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Helge AW, Hanif U, Joergensen VH, Jennum P, Mignot E, Sorensen HBD. Detection of Cheyne-Stokes Breathing using a transformer-based neural network. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:4580-4583. [PMID: 36086293 DOI: 10.1109/embc48229.2022.9871537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Annotation of sleep disordered breathing, including Cheyne-Stokes Breathing (CSB), is an expensive and time-consuming process for the clinician. To solve the problem, this paper presents a deep learning-based algorithm for automatic sample-wise detection of CSB in nocturnal polysomnographic (PSG) recordings. 523 PSG recordings were retrieved from four different sleep cohorts and subsequently scored for CSB by three certified sleep technicians. The data was pre-processed and 16 time domain features were extracted and passed into a neural network inspired by the transformer unit. Finally, the network output was post-processed to achieve physiologically meaningful predictions. The algorithm reached a F1-score of 0.76, close to the certified sleep technicians showing that it is possible to automatically detect CSB with the proposed model. The algorithm had difficulties distinguishing between severe obstructive sleep apnea and CSB but this was not dissimilar to technician performance. In conclusion, the proposed algorithm showed promising results and a confirmation of the performance could make it relevant as a screening tool in a clinical setting.
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Chuang LP, Pang JHS, Lin SW, Hung KC, Hu HC, Kao KC, Wen MS, Chen NH. Elevated serum matrix metalloproteinase-2 levels in heart failure patients with reduced ejection fraction and Cheyne-Stokes respiration. J Clin Sleep Med 2022; 18:1365-1373. [PMID: 35023473 PMCID: PMC9059589 DOI: 10.5664/jcsm.9870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Cheyne-Stokes respiration (CSR), a kind of central sleep apnea (CSA), is referred to as a poor prognostic factor in heart failure patients with reduced ejection fraction (HFrEF). Matrix metalloproteinase (MMP) and B-type natriuretic peptide (BNP) play important roles in HFrEF patients and are markers of poor prognosis. However, there is no literature mentioning the changes in MMP and BNP in HFrEF patients with CSR. METHODS From June 2018 to June 2019, 41 adult patients with stable heart failure and left ventricular ejection fraction (LVEF) <50% were enrolled from the cardiology clinic. After history taking and medication review to exclude possible central nervous system or medication related CSA, an overnight polysomnography study was performed, and CSR was identified. The morning serum MMP-2, MMP-9 and BNP levels were determined using enzyme-linked immunosorbent assay and fluorescence immunoassay techniques. A positive airway pressure (PAP) device was applied to 7 patients for 3 months. RESULTS The serum MMP-2 and BNP levels were significantly higher in HFrEF patients with CSR than in patients without CSR. In addition, elevated serum MMP-2 levels correlated well with the severity of sleep apnea and intermittent hypoxia, which were represented as the apnea-hypopnea index and the oxygen-desaturation index. No positive correlation was found between those markers and LVEF. Finally, the treatment of sleep apnea with CPAP for 3 months tended to reduce the elevated serum MMP-2 levels. CONCLUSIONS Higher serum MMP-2 and BNP levels were found in HFrEF patients with CSR. Elevated MMP-2 levels were correlated with the severity of sleep apnea and intermittent hypoxia.
