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Pontier-Marchandise S, Texereau J, Prigent A, Gonzalez-Bermejo J, Rabec C, Gagnadoux F, Letierce A, Winck JC. Home NIV treatment quality in patients with chronic respiratory failure having participated to the French nationwide telemonitoring experimental program (The TELVENT study). Respir Med Res 2023; 84:101028. [PMID: 37683442 DOI: 10.1016/j.resmer.2023.101028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND The ETAPES program is a national telemedicine experiment conducted in France between 2018 and 2023 to investigate whether home non-invasive ventilation (NIV) telemonitoring improves healthcare pathways in patients with chronic respiratory failure (CRF) and impacts healthcare organization. The program provides a combination of therapeutic education and NIV telemonitoring with data processed by an algorithm generating alerts. The TELVENT study objective was to analyze the evolution of ventilation quality in patients included in the ETAPES program. METHODS Multicentric cohort study on patients undergoing long-term NIV included in the ETAPES program between September 2018 and December 2020 and who did not refuse the use of their data for this research. Data were obtained from homecare provider databases. The primary endpoint was to attain successful NIV treatment, which was determined by a combination of daily NIV usage for > 4 h per day, low leaks, and a low apnea-hypopnea index (AHI) identified by the NIV device. Respiratory disability was assessed using the DIRECT questionnaire. RESULTS 329 patients were included in the study of which 145 had COPD and 83 had started NIV and ETAPES within one-month delay. Approximately 25% of patients did not achieve the criteria for successful NIV at ETAPES entry. The proportion of patients with successful NIV treatment increased to 86.8% at six months (p = 0.003, Cochran-Armitage trend test) regardless of NIV history and continued to increase at 12 months in newly equipped NIV patients (93.8%, at month 12, p = 0.0026 for trend test). Over time, a significant increase in NIV use and compliance was observed, while AHI significantly decreased in the overall population. No significant decrease was observed for non-intentional leaks. Approximately 4.9 alerts were generated per patient per 6 months. Their number and type (low NIV use, high AHI or leaks) differed among patients based on their NIV history. Respiratory disability score decreased over time compared with baseline. CONCLUSION The TELVENT study highlights the importance of remote NIV monitoring to rapidly identify patients with unsuccessful ventilation. The combination of remote monitoring and therapeutic education may improve the quality of home NIV, especially in the first months of treatment.
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Affiliation(s)
| | - Joelle Texereau
- Lung Function & Respiratory Physiology Units, Cochin University Hospital, AP-HP, Paris, France; VitalAire, Air Liquide Healthcare, Bagneux, France
| | - Arnaud Prigent
- Pulmonology Medical Group, Polyclinique Saint-Laurent, Rennes, France
| | - Jésus Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France; AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, SSR respiratoire (Département R3S), F-75013, Paris, France
| | - Claudio Rabec
- Pulmonary Department and Respiratory Critical Care Unit, Dijon University Hospital, Dijon, France
| | - Frédéric Gagnadoux
- Department of Respiratory and Sleep Medicine, Angers University hospital and INSERM 1083, UMR CNRS 6015, MITOVASC, Equipe CarME, SFR ICAT, University of Angers, 49000 Angers, France
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Letellier C, Lujan M, Arnal JM, Carlucci A, Chatwin M, Ergan B, Kampelmacher M, Storre JH, Hart N, Gonzalez-Bermejo J, Nava S. Patient-Ventilator Synchronization During Non-invasive Ventilation: A Pilot Study of an Automated Analysis System. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 3:690442. [PMID: 35047935 PMCID: PMC8757845 DOI: 10.3389/fmedt.2021.690442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Patient-ventilator synchronization during non-invasive ventilation (NIV) can be assessed by visual inspection of flow and pressure waveforms but it remains time consuming and there is a large inter-rater variability, even among expert physicians. SyncSmart™ software developed by Breas Medical (Mölnycke, Sweden) provides an automatic detection and scoring of patient-ventilator asynchrony to help physicians in their daily clinical practice. This study was designed to assess performance of the automatic scoring by the SyncSmart software using expert clinicians as a reference in patient with chronic respiratory failure receiving NIV. Methods: From nine patients, 20 min data sets were analyzed automatically by SyncSmart software and reviewed by nine expert physicians who were asked to score auto-triggering (AT), double-triggering (DT), and ineffective efforts (IE). The study procedure was similar to the one commonly used for validating the automatic sleep scoring technique. For each patient, the asynchrony index was computed by automatic scoring and each expert, respectively. Considering successively each expert scoring as a reference, sensitivity, specificity, positive predictive value (PPV), κ-coefficients, and agreement were calculated. Results: The asynchrony index assessed by SynSmart was not significantly different from the one assessed by the experts (18.9 ± 17.7 vs. 12.8 ± 9.4, p = 0.19). When compared to an expert, the sensitivity and specificity provided by SyncSmart for DT, AT, and IE were significantly greater than those provided by an expert when compared to another expert. Conclusions:SyncSmart software is able to score asynchrony events within the inter-rater variability. When the breathing frequency is not too high (<24), it therefore provides a reliable assessment of patient-ventilator asynchrony; AT is over detected otherwise.
