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Korostovtseva LS, Ionov MV, Shcherbakova EA, Bochkarev MV, Emelyanov IV, Yudina YS, Mironova SA, Zverev DA, Lebedev DS, Vakhrushev AD, Avdonina NG, Zvartau NE, Mikhaylov EN, Sviryaev YV, Konradi AO. Progression of obstructive sleep apnoea after renal denervation is not associated with hypertension exaggeration. BMC Pulm Med 2023; 23:467. [PMID: 37996833 PMCID: PMC10668416 DOI: 10.1186/s12890-023-02757-1] [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: 09/10/2022] [Accepted: 03/20/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE In a cohort, observational prospective trial, we assessed the long-term dynamics of sleep-disordered breathing in patients with resistant hypertension after renal denervation and their association with blood pressure change at remote follow-up. MATERIALS AND METHODS Twenty-eight patients with stable hypertension who were recruited for endovascular radiofrequency renal denervation in 2012-2019 and had valid both baseline and follow-up sleep study, were included in the analysis. All patients underwent physical examination, anthropometry, office and ambulatory blood pressure measurements, blood and urine tests, kidney visualization, and full polysomnography before and within 12-36 months after renal denervation. RESULTS The average follow-up comprised 30.1 ± 8.4 months. At long-term follow-up, no significant changes in creatinine level, estimated glomerular filtration rate, body mass index were registered. There was a significant increase in sleep apnea severity indices: the mean change in apnea-hypopnea index comprised 9.0(-21.1;25.2) episodes/h, in oxygen desaturation index 6.5(-16.8;35.9) episodes/h, in the average SpO2 -1.7(-5.6;1.9)%. Over 12-month follow-up, there were no significant differences in blood pressure response in patients with and without sleep apnea. The baseline apnea-hypopnea and oxygen desaturation indices and the mean SpO2 were associated with the circadian blood pressure profile at follow-up, but did not correlate with the blood pressure response. CONCLUSIONS Although the severity of sleep apnea worsens at > 12 months follow-up after renal denervation, this is not associated with hypertension exaggeration.
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Affiliation(s)
| | - Mikhail V Ionov
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | | | - Mikhail V Bochkarev
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Igor V Emelyanov
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Yulia S Yudina
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Svetlana A Mironova
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Dmitry A Zverev
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Dmitry S Lebedev
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Aleksandr D Vakhrushev
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Natalia G Avdonina
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Nadezhda E Zvartau
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Evgeny N Mikhaylov
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Yurii V Sviryaev
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
| | - Aleksandra O Konradi
- Almazov National Medical Research Centre, 2 Akkuratov str., St Petersburg, 197341, Russia
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 62] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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To KW, Chan TO, Chan WC, Choo KL, Hui DSC. Using a portable monitoring device for diagnosing obstructive sleep apnea in patients with multiple coexisting medical illnesses. THE CLINICAL RESPIRATORY JOURNAL 2021; 15:1104-1112. [PMID: 34224640 DOI: 10.1111/crj.13416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The existing guidelines recommend type III devices should be used in patients without significant comorbidities. OBJECTIVES This study explored the reliability of using a type III device in patients with significant medical conditions to diagnose sleep apnea. METHODS Patients had an overnight sleep study conducted simultaneously with both polysomnography (PSG) and a type III (NOX-T3) monitoring device. All patients had stable multiple coexisting medical illnesses without any changes in medications and conditions within 1 month of sleep study. RESULTS Between July 2019 and March 2020, there were altogether 74 patients recruited with analyzable data. Five major disease groups were identified in the cohort: psychiatric illnesses, stroke, ischemic heart diseases (IHDs), chronic kidney diseases (CKDs), and others. Psychiatric patients with medications were found to have the lowest apnea hypopnea index (AHI) (23.7 per hour) and arousal index (46.6 per hour). The CKD group had the highest mean arousal index (71.4 per hour) and obstructive apnea count (110.2). NOX-T3 respiratory event index (REI) was significantly lower than the PSG AHI (mean REI 31.4 vs. mean AHI: 42.2). The number of patients with no/mild/moderate/severe obstructive sleep apnea (OSA) diagnosed by NOX-T3 and PSG was 7/17/19/31 and 5/11/20/38, respectively. CONCLUSION NOX-T3 device can reliably diagnose OSA in patients with different stable coexisting medical conditions. There is a tendency for underestimation of the severity of the OSA with NOX-T3 in patients with coexisting medical conditions especially with sedative medications. A positive NOX-T3 reliably diagnoses OSA whereas a negative NOX-T3 result needs to be interpreted with caution.