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Affiliation(s)
- Li-Pang Chuang
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Jong-Hwei S Pang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Lin
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kuo-Chun Hung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Han-Chung Hu
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shien Wen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ning-Hung Chen
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan.,Department of Respiratory Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
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Szczuko P, Kurowski A, Odya P, Czyżewski A, Kostek B, Graff B, Narkiewicz K. Mining Knowledge of Respiratory Rate Quantification and Abnormal Pattern Prediction. Cognit Comput 2021; 14:2120-2140. [PMID: 34276830 PMCID: PMC8272620 DOI: 10.1007/s12559-021-09908-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 06/23/2021] [Indexed: 12/02/2022]
Abstract
The described application of granular computing is motivated because cardiovascular disease (CVD) remains a major killer globally. There is increasing evidence that abnormal respiratory patterns might contribute to the development and progression of CVD. Consequently, a method that would support a physician in respiratory pattern evaluation should be developed. Group decision-making, tri-way reasoning, and rough set–based analysis were applied to granular computing. Signal attributes and anthropomorphic parameters were explored to develop prediction models to determine the percentage contribution of periodic-like, intermediate, and normal breathing patterns in the analyzed signals. The proposed methodology was validated employing k-nearest neighbor (k-NN) and UMAP (uniform manifold approximation and projection). The presented approach applied to respiratory pattern evaluation shows that median accuracies in a considerable number of cases exceeded 0.75. Overall, parameters related to signal analysis are indicated as more important than anthropomorphic features. It was also found that obesity characterized by a high WHR (waist-to-hip ratio) and male sex were predisposing factors for the occurrence of periodic-like or intermediate patterns of respiration. It may be among the essential findings derived from this study. Based on classification measures, it may be observed that a physician may use such a methodology as a respiratory pattern evaluation-aided method.
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Affiliation(s)
- Piotr Szczuko
- Multimedia System Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Adam Kurowski
- Multimedia System Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, 80-233 Gdańsk, Poland.,Audio Acoustics Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Piotr Odya
- Multimedia System Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Andrzej Czyżewski
- Multimedia System Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Bożena Kostek
- Audio Acoustics Department, Faculty of Electronics, Telecommunications and Informatics, Gdańsk University of Technology, 80-233 Gdańsk, Poland
| | - Beata Graff
- Department of Hypertension and Diabetology, Medical University of Gdansk, 80-210 Gdańsk, Poland
| | - Krzysztof Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdansk, 80-210 Gdańsk, Poland
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Okamoto S, Ishii M, Hibi S, Akishita M, Yamaguchi Y. Breathing irregularities before sleep onset on polysomnography in patients with heart diseases. Sleep Breath 2021; 26:605-612. [PMID: 34184197 DOI: 10.1007/s11325-021-02403-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/11/2021] [Accepted: 05/12/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Severe cardiac dysfunction can manifest with diurnal breathing irregularity. However, it remains to be clarified whether or not diurnal breathing irregularity is observed in patients with heart diseases, including relatively mild chronic heart failure (CHF), compared to those without heart diseases. METHODS In this cross-sectional study, consecutive inpatients who were admitted for evaluation of sleep-disordered breathing were enrolled. We extracted 3.5 min of stable respiratory signals before sleep onset using polysomnography, analyzed the airflow data using fast Fourier transform, and quantified breathing irregularities using Shannon entropy S. RESULTS A total of 162 subjects were evaluated. Among these, 39 subjects had heart diseases, including ischemic heart disease (IHD), atrial fibrillation (Af), CHF, and a history of aortic dissection. The values of Shannon entropy S of airflow signals in subjects with heart diseases were significantly higher than in those without heart diseases (p < 0.001). After excluding CHF, the Shannon entropy S was also significantly higher in subjects with heart diseases than in those without heart diseases (p < 0.001). The values of Shannon entropy S were significantly correlated with plasma brain natriuretic peptide levels (r = 0.443, p < 0.001). Although the values were also significantly correlated with body mass index, the presence of heart diseases was independently associated with breathing irregularity in the multiple logistic analysis. Matching analysis revealed consistent differences between subjects with heart diseases and without heart diseases. CONCLUSION Breathing irregularity was observed before sleep onset in subjects with heart diseases who underwent polysomnography to diagnose sleep-disordered breathing.
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Affiliation(s)
- Soshi Okamoto
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masaki Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shinichiro Hibi
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiro Yamaguchi
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. .,Department of Respiratory Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama, 330-8503, Japan.