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Affiliation(s)
- Christophe Letellier
- Normandie Université - CORIA, Avenue de l'Université, Saint-Etienne du Rouvray, France
| | - Manel Lujan
- Servei de Pneumologia, Corporació Parc Taulí, Sabadell, Spain.,Departament de Medicina, Universitat Autònoma de Bellaterra, Barcelona, Spain
| | - Jean-Michel Arnal
- Service de Réanimation Polyvalente, Unité de Ventilation à domicile, Hôpital Sainte Musse, Toulon, France
| | - Annalisa Carlucci
- Pulmonary Rehabilitation, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico, Pavia and Department of Medicine and Surgery, Respiratory Diseases, University of Insubria, Varese-Como, Italy
| | - Michelle Chatwin
- Clinical and Academic Department of Sleep and Breathing, Royal Brompton & Harefield, National Health Service Foundation Trust, London, United Kingdom
| | - Begum Ergan
- Division of Intensive Care, Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Mike Kampelmacher
- Department of Pulmonology, Antwerp University Hospital and Antwerp University, Antwerp, Belgium
| | - Jan Hendrik Storre
- Department of Pneumology, University Medical Hospital, Freiburg, Germany.,Pneumologie Solln, Munich, Germany
| | - Nicholas Hart
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jesus Gonzalez-Bermejo
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Soins de Suites et réhabilitation respiratoire-Département R3S, Paris, France
| | - Stefano Nava
- Respiratory and Critical Care, Sant'Orsola Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Bologna, Italy
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Rao F, Garuti G, Vitacca M, Banfi P, Racca F, Cutrera R, Pavone M, Pedemonte M, Schisano M, Pedroni S, Casiraghi J, Vianello A, Sansone VA. Management of respiratory complications and rehabilitation in individuals with muscular dystrophies: 1st Consensus Conference report from UILDM - Italian Muscular Dystrophy Association (Milan, January 25-26, 2019). ACTA MYOLOGICA : MYOPATHIES AND CARDIOMYOPATHIES : OFFICIAL JOURNAL OF THE MEDITERRANEAN SOCIETY OF MYOLOGY 2021; 40:8-42. [PMID: 33870094 PMCID: PMC8033426 DOI: 10.36185/2532-1900-045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/16/2021] [Indexed: 12/03/2022]
Abstract
Respiratory complications are common in the patient with muscular dystrophy. The periodic clinical and instrumental respiratory evaluation is extremely important. Despite the presence in the literature of updated guidelines, patient associations often report lack of knowledge of these pathologies, particularly in peripheral hospitals. The purpose of this work, inspired by the Italian Muscular Dystrophy Association (UILDM) is to improve management of respiratory problems necessary for the management of these patients complex. To this end, the main items that the specialist can meet in the follow-up of these pathologies have been analyzed and discussed, among which the respiratory basal evaluation, the criteria of adaptation to non-invasive ventilation, management of bronchial secretions, situations of respiratory emergency, indications for tracheostomy and the subject of advance directives of treatment (DAT).
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Affiliation(s)
- Fabrizio Rao
- Respiratory Unit, NEuroMuscular OmniCentre (NeMO), Serena Onlus Foundation, Niguarda Hospital, Milan, Italy
| | - Giancarlo Garuti
- Pneumology Unit, Santa Maria Bianca Hospital, AUSL Modena, Italy
| | | | - Paolo Banfi
- IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Fabrizio Racca
- Department of Anaesthesia and Intensive Care, Division of Paediatric Intensive Care Unit, Alessandria General Hospital, Alessandria, Italy
| | - Renato Cutrera
- Pulmonology Unit, Academic Paediatric Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Martino Pavone
- Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Department of Pediatrics, Bambino Gesù Children’s Research Hospital, Rome, Italy
| | - Marina Pedemonte
- Pediatric Neurology and Muscle Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Matteo Schisano
- Respiratory Medicine Unit, AOU “Policlinico-San Marco”, Catania, Italy
| | - Stefania Pedroni
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
| | - Jacopo Casiraghi
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Valeria A Sansone
- Neurorehabilitation Unit, the NEMO Clinical Center in Milan, University of Milan, Italy
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Abstract
"Home noninvasive ventilation (NIV) is indicated for numerous conditions including neuromuscular disease, thoracic cage disorders, chronic obstructive pulmonary disease, and hypoventilation syndromes. Effective management of patients on home NIV requires clinicians to interpret data downloads from NIV devices. Clinicians must first look at adherence and factors that may impact this including mask comfort and fit. Next, leak assessment is undertaken. Once these are addressed, such information as apnea-hypopnea index, exhaled tidal volume, and percent triggered breaths help clinicians troubleshoot setting changes. Finally, overnight oximetry and transcutaneous CO2 monitoring are useful adjuncts to the data download to optimize NIV settings."