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Affiliation(s)
- Kin Wang To
- Respiratory Division, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Sleep Apnea Management Center, The Chinese University of Hong Kong, Hong Kong, China
| | - Tat On Chan
- Respiratory Division, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Sleep Apnea Management Center, The Chinese University of Hong Kong, Hong Kong, China
| | - Wing Chi Chan
- Respiratory Division, Department of Medicine, North District Hospital, Hong Kong, China
| | - Kah Lin Choo
- Respiratory Division, Department of Medicine, North District Hospital, Hong Kong, China
| | - David S C Hui
- Respiratory Division, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,SH Ho Sleep Apnea Management Center, The Chinese University of Hong Kong, Hong Kong, China
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Alonderis A, Raskauskiene N, Gelziniene V, Zaliunaite V, Brozaitiene J. Undiagnosed sleep apnoea in cardiac rehabilitation: Age-dependent effect on diastolic function in coronary artery disease patients with preserved ejection fraction. Eur J Cardiovasc Nurs 2021; 20:202–211. [PMID: 33611367 DOI: 10.1177/1474515120941373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 04/03/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Focusing on detection of sleep apnoea early in the cardiac rehabilitation process may improve the recovery process and reduce recurrence of cardiovascular events. Patients who continue to be undiagnosed may experience a significantly worse outcome during their cardiac rehabilitation and recovery. Diastolic dysfunction has both diagnostic and prognostic importance in the management of coronary artery disease. We hypothesise that undiagnosed/untreated sleep apnoea in middle-aged coronary artery disease patients with preserved left ventricular ejection fraction changes the pattern of diastolic filling close to that in elderly patients without sleep apnoea. METHODS AND RESULTS This cross-sectional study included the 450 coronary artery disease patients with undiagnosed sleep apnoea who had left ventricular ejection fraction ⩾50% and were referred consecutively to the Clinic of Cardiovascular Rehabilitation within two weeks after treatment for acute coronary syndrome. Polysomnographic and echocardiographic measurements were analysed. Mild to severe sleep apnoea was defined as the apnoea-hypopnea index ⩾5. Age was dichotomised into under the age of 60 years and age 60 years or over. Up to 35% of coronary artery disease patients were likely to have undiagnosed sleep apnoea. There was a statistically significant interaction between the effect of sleep apnoea and age group on diastolic function defined as the ratio peak flow velocity in early diastole/peak flow velocity in atrial contraction ratio (p=0.036). This ratio was significantly (p=0.029) lower in the mild-severe sleep apnoea group (0.97, 95% confidence interval 0.88-1.06) than in the non-sleep apnoea group (1.09, 95% confidence interval 1.03-1.15) among middle aged (<60 years) coronary artery disease patients. Therefore, filling patterns in the middle aged (<60 years) patients with sleep apnoea resemble those observed in the elderly (⩾60 years) patients without sleep apnoea. The effect of sleep apnoea on left ventricular filling pattern in elderly was not observed. CONCLUSIONS Age modifies the effect of sleep apnoea on cardiovascular outcomes. The findings that undiagnosed sleep apnoea impairs diastolic function in a middle-aged coronary artery disease patient underscore the importance of early diagnosis and treatment of sleep apnoea. It is recommended to train and educate cardiac rehabilitation staff on the importance of sleep disorders in this population.
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Linz D, Baumert M, Desteghe L, Kadhim K, Vernooy K, Kalman JM, Dobrev D, Arzt M, Sastry M, Crijns HJ, Schotten U, Cowie MR, McEvoy RD, Heidbuchel H, Hendriks J, Sanders P, Lau DH. Nightly sleep apnea severity in patients with atrial fibrillation: Potential applications of long-term sleep apnea monitoring. IJC HEART & VASCULATURE 2019; 24:100424. [PMID: 31763438 PMCID: PMC6859526 DOI: 10.1016/j.ijcha.2019.100424] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In patients with atrial fibrillation (AF), the prevalence of moderate-to-severe sleep-disordered breathing (SDB) ranges between 21% and 72% and observational studies have demonstrated that SDB reduces the efficacy of rhythm control strategies, while treatment with continuous positive airway pressure lowers the rate of AF recurrence. Currently, the number of apneas and hypopneas per hour (apnea-hypopnea-index, AHI) determined during a single overnight sleep study is clinically used to assess the severity of SDB. However, recent studies suggest that SDB-severity in an individual patient is not stable over time but exhibits a considerable night-to-night variability which cannot be detected by only one overnight sleep assessment. Nightly SDB-severity assessment rather than the single-night diagnosis by one overnight sleep study may better reflect the exposure to SDB-related factors and yield a superior metric to determine SDB-severity in the management of AF. In this review we discuss mechanisms of night-to-night SDB variability, arrhythmogenic consequences of night-to-night SDB variability, strategies for longitudinal assessment of nightly SDB-severity and clinical implications for screening and management of SDB in AF patients.
