1
|
Cribbet MR, Thayer JF, Jarczok MN, Fischer JE. High-Frequency Heart Rate Variability Is Prospectively Associated With Sleep Complaints in a Healthy Working Cohort. Psychosom Med 2024; 86:342-348. [PMID: 38724040 PMCID: PMC11090416 DOI: 10.1097/psy.0000000000001302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
OBJECTIVE Vagus nerve functioning, as indexed by high-frequency heart rate variability (HF-HRV), has been implicated in a wide range of mental and physical health conditions, including sleep complaints. This study aimed to test associations between HF-HRV measured during sleep (sleep HF-HRV) and subjective sleep complaints 4 years later. METHODS One hundred forty-three healthy employees (91% male; MAge = 47.8 years [time 2], SD = 8.3 years) of an industrial company in Southern Germany completed the Jenkins Sleep Problems Scale, participated in a voluntary health assessment, and were given a 24-hour ambulatory heart rate recording device in 2007. Employees returned for a health assessment and completed the Jenkins Sleep Problems Scale 4 years later. RESULTS Hierarchical regression analyses showed that lower sleep HF-HRV measured in 2007 was associated with higher self-reported sleep complaints 4 years later after controlling for covariates (rab,c = -0.096, b = -0.108, 95% CI, -0.298 to 0.081, ΔR2 = 0.009, p = .050). CONCLUSIONS These data are the first to show that lower sleep HF-HRV predicted worse sleep 4 years later, highlighting the importance of vagus nerve functioning in adaptability and health.
Collapse
Affiliation(s)
- Matthew R. Cribbet
- Department of Psychology, The University of Alabama, Tuscaloosa, Alabama
| | - Julian F. Thayer
- Department of Psychological Science, The University of California at Irvine, Irvine, CA
| | - Marc N. Jarczok
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Joachim E. Fischer
- General Medicine, Center for Preventive Medicine and Digital Health, Mannheim Medical Facility, Heidelberg University, Mannheim, Germany
| |
Collapse
|
2
|
Lee PL, Wu YW, Cheng HM, Wang CY, Chuang LP, Lin CH, Hang LW, Yu CC, Hung CL, Liu CL, Chou KT, Su MC, Cheng KH, Huang CY, Hou CJY, Chiu KL. Recommended assessment and management of sleep disordered breathing in patients with atrial fibrillation, hypertension and heart failure: Taiwan Society of Cardiology/Taiwan Society of sleep Medicine/Taiwan Society of pulmonary and Critical Care Medicine joint consensus statement. J Formos Med Assoc 2024; 123:159-178. [PMID: 37714768 DOI: 10.1016/j.jfma.2023.08.024] [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: 04/16/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients.
Collapse
Affiliation(s)
- Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan; PhD Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Pang Chuang
- Sleep Center, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Tauyan, Taiwan
| | - Chou-Han Lin
- Division of Respirology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Liang-Wen Hang
- School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan; Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chieh Yu
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, Taipei, Taiwan
| | - Ching-Lung Liu
- Division of Chest, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Kun-Ta Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mao-Chang Su
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Kai-Hung Cheng
- Kao-Ho Hospital, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan.
| | - Kuo-Liang Chiu
- Division of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
| |
Collapse
|
3
|
Polecka A, Olszewska N, Danielski Ł, Olszewska E. Association between Obstructive Sleep Apnea and Heart Failure in Adults-A Systematic Review. J Clin Med 2023; 12:6139. [PMID: 37834783 PMCID: PMC10573908 DOI: 10.3390/jcm12196139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes. METHODS We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed. RESULTS Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles. CONCLUSIONS The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies.
Collapse
Affiliation(s)
- Agnieszka Polecka
- Doctoral School of the Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Natalia Olszewska
- Student Research Group, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Łukasz Danielski
- Student Research Group, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| | - Ewa Olszewska
- Sleep Apnea Surgery Center, Department of Otolaryngology, Medical University of Bialystok, 15-089 Bialystok, Poland
| |
Collapse
|
4
|
Baumert M, Linz D, McKane S, Immanuel S. Transvenous phrenic nerve stimulation is associated with normalization of nocturnal heart rate perturbations in patients with central sleep apnea. Sleep 2023; 46:zsad166. [PMID: 37284759 PMCID: PMC10485567 DOI: 10.1093/sleep/zsad166] [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: 03/08/2023] [Revised: 05/01/2023] [Indexed: 06/08/2023] Open
Abstract
STUDY OBJECTIVES To determine the effect of transvenous phrenic nerve stimulation (TPNS) on nocturnal heart rate perturbations in patients with CSA. METHODS In this ancillary study of the remedē System Pivotal Trial, we analyzed electrocardiograms from baseline and follow-up overnight polysomnograms (PSG) in 48 CSA patients in sinus rhythm with implanted TPNS randomized to stimulation (treatment group; TPNS on) or no stimulation (control group; TPNS off). We quantified heart rate variability in the time and frequency domain. Mean change from baseline and standard error is provided. RESULTS TPNS titrated to reduce respiratory events is associated with reduced cyclical heart rate variations in the very low-frequency domain across REM (VLFI: 4.12 ± 0.79% vs. 6.87 ± 0.82%, p = 0.02) and NREM sleep (VLFI: 5.05 ± 0.68% vs. 6.74 ± 0.70%, p = 0.08) compared to the control group. Further, low-frequency oscillations were reduced in the treatment arm in REM (LFn: 0.67 ± 0.03 n.u. vs. 0.77 ± 0.03 n.u., p = 0.02) and NREM sleep (LFn: 0.70 ± 0.02 n.u. vs. 0.76 ± 0.02 n.u., p = 0.03). CONCLUSION In adult patients with moderate to severe central sleep apnea, transvenous phrenic nerve stimulation reduces respiratory events and is associated with the normalization of nocturnal heart rate perturbations. Long-term follow-up studies could establish whether the reduction in heart rate perturbation by TPNS also translates into cardiovascular mortality reduction. CLINICAL TRIAL A Randomized Trial Evaluating the Safety and Effectiveness of the remedē® System in Patients With Central Sleep Apnea, ClinicalTrials.gov, NCT01816776.