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Affiliation(s)
- Philip Choi
- University of Michigan, 3916 Taubman Center/1500 East Medical Center Drive, SPC 5360, Ann Arbor, MI 48109, USA
| | - Veronique Adam
- Programme National d'assistance Ventilatoire à Domicile, McGill University Health Center, Building V - Division of Clinical Epidemiology, 1025 Pine Ave W, Montreal, Quebec H3A 1A1, Canada
| | - David Zielinski
- Montreal Children's Hospital, Research Institute of McGill University Health Centre, McGill University, 1001 Decarie Boulevard, Montreal, Quebec H4A 3J1, Canada.
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Egea-Santaolalla CJ, Chiner Vives E, Díaz Lobato S, Mangado NG, Lujan Tomé M, Mediano San Andrés O. Ventilación mecánica a domicilio. OPEN RESPIRATORY ARCHIVES 2020. [DOI: 10.1016/j.opresp.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Runte M, Spiesshoefer J, Heidbreder A, Dreher M, Young P, Brix T, Boentert M. Sleep-related breathing disorders in facioscapulohumeral dystrophy. Sleep Breath 2019; 23:899-906. [PMID: 31025273 DOI: 10.1007/s11325-019-01843-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Severe manifestations of facioscapulohumeral dystrophy (FSHD) may be associated with sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA) and nocturnal hypoventilation (NH), but prevalence data are scarce. In patients with respiratory muscle weakness, detection of NH can be facilitated by transcutaneous capnometry, but respective data derived from FSHD patients have not yet been published. METHODS We collected sleep studies and capnometry recordings from 31 adult patients with genetically confirmed FSHD who were admitted to our sleep laboratory for first-ever evaluation of sleep-related breathing. Indications for admission included non-restorative sleep, morning headache, or excessive daytime sleepiness. In addition, sleep studies were initiated if symptoms or signs of respiratory muscle weakness were present. Thirty-one subjects with insomnia served as controls for comparison of respiratory measures during sleep. RESULTS In the FSHD group, 17/31 (55%) patients showed OSA and 8 (26%) had NH. NH would have been missed in 7/8 patients if only oximetry criteria of hypoventilation had been applied. Capnography results were correlated with disease severity as reflected by the Clinical Severity Score (CSS). Non-invasive ventilation (NIV) was started in 6 patients with NH and 3 individuals with OSA. Nocturnal continuous positive airway pressure was administered to 2 patients, and positional therapy was sufficient in 4 individuals. In patients initiated on NIV, nocturnal gas exchange already improved in the first night of treatment. CONCLUSIONS SDB is common in adult patients with FSHD complaining of sleep-related symptoms. It may comprise OSA, NH, and most often, the combination of both. Sleep-related hypercapnia is associated with disease severity. Transcutaneous capnometry is superior to pulse oximetry for detection of NH.
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Affiliation(s)
- Maya Runte
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Jens Spiesshoefer
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Anna Heidbreder
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany
| | - Peter Young
- Medical Park Klinik Reithofpark, Neurology, Bad Feilnbach, Germany
| | - Tobias Brix
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Matthias Boentert
- Department of Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
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Boentert M, Glatz C, Helmle C, Okegwo A, Young P. Prevalence of sleep apnoea and capnographic detection of nocturnal hypoventilation in amyotrophic lateral sclerosis. J Neurol Neurosurg Psychiatry 2018; 89:418-424. [PMID: 29054915 DOI: 10.1136/jnnp-2017-316515] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/03/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE This retrospective study aimed to investigate whether overnight oxymetry and early morning blood gas analysis predict nocturnal hypoventilation (NH) as reflected by night-time hypercapnia in patients with amyotrophic lateral sclerosis (ALS). In addition, prevalence and clinical determinants of sleep apnoea in ALS were evaluated. METHODS In 250 patients with non-ventilated ALS, transcutaneous capnometry was performed along with polysomnography or polygraphy and early morning blood gases. RESULTS 123 patients were female, and 84 patients had bulbar-onset ALS. 40.0% showed NH, and an apnoea-hypopnoea index (AHI) >5/hour was found in 45.6%. In 22.3%, sleep apnoea and NH coincided. The obstructive apnoea index was significantly higher than the central apnoea index (p<0.0001). Both NH and sleep apnoea were significantly more common in male than in female patients. Sleep apnoea and AHI were associated with better bulbar function. Desaturation time (t<90%) and transcutaneous CO2 were negatively correlated with upright vital capacity. Early morning base excess (EMBE), bicarbonate and t<90% were independent predictors of NH. However, among 100 patients with NH, 31 were missed by t<90% >5 min and 17 were not identified when EMBE >3 mmol/L and t<90% >5 min were combined. CONCLUSION In ALS, sleep apnoea is common and often accompanies NH. It is mainly obstructive, and central apnoea appears to be clinically irrelevant. Polygraphy or oxymetry alone are not sufficient to uncover NH. Combination of EMBE and t<90% may increase sensitivity, but transcutaneous capnography is strongly recommended for reliable detection of NH in patients with ALS.