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Affiliation(s)
- Dominik Linz
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Mathias Baumert
- University of Adelaide, School of Electrical and Electronic Engineering, Adelaide, Australia
| | - Lien Desteghe
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Kadhim Kadhim
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Jonathan M. Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Dobromir Dobrev
- Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Essen, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Medical Centre Regensburg, Regensburg, Germany
| | - Manu Sastry
- Academic Sleep Centre (CIRO+), Horn, the Netherlands
| | - Harry J.G.M. Crijns
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, the Netherlands
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Martin R. Cowie
- National Heart and Lung Institute, Imperial College London (Royal Brompton Hospital), London, England, UK
| | - R. Doug McEvoy
- Adelaide Institute for Sleep Health (AISH), College of Medicine and Public Health, Flinders University and Sleep Health Service, Respiratory and Sleep Services, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Hein Heidbuchel
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- University of Antwerp and Antwerp University Hospital, Edegem, Belgium
| | - Jeroen Hendriks
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H. Lau
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Nakamura T, Alqurashi YD, Morrell MJ, Mandic DP. Hearables: Automatic Overnight Sleep Monitoring With Standardized In-Ear EEG Sensor. IEEE Trans Biomed Eng 2019; 67:203-212. [PMID: 31021747 DOI: 10.1109/tbme.2019.2911423] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Advances in sensor miniaturization and computational power have served as enabling technologies for monitoring human physiological conditions in real-world scenarios. Sleep disruption may impact neural function, and can be a symptom of both physical and mental disorders. This study proposes wearable in-ear electroencephalography (ear-EEG) for overnight sleep monitoring as a 24/7 continuous and unobtrusive technology for sleep quality assessment in the community. METHODS A total of 22 healthy participants took part in overnight sleep monitoring with simultaneous ear-EEG and conventional full polysomnography recordings. The ear-EEG data were analyzed in the both structural complexity and spectral domains. The extracted features were used for automatic sleep stage prediction through supervized machine learning, whereby the PSG data were manually scored by a sleep clinician. RESULTS The agreement between automatic sleep stage prediction based on ear-EEG from a single in-ear sensor and the hypnogram based on the full PSG was 74.1% in the accuracy over five sleep stage classification. This is supported by a substantial agreement in the kappa metric (0.61). CONCLUSION The in-ear sensor is feasible for monitoring overnight sleep outside the sleep laboratory and also mitigates technical difficulties associated with PSG. It, therefore, represents a 24/7 continuously wearable alternative to conventional cumbersome and expensive sleep monitoring. SIGNIFICANCE The "standardized" one-size-fits-all viscoelastic in-ear sensor is a next generation solution to monitor sleep-this technology promises to be a viable method for readily wearable sleep monitoring in the community, a key to affordable healthcare and future eHealth.
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Baniak LM, Chasens ER. Sleep disordered breathing in older adults with heart failure with preserved ejection fraction. Geriatr Nurs 2017; 39:77-83. [PMID: 28784337 DOI: 10.1016/j.gerinurse.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 06/28/2017] [Accepted: 07/01/2017] [Indexed: 12/28/2022]
Abstract
Heart failure in older adults is frequently accompanied by sleep disordered breathing (SDB). Treatment of SDB in persons with heart failure with preserved ejection fraction (HFpEF) is unclear because most data is on heart failure with reduced ejection fraction (HFrEF). The purpose of this paper was to evaluate studies that report on the effects of positive airway pressure on patient outcomes in older adults with HFpEF and comorbid SDB. A search of the literature found six data-based studies (N = 36 to 126). Treatment with positive airway pressure reduced nighttime SDB symptoms and improved daytime functional status in persons with HFPEF and SDB (New York Heart Association Functional Class: effect sizes = -0.67 to -1.60). Limitations (i.e. only two studies were randomized controlled trials, small sample sizes, and women were under-represented) suggest that additional evidence is needed to guide treatment of SDB in older adults with HFpEF.
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Affiliation(s)
- Lynn M Baniak
- University of Pittsburgh, School of Nursing, 3500 Victoria St., Victoria Building, Pittsburgh, PA, 15261, United States.
| | - Eileen R Chasens
- University of Pittsburgh, School of Nursing, 3500 Victoria St., Victoria Building, Pittsburgh, PA, 15261, United States.