Collapse
Affiliation(s)
- Mathias Baumert
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute, Maastricht, The Netherlands
- Centre for Heart Rhythm Disorders, The University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Immanuel
- Discipline of Biomedical Engineering, School of Electrical and Mechanical Engineering, The University of Adelaide, Adelaide, Australia
- School of Business Information Systems, Torrens University, Adelaide, Australia
| |
Collapse
|
5
|
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: 55] [Impact Index Per Article: 55.0] [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.
Collapse
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
| |
Collapse
|
6
|
Grzęda-Hałon M, Poręba M, Gut G, Czerwińska K, Gać P, Martynowicz H, Mazur G, Poręba R. The effect of CPAP therapy on heart rate variability in patients with obstructive sleep apnea. Sleep Biol Rhythms 2023; 21:143-154. [PMID: 38469284 PMCID: PMC10899982 DOI: 10.1007/s41105-022-00424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/30/2022] [Indexed: 10/14/2022]
Abstract
The aim of this study was to analyze the relationship between the initiation of CPAP therapy and HRV in patients with OSA. The study group consisted of 37 patients, aged 34-79 (mean 54.95 years) with OSA treated with CPAP. Two subgroups of patients were distinguished: less than severe (AHI < 30, n = 16) and severe OSA (AHI ≥ 30, n = 21). The second study was carried out around a month after the initiation of therapy. CPAP therapy caused the improvement in polysomnographic parameters, however, in most parameters in time and frequency analysis, there were no significant positive changes in parasympathetic tone. Moreover, in HRV time analysis, the reduced rMSSD and pNN50 parameters in the hours of night rest and rMSSD and SDSD during the 15-min N3 sleep period were noted. Especially, in the group with AHI ≥ 30, we observed significant decreases in rMSSD and pNN50 for the entire time. The changes were mainly for the night periods including the N3 sleep period, which is especially connected with sleep apnea (parameters: rMSSD, SDSD, and pNN50). In spectral analysis, the decrease in HF from the 15-min daily activity period and the N3 sleep period was observed. Inverse correlations were seen between the maximum, median, and mean positive airway pressure (PAP) and the change in rMSSD, SDNN, and SDSD, mainly during night hours and the N3 sleep period. Only in patients with AHI < 30 the increase in SDNN was observed in 15-min N3 sleep period. The beneficial increase in SDNN parameter from time analysis was observed only in one sleep period in less ill patients with OSA. The lack of significant changes was observed in the majority of the parameters of heart rate variability after initiation of CPAP therapy in a short observational time; however, the shift towards reduced HRV was observed in patients with AHI > 30, so the response to CPAP therapy may depends on the severity of the apnea. The results may suggest that a longer observational period is needed in such studies, and the problem is still not fully elucidated.
Collapse
Affiliation(s)
- Magda Grzęda-Hałon
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PL Poland
| | - Małgorzata Poręba
- Department of Paralympic Sports, Wroclaw University of Health and Sport Sciences, Witelona 25a, 51-617 Wroclaw, PL Poland
| | - Gabriela Gut
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PL Poland
| | - Karolina Czerwińska
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wroclaw, PL Poland
| | - Paweł Gać
- Department of Population Health, Division of Environmental Health and Occupational Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 7, 50-368 Wroclaw, PL Poland
| | - Helena Martynowicz
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PL Poland
| | - Grzegorz Mazur
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PL Poland
| | - Rafał Poręba
- Department of Internal Medicine, Occupational Diseases and Hypertension, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, PL Poland
| |
Collapse
|
7
|
Statello R, Rossi S, Pisani F, Bonzini M, Andreoli R, Martini A, Puligheddu M, Cocco P, Miragoli M. Nocturnal Heart Rate Variability Might Help in Predicting Severe Obstructive Sleep-Disordered Breathing. BIOLOGY 2023; 12:biology12040533. [PMID: 37106734 PMCID: PMC10135696 DOI: 10.3390/biology12040533] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
Obstructive sleep apnea (OSA) can have long-term cardiovascular and metabolic effects. The identification of OSA-related impairments would provide diagnostic and prognostic value. Heart rate variability (HRV) as a measure of cardiac autonomic regulation is a promising candidate marker of OSA and OSA-related conditions. We took advantage of the Physionet Apnea-ECG database for two purposes. First, we performed time- and frequency-domain analysis of nocturnal HRV on each recording of this database to evaluate the cardiac autonomic regulation in patients with nighttime sleep breathing disorders. Second, we conducted a logistic regression analysis (backward stepwise) to identify the HRV indices able to predict the apnea–hypopnea index (AHI) categories (i.e., “Severe OSA”, AHI ≥ 30; “Moderate-Mild OSA”, 5 ≥ AHI < 30; and “Normal”, AHI < 5). Compared to the “Normal”, the “Severe OSA” group showed lower high-frequency power in normalized units (HFnu) and higher low-frequency power in normalized units (LFnu). The standard deviation of normal R–R intervals (SDNN) and the root mean square of successive R–R interval differences (RMSSD) were independently associated with sleep-disordered breathing. Our findings suggest altered cardiac autonomic regulation with a reduced parasympathetic component in OSA patients and suggest a role of nighttime HRV in the characterization and identification of sleep breathing disorders.
Collapse
|
8
|
Chen M, Wu S, Chen T, Wang C, Liu G. Information-Based Similarity of Ordinal Pattern Sequences as a Novel Descriptor in Obstructive Sleep Apnea Screening Based on Wearable Photoplethysmography Bracelets. BIOSENSORS 2022; 12:1089. [PMID: 36551056 PMCID: PMC9775447 DOI: 10.3390/bios12121089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Obstructive sleep apnea (OSA) is a common respiratory disorder associated with autonomic nervous system (ANS) dysfunction, resulting in abnormal heart rate variability (HRV). Capable of acquiring heart rate (HR) information with more convenience, wearable photoplethysmography (PPG) bracelets are proven to be a potential surrogate for electrocardiogram (ECG)-based devices. Meanwhile, bracelet-type PPG has been heavily marketed and widely accepted. This study aims to investigate the algorithm that can identify OSA with wearable devices. The information-based similarity of ordinal pattern sequences (OP_IBS), which is a modified version of the information-based similarity (IBS), has been proposed as a novel index to detect OSA based on wearable PPG signals. A total of 92 PPG recordings (29 normal subjects, 39 mild-moderate OSA subjects and 24 severe OSA subjects) were included in this study. OP_IBS along with classical indices were calculated. For severe OSA detection, the accuracy of OP_IBS was 85.9%, much higher than that of the low-frequency power to high-frequency power ratio (70.7%). The combination of OP_IBS, IBS, CV and LF/HF can achieve 91.3% accuracy, 91.0% sensitivity and 91.5% specificity. The performance of OP_IBS is significantly improved compared with our previous study based on the same database with the IBS method. In the Physionet database, OP_IBS also performed exceptionally well with an accuracy of 91.7%. This research shows that the OP_IBS method can access the HR dynamics of OSA subjects and help diagnose OSA in clinical environments.