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Affiliation(s)
- Matthias Boentert
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Münster, Münster, Germany
| | - Christian Glatz
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Münster, Münster, Germany
| | - Cornelia Helmle
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Münster, Münster, Germany
| | - Angelika Okegwo
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Münster, Münster, Germany
| | - Peter Young
- Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Münster, Münster, Germany
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Larrosa-Barrero R, Matute WG, Mutiozábal AM, Voth AH, Catalán JS. Central alveolar hypoventilation due to progressive multifocal leukoencephalopathy. Pulmonology 2018; 24:54-56. [DOI: 10.1016/j.pulmoe.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/06/2017] [Accepted: 12/03/2017] [Indexed: 11/25/2022] Open
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Borsini E, Ernst G, Blanco M, Blasco M, Bosio M, Salvado A, Nigro C. Respiratory polygraphy monitoring of intensive care patients receiving non-invasive ventilation. ACTA ACUST UNITED AC 2017; 10:35-40. [PMID: 28966736 PMCID: PMC5611770 DOI: 10.5935/1984-0063.20170006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction Patients that started on Non-Invasive Ventilation (NIV) need to define
several parameters selected on the basis of diurnal arterial blood gas and
underlying disease. We hypothesize that respiratory polygraphy (RP) could be
useful to monitor NIV. This retrospective work describes RP findings and
their impact on the setting of continuous flow ventilators from patients on
NIV of Intensive Care Unit (ICU). Material and Methods Patient's data on NIV from at the ICU of Hospital Británico were
included in this study. RP recordings were performed in all of them.
Respiratory events, such as ventilatory pattern changes, impact on oximetry
or tidal volume, were observed to modify the ventilatory mode after RP. Results The RP findings have contributes to change the ventilatory mode for one third
of the patients. The mean values of expiratory positive airway pressure
(EPAP) and inspiratory positive airway pressure (IPAP) were not
significantly different across all the population before or after RP:
8.7±0.3 vs. 8.6±0.4; p<0.88 and 18.6±0.6 vs.
17.7±0.7; p<0.26 respectively, however, half the patients
presented > 2 cmH2O pressure value changes after RP. Conclusions RP recordings could contribute to broad range of data useful to make
decisions about changes in programming and allowed to identify adverse
events related to positive pressure.
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Respiratory polygraphy monitoring of intensive care patients receiving non-invasive ventilation. Sleep Sci 2017. [DOI: 10.1016/j.slsci.2016.12.006] [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
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Abstract
Awareness of the importance of sleep-related disorders in patients with cardiovascular diseases is growing. In particular, sleep-disordered breathing, short sleep time, and low sleep quality are frequently reported by patients with heart failure (HF). Sleep-disordered breathing, which includes obstructive sleep apnoea (OSA) and central sleep apnoea (CSA), is common in patients with HF and has been suggested to increase the morbidity and mortality in these patients. Both OSA and CSA are associated with increased sympathetic activation, vagal withdrawal, altered haemodynamic loading conditions, and hypoxaemia. Moreover, OSA is strongly associated with arterial hypertension, the most common risk factor for cardiac hypertrophy and failure. Intrathoracic pressure changes are also associated with OSA, contributing to haemodynamic alterations and potentially affecting overexpression of genes involved in ventricular remodelling. HF treatment can decrease the severity of both OSA and CSA. Indeed, furosemide and spironolactone administration, exercise training, cardiac resynchronization therapy, and eventually heart transplantation have shown a positive effect on OSA and CSA in patients with HF. At present, whether CSA should be treated and, if so, which is the optimal therapy is still debated. By contrast, more evidence is available on the beneficial effects of OSA treatment in patients with HF.
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