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Frija-Masson J, Wanono R, Robinot A, d’Ortho MP. Syndrome d’apnées centrales du sommeil. Presse Med 2017; 46:413-422. [DOI: 10.1016/j.lpm.2016.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/06/2016] [Indexed: 11/16/2022] Open
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9
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Brill AK, Pichler Hefti J, Geiser T, Ott SR. The SERVE-HF safety notice in clinical practice - experiences of a tertiary sleep center. Sleep Med 2017; 37:201-207. [PMID: 28755899 DOI: 10.1016/j.sleep.2017.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND In May 2015, the results of the SERVE-HF trial - addressing adaptive servoventilation (ASV) in chronic congestive heart failure (CHF) patients with central sleep apnea (CSA) - prompted a field safety notice. It was recommended to identify CHF patients treated with ASV and to advise the discontinuation of the treatment. We aimed to analyze the identification process and effect of ASV discontinuation on affected patients. METHODS 126 patients treated with ASV on May 13th, 2015 at our institution were retrospectively analyzed. Treatment decisions, effect of ASV discontinuation and clinical course were followed for a year. Patients on ASV with CHF were compared to those without CHF. RESULTS The risk criteria of the safety notice were fulfilled by 10.3% of patients (13/126). Additional echocardiographies were performed in 38%. ASV was discontinued in 93% of patients without adverse events (emergency hospitalization in n = 1). CSA reappeared immediately. Day- or nighttime symptoms were reported by 61%. Symptomatic patients were started on alternative treatments. CHF and non-CHF patients differed in cardiac function and type of SDB. CHF patients had shorter overall treatment duration. Compliance to ASV was similar in both groups with a median usage of 412 min (269; 495)/night in the CHF group and 414.5 min (347; 480) in the non-CHF group. CONCLUSION Identification of patients "at risk" is feasible but outcome of discontinuation of ASV cannot be evaluated based on these data. ASV withdrawal in patients with stable chronic CHF and CSA leads to an immediate return of sleep disordered breathing. Symptomatic patients may ask for alternative treatment options.
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Affiliation(s)
- Anne-Kathrin Brill
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University Bern, Switzerland.
| | - Jacqueline Pichler Hefti
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University Bern, Switzerland
| | - Thomas Geiser
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University Bern, Switzerland
| | - Sebastian R Ott
- Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University Bern, Switzerland
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Pearse SG, Cowie MR. Sleep-disordered breathing in heart failure. Eur J Heart Fail 2016; 18:353-61. [PMID: 26869027 DOI: 10.1002/ejhf.492] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 01/04/2016] [Accepted: 01/05/2016] [Indexed: 12/20/2022] Open
Abstract
Sleep-disordered breathing-comprising obstructive sleep apnoea (OSA), central sleep apnoea (CSA), or a combination of the two-is found in over half of heart failure (HF) patients and may have harmful effects on cardiac function, with swings in intrathoracic pressure (and therefore preload and afterload), blood pressure, sympathetic activity, and repetitive hypoxaemia. It is associated with reduced health-related quality of life, higher healthcare utilization, and a poor prognosis. Whilst continuous positive airway pressure (CPAP) is the treatment of choice for patients with daytime sleepiness due to OSA, the optimal management of CSA remains uncertain. There is much circumstantial evidence that the treatment of OSA in HF patients with CPAP can improve symptoms, cardiac function, biomarkers of cardiovascular disease, and quality of life, but the quality of evidence for an improvement in mortality is weak. For systolic HF patients with CSA, the CANPAP trial did not demonstrate an overall survival or hospitalization advantage for CPAP. A minute ventilation-targeted positive airway therapy, adaptive servoventilation (ASV), can control CSA and improves several surrogate markers of cardiovascular outcome, but in the recently published SERVE-HF randomized trial, ASV was associated with significantly increased mortality and no improvement in HF hospitalization or quality of life. Further research is needed to clarify the therapeutic rationale for the treatment of CSA in HF. Cardiologists should have a high index of suspicion for sleep-disordered breathing in those with HF, and work closely with sleep physicians to optimize patient management.
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Affiliation(s)
- Simon G Pearse
- Imperial College London and Royal Brompton Hospital, London, UK
| | - Martin R Cowie
- Imperial College London and Royal Brompton Hospital, London, UK
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Sériès F. Should All Congestive Heart Failure Patients Have a Routine Sleep Apnea Screening? Pro. Can J Cardiol 2015; 31:935-9. [PMID: 26112303 DOI: 10.1016/j.cjca.2015.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 04/21/2015] [Accepted: 04/21/2015] [Indexed: 10/23/2022] Open
Abstract
Sleep-disordered breathing (SDB) is highly prevalent in heart failure (HF) patients. These breathing disturbances are independent predictors of increased morbidity and comorbid conditions that improve with SDB treatment. Considering the overlap between SDB-related and HF clinical symptoms reported by patients, objective tests need to be conducted for a diagnosis to be firmly established and to determine the type and severity of SDB that will dictate treatment alternatives. Considering the high success rate and diagnostic value of ambulatory monitoring techniques, they represent a practical, cost-effective, and accurate alternative to diagnosing SDB in HF patients.