Collapse
Affiliation(s)
- Mingjing Chen
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
- Alfred E. Mann Department of Biomedical Engineering, University of Southern California, Los Angeles, CA 90089-1112, USA
| | - Shan Wu
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
| | - Tian Chen
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
| | - Changhong Wang
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
| | - Guanzheng Liu
- School of Biomedical Engineering, Sun Yat-Sen University, Shenzhen 518107, China
| |
Collapse
|
9
|
Lin R, Yi M, Yan W, Zhang Y. Positive airway pressure therapy in heart failure patients comorbid with obstructive sleep apnea: Cardiovascular outcomes and nighttime-duration effect. Eur J Clin Invest 2022; 52:e13821. [PMID: 35638392 DOI: 10.1111/eci.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/15/2022] [Accepted: 05/19/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Comorbidity of obstructive sleep apnea (OSA) and heart failure (HF) is becoming increasingly common. This is a global analysis of positive airway pressure (PAP) efficacy for the cardiovascular outcomes in those HF Patients with comorbid OSA. METHODS Related randomized controlled trials were included. Analysed indicators covered primary outcomes (cardiac function, motor ability and life quality) and secondary outcomes (blood pressure and OSA-accompanying symptoms). Weighted mean difference was used to analyse the PAP-control difference in different experimental phases and the baseline-post difference in different groups. RESULTS Compared with control group, PAP was associated with a 3.48% increase in left ventricle ejection fraction (LVEF) (p < .00001) and little decrease in heart rate (HR) (p = .67). Over 6 h of mean nighttime use was associated with a greater increase in LVEF of 5.21% (p = .0002) and a significant reduction in HR of 3.81 bpm (p = .03). There was no significant difference between PAP and control group in their association with change in motor ability and life quality. Besides, PAP was associated with a 13.08 mm Hg decrease in systolic blood pressure and great improvements in OSA-accompanying symptoms: Apnea-Hypopnea Index, -23.73 e/h; mean oxygen saturation, 1.86%; minimum oxygen saturation, 8.78%; Epworth Sleepiness Scale, -1.39 point; arousal index, -16.41 e/h. There was also no significant difference in diastolic blood pressure. CONCLUSIONS Positive airway pressure treatment improves cardiac function in HF patients with comorbid OSA, but the improved magnitude is associated with the duration of nighttime use rather than the duration of treatment.
Collapse
Affiliation(s)
- Ruihan Lin
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Minhan Yi
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.,School of Life Sciences, Central South University, Changsha, Hunan, China
| | - Wenjie Yan
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.,Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yuan Zhang
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| |
Collapse
|
10
|
Lévy P, Naughton MT, Tamisier R, Cowie MR, Bradley TD. Sleep Apnoea and Heart Failure. Eur Respir J 2021; 59:13993003.01640-2021. [PMID: 34949696 DOI: 10.1183/13993003.01640-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/07/2021] [Indexed: 11/05/2022]
Abstract
Heart Failure (HF) and Sleep-Disordered-Breathing (SDB) are two common conditions that frequently overlap and have been studied extensively in the past three decades. Obstructive Sleep Apnea (OSA) may result in myocardial damage, due to intermittent hypoxia increased sympathetic activity and transmural pressures, low-grade vascular inflammation and oxidative stress. On the other hand, central sleep apnoea and Cheyne-Stokes respiration (CSA-CSR) occurs in HF, irrespective of ejection fraction either reduced (HFrEF), preserved (HFpEF) or mildly reduced (HFmrEF). The pathophysiology of CSA-CSR relies on several mechanisms leading to hyperventilation, breathing cessation and periodic breathing. Pharyngeal collapse may result at least in part from fluid accumulation in the neck, owing to daytime fluid retention and overnight rostral fluid shift from the legs. Although both OSA and CSA-CSR occur in HF, the symptoms are less suggestive than in typical (non-HF related) OSA. Overnight monitoring is mandatory for a proper diagnosis, with accurate measurement and scoring of central and obstructive events, since the management will be different depending on whether the sleep apnea in HF is predominantly OSA or CSA-CSR. SDB in HF are associated with worse prognosis, including higher mortality than in patients with HF but without SDB. However, there is currently no evidence that treating SDB improves clinically important outcomes in patients with HF, such as cardiovascular morbidity and mortality.
Collapse
Affiliation(s)
- Patrick Lévy
- Univ Grenoble Alpes, Inserm, HP2 laboratory, Grenoble, France .,CHU Grenoble Alpes, Physiology, EFCR, Grenoble, France.,All authors contributed equally to the manuscript
| | - Matt T Naughton
- Alfred Hospital, Department of Respiratory Medicine and Monash University, Melbourne, Australia.,All authors contributed equally to the manuscript
| | - Renaud Tamisier
- Univ Grenoble Alpes, Inserm, HP2 laboratory, Grenoble, France.,CHU Grenoble Alpes, Physiology, EFCR, Grenoble, France.,All authors contributed equally to the manuscript
| | - Martin R Cowie
- Royal Brompton Hospital and Faculty of Lifesciences & Medicine, King"s College London, London, UK.,All authors contributed equally to the manuscript
| | - T Douglas Bradley
- Sleep Research Laboratory of the University Health Network Toronto Rehabilitation Institute, Centre for Sleep Medicine and Circadian Biology of the University of Toronto and Department of Medicine of the University Health Network Toronto General Hospital, Canada.,All authors contributed equally to the manuscript
| |
Collapse
|
11
|
Al Ashry HS, Ni Y, Thomas RJ. Cardiopulmonary Sleep Spectrograms Open a Novel Window Into Sleep Biology-Implications for Health and Disease. Front Neurosci 2021; 15:755464. [PMID: 34867165 PMCID: PMC8633537 DOI: 10.3389/fnins.2021.755464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/08/2021] [Indexed: 02/05/2023] Open
Abstract
The interactions of heart rate variability and respiratory rate and tidal volume fluctuations provide key information about normal and abnormal sleep. A set of metrics can be computed by analysis of coupling and coherence of these signals, cardiopulmonary coupling (CPC). There are several forms of CPC, which may provide information about normal sleep physiology, and pathological sleep states ranging from insomnia to sleep apnea and hypertension. As CPC may be computed from reduced or limited signals such as the electrocardiogram or photoplethysmogram (PPG) vs. full polysomnography, wide application including in wearable and non-contact devices is possible. When computed from PPG, which may be acquired from oximetry alone, an automated apnea hypopnea index derived from CPC-oximetry can be calculated. Sleep profiling using CPC demonstrates the impact of stable and unstable sleep on insomnia (exaggerated variability), hypertension (unstable sleep as risk factor), improved glucose handling (associated with stable sleep), drug effects (benzodiazepines increase sleep stability), sleep apnea phenotypes (obstructive vs. central sleep apnea), sleep fragmentations due to psychiatric disorders (increased unstable sleep in depression).
