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tripti Gupta
- Divison of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Harshil Patel
- Department of Cardiovascular Disease, Ascension Providence Hospital, Southfield, MI, USA
| | - Ashok Kondur
- Department of Cardiovascular Disease, Garden City Hospital, Garden City, MI, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA, USA
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Momcilovic D, Reznakova B, Bosse F, Begrich C, Bernhardt C, Hamiko M, Bakhtiary F, Nickenig G, Skowasch D, Pizarro C. Sleep-disordered breathing and lung function abnormalities in adults with congenital heart disease. Sleep Breath 2024; 28:241-250. [PMID: 37552390 PMCID: PMC10954938 DOI: 10.1007/s11325-023-02899-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Advances in treatment enables most patients with congenital heart diseases (CHD) to survive into adulthood, implying the need to address comorbid conditions in this growing cohort of patients. The aim of this study was to evaluate the prevalence of sleep-disordered breathing (SDB) and lung function abnormalities in patients with adult congenital heart disease (ACHD). METHODS Patients with ACHD underwent level 3 sleep testing (Embletta MPR polygraphy) and pulmonary function testing. Results were stratified by the underlying haemodynamic ACHD lesion group. RESULTS Patients with ACHD (n = 100) were middle-aged (42.3 ± 14.6 years), 54% male and slightly overweight (BMI 25.9 ± 5.5 kg/m2). Polygraphy revealed a prevalence of sleep apnoea of 39% with 15% of patients presenting with predominantly obstructive apnoeic episodes, while 23% of patients presenting primarily with central sleep apnoea. The distribution of mild, moderate, and severe sleep apnoea in the total study population was 26%, 7% and 6%, respectively. Comparison of apnoea-hypopnoea index, presence of sleep apnoea, and apnoea severity did not offer significant differences between the four ACHD lesion groups (p = 0.29, p = 0.41 and p = 0.18, respectively). Pulmonary function testing revealed obstructive lung disease in 19 of 100 patients. Concomitant chronic obstructive pulmonary disease and obstructive sleep apnoea were diagnosed in 3% of patients and were associated with profound nocturnal desaturation. CONCLUSION The findings suggest a mild propensity amongst patients with ACHD to develop SDB that seems to be unaffected by the specific underlying congenital lesion.
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Affiliation(s)
- D Momcilovic
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - B Reznakova
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - F Bosse
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Begrich
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - C Bernhardt
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - M Hamiko
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - F Bakhtiary
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - D Skowasch
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carmen Pizarro
- Department of Internal Medicine II - Cardiology, Pneumology, Angiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Anagnostopoulou A. Τhe Burden of Obesity on Adult Survivors of Congenital Heart Disease, Past, and Future Directions. Curr Probl Cardiol 2023; 48:101610. [PMID: 36682391 DOI: 10.1016/j.cpcardiol.2023.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
The ongoing obesity epidemic has started to ebb. However, as most children with congenital heart disease survive until adulthood, the burgeoning trend has started to spill over in the adult congenital heart disease population as well. This review aims to decipher the prevalence, outcomes, and future directions of obesity in adult survivors of congenital heart disease.
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Suenaga T, Ishikita A, Sakamoto I, Nishizaka M, Nishizaki A, Umemoto S, Nagata H, Yamamura K, Sonoda H, Yoshida H, Ando SI, Shiose A, Tsutsui H. Successful Total Management of Multi-Causative Sleep-Disordered Breathing Complicated with Patient with Adult Congenital Heart Disease. Int Heart J 2022; 63:978-983. [PMID: 36104229 DOI: 10.1536/ihj.22-073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sleep-disordered breathing is one of the complications commonly seen in patients with adult congenital heart disease (ACHD) due to multiple causes including complex underlying cardiac defects, cardiomegaly, previous thoracotomies, obesity, scoliosis, and paralysis of the diaphragm. It is often hard to determine its main cause and predict the efficacy of each treatment in its management. We herein report a 30-year-old woman after biventricular repair of pulmonary atresia with intact ventricular septum diagnosed as sleep-related hypoventilation disorder. Simultaneous treatment targeting obesity, paralysis of the diaphragm, and cardiomegaly followed by respiratory muscle reinforcement through non-invasive ventilation resolved her sleep-related hypoventilation disorder. Such management for each factor responsible for the hypoventilation is expected to provide synergetic therapeutic efficacy and increase daily activity in a patient with ACHD.