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Affiliation(s)
- Frédéric Sériès
- Unité de recherche en pneumologie, Centre de recherche, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, Québec, Canada.
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Can cardiorespiratory polygraphy replace portable polysomnography in the assessment of sleep-disordered breathing in heart failure patients? Sleep Breath 2013; 18:475-82. [PMID: 24242991 DOI: 10.1007/s11325-013-0908-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Portable polysomnography (PSG) and cardiorespiratory polygraphy are increasingly being used in the assessment of sleep-disordered breathing (SDB) in heart failure patients. Scoring of SDB from cardiorespiratory polygraphy recordings is based only on respiratory signals, while electroencephalographic, electrooculographic and electromyographic channels are taken into account when using PSG recordings. The aim of this study was to assess the agreement between these two scoring methods. METHODS An overnight sleep study was performed in 67 heart failure patients using a standard portable polysomnograph. Each recording was scored twice, once using all acquired signals (PSG mode) and, after a median of 64 days, using only respiratory signals (cardiorespiratory mode). Agreement was assessed by Bland-Altman analysis and Cohen's kappa. RESULTS We found that (1) more respiratory events were detected using cardiorespiratory analysis [median (25th percentile, 75th percentile), 75 (39, 200) events] compared to analysis of portable PSG [69 (29, 173) events, p < 0.0001], the extra events being, for the vast majority, central in origin; (2) the apnea/hypopnea index (AHI) estimated by cardiorespiratory polygraphy [11.9 (5.7, 30.8)/h] showed a negligible negative bias relative to portable PSG [15.1 (5.7, 33.6)/h; bias, -0.8 (-2.9, 0.4)/h, p = 0.0002]; (3) limits of agreement between the two systems (-6.2/h, 1.7/h) were much smaller than those previously observed between two nights using the same scoring modality; and (4) the kappa coefficient using categorised AHI was 0.89 (95% confidence interval (CI) 0.82, 0.96). CONCLUSIONS We found a high degree of agreement between the AHIs obtained from the two scoring methods, thus suggesting that cardiorespiratory polygraphy may be used as an alternative to portable PSG in the assessment of SDB in heart failure patients.
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Ward NR, Roldao V, Cowie MR, Rosen SD, McDonagh TA, Simonds AK, Morrell MJ. The effect of respiratory scoring on the diagnosis and classification of sleep disordered breathing in chronic heart failure. Sleep 2013; 36:1341-8. [PMID: 23997367 DOI: 10.5665/sleep.2960] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To evaluate the effect of respiratory scoring criteria on diagnosis and classification of sleep disordered breathing (SDB) in chronic heart failure (CHF). DESIGN Cross-sectional observational study. SETTING Heart failure and general cardiology clinics at two London hospitals. PATIENTS OR PARTICIPANTS One hundred eighty stable patients with CHF and a median age of 69.6 y, 86% male. INTERVENTIONS SDB was diagnosed by polysomnography. The apnea-hypopnea index (AHI) was initially scored using a conservative hypopnea definition of a ≥ 50% decrease in nasal airflow with a ≥ 4% oxygen desaturation. The AHI was rescored with hypopnea defined according to the American Academy of Sleep Medicine (AASM) alternative scoring rule, requiring an associated ≥ 3% oxygen desaturation or arousal. SDB was defined as AHI ≥ 15/h. Diagnosis and classification of SDB as obstructive sleep apnea (OSA) or central sleep apnea (CSA) with each rule were compared. The effect of mixed apneas on classification of SDB as CSA or OSA was also investigated. MEASUREMENTS AND RESULTS Median AHI increased from 9.3/h to 13.8/h (median difference 4.6/h) when the AASM alternative rule was used to score hypopneas. SDB prevalence increased from 29% to 46% with the alternative scoring rule (P < 0.001). Classification of SDB as OSA or CSA was not significantly altered by hypopnea scoring rules or the categorization of mixed apneas. CONCLUSION Hypopnea scoring rules can significantly influence the apnea-hypopnea index and diagnosis of sleep disordered breathing in chronic heart failure but do not alter the classification as obstructive sleep apnea or central sleep apnea. Standardization of hypopnea scoring rules is important to ensure consistency in diagnosis of sleep disordered breathing in chronic heart failure patients.