Collapse
Affiliation(s)
- Haitham S Al Ashry
- Division of Pulmonary and Sleep Medicine, Elliot Health System, Manchester, NH, United States
| | - Yuenan Ni
- Division of Pulmonary, Critical Care and Sleep Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Robert J Thomas
- Division of Pulmonary and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| |
Collapse
|
12
|
D'Addio G, De Felice A, Donisi L, Braghiroli A, Maniscalco M. Heart rate turbulence in obstructive sleep apnea syndrome: The effect of short-term CPAP therapy. Eur J Intern Med 2021; 86:111-114. [PMID: 33390320 DOI: 10.1016/j.ejim.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Giovanni D'Addio
- Bioengineering Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy
| | - Alberto De Felice
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy
| | - Leandro Donisi
- Bioengineering Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Napoli, Italy
| | - Alberto Braghiroli
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy.
| |
Collapse
|
13
|
Application of the Variance Delay Fuzzy Approximate Entropy for Autonomic Nervous System Fluctuation Analysis in Obstructive Sleep Apnea Patients. ENTROPY 2020; 22:e22090915. [PMID: 33286684 PMCID: PMC7597154 DOI: 10.3390/e22090915] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/12/2022]
Abstract
Obstructive sleep apnea (OSA) is a fatal respiratory disease occurring in sleep. OSA can induce declined heart rate variability (HRV) and was reported to have autonomic nerve system (ANS) dysfunction. Variance delay fuzzy approximate entropy (VD_fApEn) was proposed as a nonlinear index to study the fluctuation change of ANS in OSA patients. Sixty electrocardiogram (ECG) recordings of the PhysioNet database (20 normal, 14 mild-moderate OSA, and 26 severe OSA) were intercepted for 6 h and divided into 5-min segments. HRV analysis were adopted in traditional frequency domain, and nonlinear HRV indices were also calculated. Among these indices, VD_fApEn could significantly differentiate among the three groups (p < 0.05) compared with the ratio of low frequency power and high frequency power (LF/HF ratio) and fuzzy approximate entropy (fApEn). Moreover, the VD_fApEn (90%) reached a higher OSA screening accuracy compared with LF/HF ratio (80%) and fApEn (78.3%). Therefore, VD_fApEn provides a potential clinical method for ANS fluctuation analysis in OSA patients and OSA severity analysis.
Collapse
|
14
|
Efazati N, Rahimi B, Mirdamadi M, Edalatifard M, Tavoosi A. Changes in heart rate variability (HRV) in patients with severe and moderate obstructive sleep apnea before and after acute CPAP therapy during nocturnal polysomnography. Sleep Sci 2020; 13:97-102. [PMID: 32742578 PMCID: PMC7384525 DOI: 10.5935/1984-0063.20200003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Obstructive sleep apnea is an important risk factor for cardiovascular disease. Noninvasive positive pressure ventilation is the standard treatment of this disease, and it can reduce mortality in patients. Dysfunction of the autonomic system is one of the reasons for an increased risk of cardiovascular disease in these patients. The purpose of the present study was to investigate the effect of positive airway pressure (PAP) therapy on heart rate variability (HRV) indices. METHODS The study population was comprised of 55 patients, who underwent nocturnal polysomnography for the diagnosis of obstructive sleep apnea and PAP titration on the same night. The levels of continuous positive airway pressure (CPAP) and bilevel positive airway pressure were adjusted to relieve obstructive sleep apnea, hypopnea, and desaturation. The patients' heart changes and cardiac characteristics were recorded before and after the start of routine CPAP therapy. Finally, the cases' sleep and polysomnography tests were analyzed and interpreted in collaboration with a sleep specialist and their cardiac changes with the aid of a cardiologist before and after treatment with CPAP. RESULTS The participants were 55 patients at a mean age of 57.04±12.9 years. There were 34 (61.8%) male and 21 (38.2%) female cases. PAP therapy on the same night resulted in a decreased standard deviation of the N-N interval index (p=0.036) and a low-frequency index (p=0.021), as well as increased high-frequency index (p<0.001) and low frequency / high frequency ratios (p=0.008). CONCLUSION Our findings indicate a relative improvement in the activity of the autonomic system in patients with obstructive sleep apnea after 1 night of PAP therapy. Overwhelming evidence suggests that improvement in the sympathetic balance can reduce the risk of cardiovascular disease in patients.
Collapse
Affiliation(s)
- Neda Efazati
- Tehran University of Medical Sciences, Department of Internal Medicine - Tehran - Iran
| | - Besharat Rahimi
- Tehran University of Medical Sciences, Advanced Thoracic Research Center - Tehran - Iran
| | - Mahsa Mirdamadi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran - Iran
| | - Maryam Edalatifard
- Tehran University of Medical Sciences, Advanced Thoracic Research Center - Tehran - Iran
| | - Anahita Tavoosi
- Tehran University of Medical Sciences, Imam Khomeini Hospital - Tehran - Iran
| |
Collapse
|
15
|
Pak VM, Strouss L, Yaggi HK, Redeker NS, Mohsenin V, Riegel B. Mechanisms of reduced sleepiness symptoms in heart failure and obstructive sleep apnea. J Sleep Res 2018; 28:e12778. [PMID: 30421541 DOI: 10.1111/jsr.12778] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/27/2018] [Accepted: 09/10/2018] [Indexed: 11/29/2022]
Abstract
Patients with both heart failure and obstructive sleep apnea often have poor, repeatedly disrupted sleep, and yet they frequently do not complain of excessive daytime sleepiness. Understanding this lack of perceived sleepiness is crucial for the case identification and treatment of obstructive sleep apnea in the heart failure population at high risk of this disease, especially given the association between untreated obstructive sleep apnea and mortality among patients with heart failure. In this review, we present epidemiologic evidence concerning the lack of sleepiness symptoms in heart failure and obstructive sleep apnea, explore possible mechanistic explanations for this relationship, assess the benefits of treatment in this population, discuss implications for clinical practice and explore directions for future research.