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Abraham WT, Pleister A, Germany R. Identification and Treatment of Central Sleep Apnoea: Beyond SERVE-HF. Card Fail Rev 2018; 4:50-53. [PMID: 29892478 DOI: 10.15420/cfr.2018:9:1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Central sleep apnoea (CSA) occurs in a large proportion of HF patients. CSA has clear detrimental effects, resulting in intermittent hypoxia and sympathetic activation, and is associated with significant morbidity and mortality. Treatment options are limited following the results of a recent trial in which adaptive servo-ventilation resulted in an increase in cardiovascular mortality. Ongoing studies utilising other forms of positive airway pressure may provide additional insight into the results of this trial. A new neurostimulation therapy, phrenic nerve stimulation, has offered a new physiological approach to the treatment of CSA. This therapy has resulted in improvements in the severity of disease and quality of life.
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Żera T, Przybylski J, Grygorowicz T, Kasarełło K, Podobińska M, Mirowska-Guzel D, Cudnoch-Jędrzejewska A. Vasopressin V1a receptors are present in the carotid body and contribute to the control of breathing in male Sprague-Dawley rats. Peptides 2018. [PMID: 29524562 DOI: 10.1016/j.peptides.2018.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vasopressin (AVP) maintains body homeostasis by regulating water balance, cardiovascular system and stress response. AVP inhibits breathing through central vasopressin 1a receptors (V1aRs). Chemoreceptors within carotid bodies (CBs) detect chemical and hormonal signals in the bloodstream and provide sensory input to respiratory and cardiovascular centers of the brainstem. In the study we investigated if CBs contain V1aRs and how the receptors are involved in the regulation of ventilation by AVP. We first immunostained CBs for V1aRs and tyrosine hydroxylase, a marker of chemoreceptor type I (glomus) cells. In urethane-anesthetized adult Sprague-Dawley male rats, we then measured hemodynamic and respiratory responses to systemic (intravenous) or local (carotid artery) administration of AVP prior and after systemic blockade of V1aRs. Immunostaining of CBs showed colocalization of V1aRs and tyrosine hydroxylase within glomus cells. Systemic administration of AVP increased mean arterial blood pressure (MABP) and decreased respiratory rate (RR) and minute ventilation (MV). Local administration of AVP increased MV and RR without significant changes in MABP or heart rate. Pretreatment with V1aR antagonist abolished responses to local and intravenous AVP administration. Our findings show that chemosensory cells within CBs express V1aRs and that local stimulation of the CB with AVP increases ventilation, which is contrary to systemic effects of AVP manifested by decreased ventilation. The responses are mediated by V1aRs, as blockade of the receptors prevents changes in ventilation. We hypothesize that excitatory effects of AVP within the CB provide a counterbalancing mechanism for the inhibitory effects of systemically acting AVP on the respiration.
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Affiliation(s)
- Tymoteusz Żera
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, the Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland.
| | - Jacek Przybylski
- Department of Biophysics and Physiology, the Medical University of Warsaw, Chałubińskiego 5, 02-004 Warsaw, Poland
| | - Tomasz Grygorowicz
- Chair and Department of Experimental and Clinical Pharmacology, Laboratory of Centre for Preclinical Research, the Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Kaja Kasarełło
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, the Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Martyna Podobińska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, the Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Dagmara Mirowska-Guzel
- Chair and Department of Experimental and Clinical Pharmacology, Laboratory of Centre for Preclinical Research, the Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
| | - Agnieszka Cudnoch-Jędrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, the Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
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Oldenburg O, Coats A. CSA Is Not Beneficial Long Term in Heart Failure Patients with Reduced Ejection Fraction. Int J Cardiol 2016; 227:474-477. [PMID: 27825728 DOI: 10.1016/j.ijcard.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/12/2016] [Accepted: 11/01/2016] [Indexed: 12/28/2022]
Abstract
Central sleep apnea (CSA) affects many patients, with heart failure and results in hypoxia and nor-epinephrine release and is associated with high morbidity and mortality. Recent trials in the treatment of CSA using positive airway pressure therapies have failed to demonstrate improvement in mortality and as a result, the compensatory nature of CSA has been questioned. The detrimental effects from CSA are clear. While there may be a short term compensatory effect, the long term effects cause chronic insult to the cardiovascular system indicating that CSA should be treated, but alternative treatment options need to be considered.
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Affiliation(s)
- Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
| | - Andrew Coats
- Monash University, Australia and University of Warwick, UK
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