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Affiliation(s)
- Neil R Ward
- Clinical and Academic Department of Sleep and Breathing, National Heart and Lung Institute, Royal Brompton Hospital and Imperial College, London, United Kingdom.
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Bordier P, Maurice-Tison S, Ramana NK. Overdrive ventricular pacing in pacemaker recipients with permanent atrial fibrillation and sleep apnea. J Clin Sleep Med 2012; 8:257-64. [PMID: 22701382 DOI: 10.5664/jcsm.1908] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Cardiac pacing is ineffective in obstructive sleep apnea (SA), but it can alleviate central SA/Cheyne-Stokes respiration (CSA) in patients with heart failure (HF). We examined whether overnight overdrive ventricular pacing (OVP) has an effect on SA in pacemaker recipients with permanent atrial fibrillation (AF). METHODS An apnea-hypopnea index (AHI) ≥ 15 was confirmed in 28/38 patients screened by finger pulse oximetry during overnight ventricular pacing at a backup rate of 40 bpm (BUV40). These patients (23 men, 77.9 ± 7.6 y, BMI 27.6 ± 5.1 kg/m(2)) were randomly assigned to 2 consecutive nocturnal ventilation polygraphies with BUV40 versus OVP at 20 bpm above the mean nocturnal heart rate observed during screening. RESULTS During BUV40 versus OVP, (1) mean heart rate was 49 ± 8 versus 71 ± 8 bpm (p < 0.0001) and percent ventricular pacing 36% ± 38% versus 96% ± 6% (p < 0.0001); (2) AHI was 35.4 ± 11.9 versus 32.5 ± 15.5 (p = ns), central AHI 23.9 ± 11.8 versus 19.1 ± 12.7 (p < 0.001), and obstructive AHI 11.6 ± 13.1 versus 13.5 ± 15.9 (p = ns). In 15/28 patients without HF, mean left ventricular ejection fraction (LVEF) was 51% ± 17%, AHI was 37.6 ± 11.0 during BUV40 and 39.0 ± 11.5 during OVP, versus 32.8 ± 12.9 and 24.9 ± 16.5 in 13/28 patients with HF (p = 0.02) and mean LVEF 35% ± 15% (p = 0.01). Between the 2 subgroups, (1) central AHI was 23.6 ± 12.4 during BUV40 and 21.5 ± 14.0 during OVP versus 24.1 ± 11.6 and 16.2 ± 10.7 (p = 0.05); (2) obstructive AHI was 14.0 ± 13.7 during BUV40 and 17.6 ± 16.5 during OVP versus 8.8 ± 12.3 and 8.7 ± 14.3 (p = ns). CONCLUSIONS The prevalence of SA, predominantly central, was high in our pacemaker recipients with permanent AF. In those with HF, a single overnight OVP resulted in modest improvement in central events.
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Brack T, Randerath W, Bloch KE. Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments. Respiration 2012; 83:165-76. [DOI: 10.1159/000331457] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Accepted: 08/02/2011] [Indexed: 12/12/2022] Open
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Tsémo Watchueng G, Mouly-Bertin C, Depagne C, Lantelme P, Guerin JC. [Associated factors for sleep apnea in heart failure]. Ann Cardiol Angeiol (Paris) 2011; 60:211-217. [PMID: 21665186 DOI: 10.1016/j.ancard.2011.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 04/28/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Genesis of sleep apnoea syndrome (SAS) in chronic heart failure (CHF) is not well known. The aim of our study was to find associated factors to SAS in heart failure (HF) and to look for differences between central sleep apnea (CSA) and obstructive sleep apnea (OSA). PATIENTS AND METHODS We realised a cross-sectional and retrospective study. Thirty patients with stable heart failure under medical optimal therapy were included. Polygraphy, echocardiography and cardiopulmonary exercise were systematically performed. RESULTS Men were predominant (80%) in the group. Mean age, left ventricular ejection fraction (LVEF) were respectively 64.1±13.8years and 40±9.8%. SAS was present in 60% of patients (33.3% were classified as central sleep apnoea [CSA] and 26.7% as obstructive sleep apnoea [OSA]). Body mass index, blood pressure and left ventricular pressures estimated by the E/Ea ratio were significantly higher in the group with SAS (P<0.05) compared to the non SAS group. New York Heart Association class was significantly higher (P=0.04) and the predicted peak VO(2) was significantly lower in CSA patients compared to OSA patients. CONCLUSION High left ventricular pressures estimated by the E/Ea are significantly associated with SAS in heart failure. CSA patients tend to have a worse functional state than OSA patients.