Collapse
Affiliation(s)
- Victoria M Pak
- Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biobehavioral Research Collaborative, School of Nursing, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Yale School of Nursing, West Haven, Connecticut, USA.,Emory Nell Hodgson School of Nursing, Atlanta, Georgia, USA
| | - Lisa Strouss
- Jefferson Medical Center, Philadelphia, Pennsylvania, USA
| | - Henry K Yaggi
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Vahid Mohsenin
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Barbara Riegel
- Department of Biobehavioral Research Collaborative, School of Nursing, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| |
Collapse
|
16
|
Khattak HK, Hayat F, Pamboukian SV, Hahn HS, Schwartz BP, Stein PK. Obstructive Sleep Apnea in Heart Failure: Review of Prevalence, Treatment with Continuous Positive Airway Pressure, and Prognosis. Tex Heart Inst J 2018; 45:151-161. [PMID: 30072851 DOI: 10.14503/thij-15-5678] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Obstructive sleep apnea is a sleep-related breathing disorder that has a major impact on cardiovascular function. It has been associated with hypertension, coronary artery disease, cardiac arrhythmias, sudden cardiac death, and heart failure. This review focuses on the relationship between obstructive sleep apnea and heart failure with either reduced or preserved ejection fraction. We discuss the pathophysiology of obstructive sleep apnea, as well as its prevalence, treatment outcomes with continuous positive airway pressure, and prognosis in these 2 distinct types of heart failure. We also identify areas in which further work is needed to improve our understanding of this association in heart failure patients.
Collapse
|
17
|
Cheng J, Liu Y, Li G, Zhang Z, Ma L, Yang X, Yang J, Zhang K, Kong J, Dong M, Zhang M, Xu X, Sui W, Wang J, Shang R, Ji X, Zhang Y, Zhang C, Hao P. Noninvasive ventilation improves cardiac function in patients with chronic heart failure. Oncotarget 2018; 7:48918-48924. [PMID: 27391436 PMCID: PMC5226480 DOI: 10.18632/oncotarget.10441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/17/2016] [Indexed: 12/14/2022] Open
Abstract
Chronic heart failure (CHF) has been shown to be associated with an increased incidence of sleep-disordered breathing. Whether treatment with noninvasivepositive-pressure ventilation (NPPV), including continuous positive airway pressure, bi-level positive airway pressure and adaptive servo-ventilation, improves clinical outcomes of CHF patients is still debated. 2,832 CHF patients were enrolled in our analysis. NPPV was significantly associated with improvement in left ventricular ejection fraction (39.39% vs. 34.24%; WMD, 5.06; 95% CI, 3.30-6.81; P < 0.00001) and plasma brain natriuretic peptide level (268.23 pg/ml vs. 455.55 pg/ml; WMD, −105.66; 95% CI, [−169.19]-[−42.13]; P = 0.001). However, NPPV did not reduce all-cause mortality (0.26% vs. 0.24%; OR, 1.13; 95% CI, 0.93-1.37; P = 0.22) or re-hospitalization rate (57.86% vs. 59.38%; OR, 0.47; 95% CI, 0.19-1.19; P = 0.02) as compared with conventional therapy. Despite no benefits on hard endpoints, NPPV may improve cardiac function of CHF patients. These data highlight the important role of NPPV in the therapy of CHF.
Collapse
Affiliation(s)
- Jing Cheng
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Yanping Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China.,Shandong Key Laboratory of Cardiovascular and Cerebrovascular Disease, Shandong Provincial Medical Imaging Institute, Shandong University, Jinan, Shandong, China
| | - Guishuang Li
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Zhongwen Zhang
- Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
| | - Lianyue Ma
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Xiaoyan Yang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Jianmin Yang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Kai Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Jing Kong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Mei Dong
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Meng Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Xingli Xu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Wenhai Sui
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Jiali Wang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Rui Shang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Xiaoping Ji
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Yun Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Cheng Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Panpan Hao
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, Jinan, Shandong, China
| |
Collapse
|
18
|
van Bilsen M, Patel HC, Bauersachs J, Böhm M, Borggrefe M, Brutsaert D, Coats AJS, de Boer RA, de Keulenaer GW, Filippatos GS, Floras J, Grassi G, Jankowska EA, Kornet L, Lunde IG, Maack C, Mahfoud F, Pollesello P, Ponikowski P, Ruschitzka F, Sabbah HN, Schultz HD, Seferovic P, Slart RHJA, Taggart P, Tocchetti CG, Van Laake LW, Zannad F, Heymans S, Lyon AR. The autonomic nervous system as a therapeutic target in heart failure: a scientific position statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2017; 19:1361-1378. [PMID: 28949064 DOI: 10.1002/ejhf.921] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/23/2017] [Accepted: 05/24/2017] [Indexed: 12/20/2022] Open
Abstract
Despite improvements in medical therapy and device-based treatment, heart failure (HF) continues to impose enormous burdens on patients and health care systems worldwide. Alterations in autonomic nervous system (ANS) activity contribute to cardiac disease progression, and the recent development of invasive techniques and electrical stimulation devices has opened new avenues for specific targeting of the sympathetic and parasympathetic branches of the ANS. The Heart Failure Association of the European Society of Cardiology recently organized an expert workshop which brought together clinicians, trialists and basic scientists to discuss the ANS as a therapeutic target in HF. The questions addressed were: (i) What are the abnormalities of ANS in HF patients? (ii) What methods are available to measure autonomic dysfunction? (iii) What therapeutic interventions are available to target the ANS in patients with HF, and what are their specific strengths and weaknesses? (iv) What have we learned from previous ANS trials? (v) How should we proceed in the future?