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Affiliation(s)
- Tomoyasu Suenaga
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Ayako Ishikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Ichiro Sakamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Mari Nishizaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University.,Department of Cardiovascular Medicine, Yagi Kouseikai, Yagi Hospital
| | - Akiko Nishizaki
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Shintaro Umemoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Hazumu Nagata
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University
| | - Kenichiro Yamamura
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University
| | | | | | - Akira Shiose
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
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Thakkar A, Hailu T, Blumenthal RS, Martin SS, Harrington CM, Yeh DD, French KA, Sharma G. Cardio-Obstetrics: the Next Frontier in Cardiovascular Disease Prevention. Curr Atheroscler Rep 2022; 24:493-507. [PMID: 35524915 PMCID: PMC9076812 DOI: 10.1007/s11883-022-01026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/05/2022]
Abstract
Purpose of Review Internationally, cardiovascular disease (CVD) is the leading cause of death in women. With risk factors for CVD continuing to rise, early identification and management of chronic diseases such as hypertension, diabetes, and obstructive sleep apnea is necessary for prevention. Pregnancy is a natural stress test for women with risk factors who may be predisposed to CVD and offers a unique opportunity to not only recognize disease but also implement effective and long-lasting strategies for prevention. Recent Findings Prevention begins before pregnancy, as preconception screening, counseling, and optimization of chronic diseases can improve maternal and fetal outcomes. Throughout pregnancy, women should maintain close follow-up, continued reevaluation of risk factors, with counseling when necessary. Continued healthcare engagement during the “fourth trimester,” 3 months following delivery, allows clinicians to continue monitoring the evolution of chronic diseases, encourage ongoing lifestyle counseling, and connect women with primary care and appropriate specialists if needed. Unfortunately, this postpartum period represents a major care gap, as a significant proportion of most women do not attend their scheduled visits. Social determinants of health including decreased access to care and economic instability lead to increased risk factors throughout pregnancy but particularly play a role in poor compliance with postpartum follow-up. The use of telemedicine clinics and remote monitoring may prove to be effective interventions, bridging the gap between physicians and patients and improving follow-up for at-risk women. Summary While many clinicians are beginning to understand the impact of CVD on women, screening and prevention strategies are not often implemented until much later in life. Pregnancy creates an opportunity to begin engaging women in cardiovascular protective strategies before the development of the disease.
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Affiliation(s)
- Aarti Thakkar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Tigist Hailu
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Colleen M Harrington
- Division of Cardiovascular Medicine, University of Massachusetts Memorial Healthcare, Worcester, MA, USA
| | - Doreen DeFaria Yeh
- Division of Cardiology, Adult Congenital Heart Disease Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Katharine A French
- Lifespan Cardiovascular Institute, Division of Cardiology, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Blalock 559, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Halling T, Akkermann S, Löffler F, Groh A, Heitland I, Haefeli WE, Bauersachs J, Kahl KG, Westhoff-Bleck M. Factors That Influence Adherence to Medication in Adults With Congenital Heart Disease (ACHD). Front Psychiatry 2021; 12:788013. [PMID: 34899440 PMCID: PMC8660073 DOI: 10.3389/fpsyt.2021.788013] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Innovative operative and interventional procedures have improved survival in congenital heart disease (CHD), and today more than 90% of these children reach adulthood. Consequently, adherence and psychosocial issues are becoming increasingly important because non-adherence to treatment recommendations worsens morbidity and mortality. This study aimed to identify factors modifying adherence to medication in adult congenital heart disease (ACHD). Methods: This cross-sectional study included 451 outpatients (female 47.9%, average age ± SD: 37.9 ± 12 years) from the ACHD department, who completed a questionnaire assessing medication non-adherence and individual barriers to treatment. Further assessments included psychological well-being (Hospital Anxiety and Depression scale; HADS), childhood traumatization, sociodemographic, and clinical data. Binary logistic regression analysis calculated the impact of these factors on drug adherence. Results: Of the 451 patients 162 participants (35.9%) reported to be non-adherent. In univariate analysis non-adherence to treatment was associated with smoking (P = < 0.001) and internet addiction (P = 0.005). Further factors negatively influencing adherence were the presence of depressive symptoms (P = 0.002), anxiety (P = 0.004), and childhood traumatization (p = 0.002). Factors positively associated with adherence were older age (P = 0.003) and more advanced heart disease as indicated by NYHA class (P = 0.01), elevated NT-proBNP (P = 0.02), device therapy (P = 0.002) and intermittent arrhythmias (P = 0.01). In multivariate analysis especially psychopathological factors such as depression (P = 0.009), anxiety (P = 0.032) and childhood traumatization (P = 0.006) predicted non-adherence. Conclusion: Adherence is a critical issue in the long-term management of ACHD. Identifying modifiable factors that worsen adherence offers the opportunity for targeted interventions. Depressive symptoms, anxiety, and adverse childhood experiences are amenable to psychosocial interventions, as well as cigarette smoking. Our study suggests that a multimodal and interdisciplinary treatment concept for the long-term management of adults with congenital heart disease could be beneficial. Whether it will further improve morbidity and mortality, should be assessed in prospective interventions.
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Affiliation(s)
- Tim Halling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Steffen Akkermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Ivo Heitland
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Walter Emil Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hanover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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