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Damy T, Paulino A, Margarit L, Drouot X, Stoica M, Vermes E, Gueret P, Adnot S, Rande JLD, D'Ortho MP, Hittinger L. Left ventricle remodelling is associated with sleep-disordered breathing in non-ischaemic cardiopathy with systolic dysfunction. J Sleep Res 2011; 20:101-9. [PMID: 20408922 DOI: 10.1111/j.1365-2869.2009.00817.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sleep-disordered breathing (SDB) is associated with left ventricle (LV) remodelling in patients with normal LV function. Sleep-disordered breathing is common in chronic heart failure (CHF) with systolic LV dysfunction, and may contribute to LV remodelling and CHF progression. Our aim was to determine the consequence of SDB on LV geometry in patients with CHF. We hypothesised that SDB severity was correlated with the degree of LV hypertrophy (LVH). One-hundred and sixty patients with CHF with a non-ischaemic systolic LV dysfunction were assessed by overnight polygraphy and echocardiography. Patients were classified in four groups according to their apnoea-hypopnoea index (AHI): <5 (no-SDB); 5-14 (mild); 15-29 (moderate); ≥30 (severe). Left ventricular mass index (LVM Ind) was calculated using the usual echocardiographic M-Mode parameters. Their mean age, New York Heart Association and left ventricular ejection fraction were, respectively: 56 ± 13 years, 2.4 ± 0.8 and 30 ± 10%, and 77% were men. Body mass index, interventricular septal and posterior LV wall thicknesses, and LVM Ind were significantly increased in severe SDB versus no-SDB. LVM Ind was correlated to the AHI (R = 0.27, P = 0.0006) and, using logistic regression, AHI was the unique independent factor of LVH in this population. In non-ischaemic CHF, SDB severity is associated with LV remodelling.
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Affiliation(s)
- Thibaud Damy
- Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier, Créteil, France.
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Maestri R, La Rovere MT, Robbi E, Pinna GD. Night-to-night repeatability of measurements of nocturnal breathing disorders in clinically stable chronic heart failure patients. Sleep Breath 2010; 15:673-8. [PMID: 20857338 DOI: 10.1007/s11325-010-0418-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 08/12/2010] [Accepted: 09/06/2010] [Indexed: 12/25/2022]
Abstract
BACKGROUND Portable sleep apnea monitors are often used to screen for sleep-disordered breathing in chronic heart failure patients (CHF), but night-to-night repeatability of obtained measurements of nocturnal breathing disorders has not been fully assessed. METHODS Fifty-six stable, moderate-to-severe CHF patients [male, 87%; age, 57 ± 9 years; NYHA class, 2.6 ± 0.6; left ventricular ejection fraction (LVEF), 32% ± 9%] underwent an unattended in-hospital cardiorespiratory recording using a portable sleep apnea monitor during two consecutive nights. The apnea/hypopnea index (AHI), apnea index (AI), oxygen desaturation index (ODI), and periodic breathing (PB) duration were computed. Intra-subject night-to-night variability was assessed by the 95% limits of random variation (LoV). We also estimated the contribution of intra-rater variability to the overall intra-subject variability. Dichotomizing the AHI and PB duration according to conventional cutoffs of, respectively, ≥5 events per hour, ≥15 events per hour, and ≥120 min, the percentage of patients concordantly classified by the two measurements was finally computed. RESULTS The 95% LoV were ±10.6, ±7.7, ±11.3 events per hour for AHI, AI and ODI, and ±63.2 min for PB duration, respectively. The contribution of intra-rater variability to total intra-subject variability was 1.7%, 1.4%, 2.5%, and 1.3% for AHI, AI, ODI, and PB duration, respectively. Most patients (85%, 82%, and 95% for AHI ≥ 5, AHI ≥ 15, and PB duration, respectively) were classified concordantly by the two measurements. CONCLUSIONS In patients with heart failure, measurements of severity of sleep-disordered breathing derived from portable sleep apnea monitors show significant night-to-night intra-subject variation with a negligible contribution from intra-rater variability; however, using the same measurements for classification purposes, as commonly performed in clinical practice to screen patients for sleep-disordered breathing, very stable results are obtained.
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Affiliation(s)
- Roberto Maestri
- Department of Biomedical Engineering, Scientific Institute of Montescano, S. Maugeri Foundation-IRCCS, Montescano, Pavia, Italy.