Collapse
Affiliation(s)
- Marc van Bilsen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Hospital, Maastricht, the Netherlands
| | - Hitesh C Patel
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK.,Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Hannover, Germany
| | - Michael Böhm
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | - Martin Borggrefe
- First Department of Medicine, Cardiology Division, University Medical Centre Mannheim, Mannheim, Germany.,German Centre for Cardiovascular Research, Mannheim, Germany
| | - Dirk Brutsaert
- Department of Cardiology, Antwerp University, Antwerp, Belgium
| | - Andrew J S Coats
- Department of Medicine, Monash University, Melbourne, Vic, Australia.,Department of Medicine, University of Warwick, Coventry, UK
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Gerasimos S Filippatos
- Department of Cardiology, School of Medicine, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - John Floras
- University Health Network and Sinai Health System Division of Cardiology, Peter Munk Cardiac Centre, Toronto General and Lunenfeld-Tanenbaum Research Institutes, University of Toronto, Toronto, ON, Canada
| | - Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,IRCCS Multimedica, Milan, Italy
| | - Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Lilian Kornet
- Medtronic, Inc., Bakken Research Centre, Maastricht, the Netherlands
| | - Ida G Lunde
- Institute for Experimental Medical Research, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Christoph Maack
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | - Felix Mahfoud
- Clinic for Internal Medicine III, Cardiology, Angiology and Intensive Internal Medicine, Homburg, Germany
| | | | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.,Centre for Heart Diseases, Military Hospital, Wroclaw, Poland
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Hani N Sabbah
- Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Harold D Schultz
- Department of Cellular and Integrative Physiology, University of Nebraska College of Medicine, Omaha, NE, USA
| | - Petar Seferovic
- Department of Cardiology, Belgrade University Medical Centre, Belgrade, Serbia
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.,Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands
| | - Peter Taggart
- Department of Cardiovascular Science, University College London, Barts Heart Centre, London, UK
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Linda W Van Laake
- Department of Cardiology, Heart and Lungs Division, and Regenerative Medicine Centre, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Faiez Zannad
- INSERM, Centre for Clinical Investigation 9501, Unit 961, University Hospital Centre, Nancy, France.,Department of Cardiology, Nancy University, University of the Lorraine, Nancy, France
| | - Stephane Heymans
- Netherlands Heart Institute, Utrecht, the Netherlands.,Department of Cardiovascular Sciences, Leuven University, Leuven, Belgium
| | - Alexander R Lyon
- National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| |
Collapse
|
19
|
Terziyski KV, Draganova AI, Taralov ZZ, Ilchev IS, Kostianev SS. The effect of continuous positive airway pressure on heart rate variability during the night in patients with chronic heart failure and central sleep apnoea. Clin Exp Pharmacol Physiol 2017; 43:1185-1190. [PMID: 27560005 DOI: 10.1111/1440-1681.12662] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022]
Abstract
Continuous positive airway pressure (CPAP) improves autonomic activity in patients with chronic heart failure (CHF) and central sleep apnoea (CSA), but its effect on heart rate variability (HRV) during therapy has not been reported. We hypothesized that CPAP may decrease HRV, despite its beneficial effects on sympathetic overactivation, due to the expected stabilization of breathing. Sixty-seven CHF patients underwent polysomnography (PSG). Ten of them presented with CSA (age 66.1±8.5 years, apnoea-hypopnea index [AHI]=57.6±23.3, central AHI [cAHI]=41.6±24.6 [mean±SD]) and were subjected to a second PSG with manual CPAP titration. Beat-to-beat heart intervals for a 6-hour period of sleep were extracted from each recording and HRV was analysed. CPAP significantly reduced AHI (AHI=23.1±18.3 P=.004). Standard deviation of normal-normal interbeat interval (SDNN) (61.5±29.0 vs 49.5±19.3 ms, P=.021), root mean square of successive differences (RMSSD) (21.8±9.2 vs 16.4±7.1 ms, P=.042), total power (lnTP=7.8±1.1 vs 7.4±0.8 ms2 , P=.037), low frequency power (lnLF=5.5±1.5 vs 5.0±1.4 ms2 , P=.003) and high frequency power (lnHF=4.6±1.0 vs 4.0±1.0 ms2 , P=.024) were decreased. There was a strong correlation between the decrease in AHI and the decrease in lnHF (Spearman's ρ=.782). CPAP leads to a decrease in spectral and time domain parameters of HRV during therapy in CHF patients with CSA. These changes are best explained by the effect which CPAP-influenced breathing pattern and lowered AHI exert on HRV.
Collapse
Affiliation(s)
- Kiril V Terziyski
- Pathophysiology Department, Medical University - Plovdiv, Plovdiv, Bulgaria
| | | | - Zdravko Z Taralov
- Pathophysiology Department, Medical University - Plovdiv, Plovdiv, Bulgaria
| | - Ilcho S Ilchev
- Cardiology Clinic, MHAT "Evrohospital", Plovdiv, Bulgaria
| | - Stefan S Kostianev
- Pathophysiology Department, Medical University - Plovdiv, Plovdiv, Bulgaria
| |
Collapse
|
20
|
Fukushima T, Yasuda K, Eguchi K, Fujino M, Kamiya H. A Patient with Heart Failure and Sleep-disordered Breathing Who Presented with Marked Reverse Remodeling by Continuous Positive Airway Pressure Therapy. Intern Med 2017; 56:2289-2294. [PMID: 28794373 PMCID: PMC5635301 DOI: 10.2169/internalmedicine.8525-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 49-year-old Japanese man with worsening dyspnea was admitted with the diagnosis of new-onset heart failure (HF). His HF symptoms improved with standard treatment, but his left ventricular ejection fraction (LVEF) 21% remained unchanged. After he was discharged, he was diagnosed with severe sleep-disordered breathing (SDB). Continuous positive airway pressure (CPAP) therapy was introduced. Seven months later, his cardiac function had greatly improved (LVEF 50%). We report this case of a HF patient with SDB whose cardiac function greatly improved by CPAP therapy, and we discuss the pathophysiologic mechanisms of successful cardiac "reverse remodeling" in this case.
Collapse
Affiliation(s)
- Taishi Fukushima
- Department of Cardiology, Japanese Red Cross Nagoya First Hospital, Japan
| | - Kenichiro Yasuda
- Department of Cardiology, Japanese Red Cross Nagoya First Hospital, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Masahiko Fujino
- Department of Pathology, Japanese Red Cross Nagoya First Hospital, Japan
| | - Haruo Kamiya
- Department of Cardiology, Japanese Red Cross Nagoya First Hospital, Japan
| |
Collapse
|
21
|
Noninvasive Positive Pressure Ventilation in Chronic Heart Failure. Can Respir J 2016; 2016:3915237. [PMID: 27891061 PMCID: PMC5116333 DOI: 10.1155/2016/3915237] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 08/22/2016] [Accepted: 10/04/2016] [Indexed: 12/23/2022] Open
Abstract
Instruction and Objectives. Noninvasive positive pressure ventilation (NPPV) alleviates sleep-disordered breathing (SDB) and it may improve cardiac function in SDB patients. Because large randomized controlled trials directly evaluating the impact of NPPV on cardiac function are lacking, we conducted a meta-analysis of published data on effectiveness of NPPV in improving cardiac function in patients with chronic heart failure regardless of SDB presence. Methods. Controlled trials were identified in PubMed, OVID, and EMBASE databases. Both fixed and randomized models were used in meta-analysis with primary outcomes of left ventricular ejection fraction (LVEF). Results. Nineteen studies were included with a total of 843 patients. Compared to standard medical treatment (SMT) plus sham-NPPV or SMT only, NPPV plus SMT was associated with improvement in LVEF (weighted mean difference 5.34, 95% CI, [3.85,6.82]; P < 0.00001) and plasma brain natriuretic peptide (BNP) level (weighted mean difference -117.37, 95% CI, [-227.22, -7.52]; P = 0.04) and no influence on overall mortality (RR 1.00, 95% CI, [0.96,1.04]; P = 0.95). Conclusions. In the present meta-analysis, use of NPPV plus SMT improved LVEF and reduced plasma BNP level but did not improve overall mortality in patients with chronic heart failure.
Collapse
|
22
|
Alshaer H, Fernie GR, Tseng WH, Bradley TD. Comparison of in-laboratory and home diagnosis of sleep apnea using a cordless portable acoustic device. Sleep Med 2016; 22:91-96. [DOI: 10.1016/j.sleep.2015.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/15/2015] [Accepted: 11/07/2015] [Indexed: 10/22/2022]
|
23
|
Faes L, Marinazzo D, Stramaglia S, Jurysta F, Porta A, Giandomenico N. Predictability decomposition detects the impairment of brain-heart dynamical networks during sleep disorders and their recovery with treatment. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2016; 374:rsta.2015.0177. [PMID: 27044993 PMCID: PMC4822440 DOI: 10.1098/rsta.2015.0177] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2016] [Indexed: 05/03/2023]
Abstract
This work introduces a framework to study the network formed by the autonomic component of heart rate variability (cardiac processη) and the amplitude of the different electroencephalographic waves (brain processes δ, θ, α, σ, β) during sleep. The framework exploits multivariate linear models to decompose the predictability of any given target process into measures of self-, causal and interaction predictability reflecting respectively the information retained in the process and related to its physiological complexity, the information transferred from the other source processes, and the information modified during the transfer according to redundant or synergistic interaction between the sources. The framework is here applied to theη,δ,θ,α,σ,βtime series measured from the sleep recordings of eight severe sleep apnoea-hypopnoea syndrome (SAHS) patients studied before and after long-term treatment with continuous positive airway pressure (CPAP) therapy, and 14 healthy controls. Results show that the full and self-predictability of η, δ and θ decreased significantly in SAHS compared with controls, and were restored with CPAP forδandθbut not forη The causal predictability of η and δ occurred through significantly redundant source interaction during healthy sleep, which was lost in SAHS and recovered after CPAP. These results indicate that predictability analysis is a viable tool to assess the modifications of complexity and causality of the cerebral and cardiac processes induced by sleep disorders, and to monitor the restoration of the neuroautonomic control of these processes during long-term treatment.
Collapse
Affiliation(s)
- Luca Faes
- Biotech, Department of Industrial Engineering, University of Trento, Trento, Italy IRCS Program, PAT-FBK Trento, Italy
| | | | - Sebastiano Stramaglia
- Department of Physics, University of Bari, Bari, Italy INFN Sezione di Bari, Bari, Italy
| | - Fabrice Jurysta
- Sleep Laboratory, Department of Psychiatry, ULB-Erasme Academic Hospital, Brussels, Belgium
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nollo Giandomenico
- Biotech, Department of Industrial Engineering, University of Trento, Trento, Italy IRCS Program, PAT-FBK Trento, Italy
| |
Collapse
|
24
|
Maeder MT, Schoch OD, Rickli H. A clinical approach to obstructive sleep apnea as a risk factor for cardiovascular disease. Vasc Health Risk Manag 2016; 12:85-103. [PMID: 27051291 PMCID: PMC4807890 DOI: 10.2147/vhrm.s74703] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obstructive sleep apnea (OSA) is associated with cardiovascular risk factors, cardiovascular diseases, and increased mortality. Epidemiological studies have established these associations, and there are now numerous experimental and clinical studies which have provided information on the possible underlying mechanisms. Mechanistic proof-of-concept studies with surrogate endpoints have been performed to demonstrate that treatment of OSA by continuous positive airway pressure (CPAP) has the potential to reverse or at least to attenuate not only OSA but also the adverse cardiovascular effects associated with OSA. However, no randomized studies have been performed to demonstrate that treatment of OSA by CPAP improves clinical outcomes in patients with cardiovascular risk factors and/or established cardiovascular disease and concomitant OSA. In the present review, we summarize the current knowledge on the role of OSA as a potential cardiovascular risk factor, the impact of OSA on cardiac function, the role of OSA as a modifier of the course of cardiovascular diseases such as coronary artery disease, atrial fibrillation, and heart failure, and the insights from studies evaluating the impact of CPAP therapy on the cardiovascular features associated with OSA.