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Current World Literature. Curr Opin Pulm Med 2009; 15:638-44. [DOI: 10.1097/mcp.0b013e3283328a80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Heart failure and sleep-disordered breathing: mechanisms, consequences and treatment. Curr Opin Pulm Med 2009; 15:565-70. [DOI: 10.1097/mcp.0b013e3283319a87] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Johansson P, Alehagen U, Svanborg E, Dahlström U, Broström A. Sleep disordered breathing in an elderly community-living population: Relationship to cardiac function, insomnia symptoms and daytime sleepiness. Sleep Med 2009; 10:1005-11. [DOI: 10.1016/j.sleep.2009.01.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 01/14/2009] [Accepted: 01/20/2009] [Indexed: 12/01/2022]
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Sleep apnoea in patients with heart failure. Part I: Diagnosis, definitions, prevalence, pathophysiology and haemodynamic consequences. Arch Cardiovasc Dis 2009; 102:651-61. [DOI: 10.1016/j.acvd.2009.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 05/06/2009] [Accepted: 05/11/2009] [Indexed: 11/16/2022]
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23
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Paulino A, Damy T, Margarit L, Stoïca M, Deswarte G, Khouri L, Vermes E, Meizels A, Hittinger L, d'Ortho MP. Prevalence of sleep-disordered breathing in a 316-patient French cohort of stable congestive heart failure. Arch Cardiovasc Dis 2009; 102:169-75. [PMID: 19375670 DOI: 10.1016/j.acvd.2008.12.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 12/11/2008] [Accepted: 12/15/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Heart failure with systolic dysfunction occurs frequently. Studies in North America and Germany have shown a high prevalence of sleep-disordered breathing in patients with heart failure. AIMS To assess the prevalence of sleep-disordered breathing and its associated risk factors in French patients with heart failure. METHODS A total of 316patients with stable heart failure and a left ventricular ejection fraction less or equal to 45% underwent polygraphy prospectively to diagnose sleep apnoea syndrome, defined as an apnoea-hypopnoea index greater or equal to 10events/h. RESULTS Mean age, left ventricular ejection fraction, and body mass index were 59+/-13years, 30+/-11% and 28+/-6kg/m(2), respectively. The prevalence of sleep breathing disorder was 81% (n=256); 30% of syndromes were classified as central and 70% as obstructive. The mean apnoea-hypopnoea index was high (30+/-3events/h) and a large proportion (41%) of syndromes had an apnoea-hypopnoea index greater or equal to 30events/h. A central sleep apnoea syndrome pattern was associated with more severe heart failure and a more elevated apnoea-hypopnoea index than an obstructive pattern. The prevalence of sleep-disordered breathing was lower in women than in men (64% versus 85%; chi(2)=0.0003) as was its severity (mean apnoea-hypopnoea index 15+/-13events/h versus 27+/-19events/h, p=0.0001). CONCLUSION The prevalence of sleep-disordered breathing was high in a French heart failure population, with most syndromes having an obstructive pattern. Prevalence and severity were higher in men than in women.
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Affiliation(s)
- Alexandra Paulino
- Fédération de cardiologie, hôpital Henri-Mondor, groupe hospitalier Henri-Mondor Albert-Chenevier, AP-HP, 51, avenue Maréchal-de-Lattre-de-Tassigny, 94010 Créteil, France
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Choi SJ. Pathogenesis and Clinical Features of Sleep Breathing Disorder. Tuberc Respir Dis (Seoul) 2009. [DOI: 10.4046/trd.2009.66.2.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Soo Jeon Choi
- Division of Respirology, Department of Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
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Low night-to-night variability of sleep disordered breathing in patients with stable congestive heart failure. Clin Res Cardiol 2008; 97:836-42. [PMID: 18648724 DOI: 10.1007/s00392-008-0695-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 06/18/2008] [Indexed: 01/11/2023]
Abstract
Sleep disordered breathing (SDB) has a high prevalence and prognostic impact in patients with chronic heart failure (CHF). Aim of this study was to investigate variability of SDB parameters in patients with stable CHF. Cardiorespiratory polygraphy was used to determine SDB in two consecutive nights in 50 CHF patients (NYHA class > or = II, LV-EF < or = 40%). The apnea-hypopnea-index (AHI) and apnoea-index (AI) were used to quantify SDB severity. Central, obstructive or mixed SDB were classified according to the majority of events. There was an excellent correlation in AHI (r = 0.948, P < 0.001) and AI (r = 0.842, P < 0.001) results of both nights. The overall number of detected apnea and hypopnea during the first night as compared to the maximum of both nights was 85% for the AHI and 77% for the AI. The reproducibility was dependent on SDB severity: AHI 15-29/h = 87%, AHI > or = 30/h = 92% and AI > or = 10/h = 83%. Classification was identical in 17 out of 19 patients with AI > or = 10/h. In patients with stable CHF a single night of cardiorespiratory monitoring leads to representative results on severity and type of SDB. This may enhance the applicability and dissemination of cardiorespiratory polygraphy in clinical practice.
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