Collapse
Affiliation(s)
- Micha T Maeder
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Otto D Schoch
- Department of Respiratory Medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland
| |
Collapse
|
25
|
Mansukhani MP, Wang S, Somers VK. Sleep, death, and the heart. Am J Physiol Heart Circ Physiol 2015; 309:H739-49. [PMID: 26188022 DOI: 10.1152/ajpheart.00285.2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 07/13/2015] [Indexed: 12/17/2022]
Abstract
Obstructive and central sleep apnea have been associated with increased risk of adverse cardiovascular events and mortality. Sympathetic dysregulation occurring as a result of the respiratory disturbance is thought to play a role in this increased risk. Sleep apnea increases the risk of arrhythmias, myocardial ischemia/infarction, stroke, and heart failure, all of which may increase mortality risk. A higher incidence of nocturnal arrhythmias, cardiac ischemia, and sudden death has been noted in subjects with sleep-disordered breathing (SDB). In this review, the association between SDB and each of these conditions is discussed, as well as the potential mechanisms underlying these risks and the effects of treatment of SDB. Particular emphasis is placed on the relationship between SDB and nocturnal atrial and ventricular arrhythmias, myocardial ischemia/infarction and sudden death.
Collapse
Affiliation(s)
- Meghna P Mansukhani
- Sleep Medicine, Affiliated Community Medical Centers, Willmar, Minnesota; and
| | - Shihan Wang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
26
|
Grau N, Bazan V, Kallouchi M, Rodriguez D, Estirado C, Corral MI, Valls MT, Ramos P, Sanjuas C, Felez M, Valles E, Benito B, Gea J, Bruguera-Cortada J, Martí-Almor J. Long-term Impact of Continuous Positive Airway Pressure Therapy on Arrhythmia and Heart Rate Variability in Patients With Sleep Apnea. Arch Bronconeumol 2015; 52:17-23. [PMID: 25937252 DOI: 10.1016/j.arbres.2015.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/28/2015] [Accepted: 03/16/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Autonomic dysfunction can alter heart rate variability and increase the incidence of arrhythmia. We analyzed the impact of continuous positive airway pressure (CPAP) on this pathophysiological phenomenon in patients with severe sleep apnea-hypopnea syndrome. METHODS Consecutive patients with recently diagnosed severe sleep apnea-hypopnea syndrome were prospectively considered for inclusion. Incidence of arrhythmia and heart rate variability (recorded on a 24-hour Holter monitoring device) were analyzed before starting CPAP therapy and 1 year thereafter. RESULTS A total of 26 patients were included in the study. CPAP was administered for 6.6 ± 1.8 hours during Holter monitoring. After starting CPAP, we observed a marginally significant reduction in mean HR (80 ± 9 to 77 ± 11 bpm, p=.05). CPAP was associated with partial modulation (only during waking hours) of r-MSSD (p=.047) and HF (p=.025) parasympathetic parameters and LF (p=.049) sympathetic modulation parameters. None of these parameters returned completely to normal levels (p<.001). The number of unsustained episodes of atrial tachycardia diminished (p=.024), but no clear effect on other arrhythmias was observed. CONCLUSIONS CPAP therapy only partially improves heart rate variability, and exclusively during waking hours, and reduces incidence of atrial tachycardia, both of which can influence cardiovascular morbidity and mortality in sleep apnea-hypopnea syndrome patients.
Collapse
Affiliation(s)
- Nuria Grau
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Victor Bazan
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Mohamed Kallouchi
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Diego Rodriguez
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Cristina Estirado
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Maria Isabel Corral
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Maria Teresa Valls
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pablo Ramos
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Carles Sanjuas
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Miquel Felez
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Ermengol Valles
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Begoña Benito
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Joaquim Gea
- Unidad de Trastornos Respiratorios del Sueño, Servicio de Neumología, CIBERES, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Jordi Bruguera-Cortada
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Julio Martí-Almor
- Unidad de Electrofisiología y Arritmias, Servicio de Cardiología, Grupo de Investigación Biomédica en Enfermedades del Corazón, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| |
Collapse
|
27
|
Heart Failure and Sleep Apnea. Can J Cardiol 2015; 31:898-908. [PMID: 26112300 DOI: 10.1016/j.cjca.2015.04.017] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/23/2015] [Accepted: 04/12/2015] [Indexed: 12/18/2022] Open
Abstract
Obstructive and central sleep apnea are far more common in heart failure patients than in the general population and their presence might contribute to the progression of heart failure by exposing the heart to intermittent hypoxia, increased preload and afterload, sympathetic nervous system activation, and vascular endothelial dysfunction. There is now substantial evidence that supports a role for fluid overload and nocturnal rostral fluid shift from the legs as unifying mechanisms in the pathogenesis of obstructive and central sleep apnea in heart failure patients, such that the predominant type of sleep apnea is related to the relative distribution of fluid from the leg to the neck and chest. Despite advances in therapies for heart failure, mortality rates remain high. Accordingly, the identification and treatment of sleep apnea in patients with heart failure might offer a novel therapeutic target to modulate this increased risk. In heart failure patients with obstructive or central sleep apnea, continuous positive airway pressure has been shown to improve cardiovascular function in short-term trials but this has not translated to improved mortality or reduced hospital admissions in long-term randomized trials. Other forms of positive airway pressure such as adaptive servoventilation have shown promising results in terms of attenuation of sleep apnea and improvement in cardiovascular function in short-term trials. Large scale, randomized trials are required to determine whether treating sleep apnea with various interventions can reduce morbidity and mortality.
Collapse
|
28
|
Rothenberger SD, Krafty RT, Taylor BJ, Cribbet MR, Thayer JF, Buysse DJ, Kravitz HM, Buysse ED, Hall MH. Time-varying correlations between delta EEG power and heart rate variability in midlife women: the SWAN Sleep Study. Psychophysiology 2015; 52:572-84. [PMID: 25431173 PMCID: PMC4376638 DOI: 10.1111/psyp.12383] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 09/25/2014] [Indexed: 11/30/2022]
Abstract
No studies have evaluated the dynamic, time-varying relationship between delta electroencephalographic (EEG) sleep and high frequency heart rate variability (HF-HRV) in women. Delta EEG and HF-HRV were measured during sleep in 197 midlife women (M(age) = 52.1, SD = 2.2). Delta EEG-HF-HRV correlations in nonrapid eye movement (NREM) sleep were modeled as whole-night averages and as continuous functions of time. The whole-night delta EEG-HF-HRV correlation was positive. The strongest correlations were observed during the first NREM sleep period preceding and following peak delta power. Time-varying correlations between delta EEG-HF-HRV were stronger in participants with sleep-disordered breathing and self-reported insomnia compared to healthy controls. The dynamic interplay between sleep and autonomic activity can be modeled across the night to examine within- and between-participant differences including individuals with and without sleep disorders.
Collapse
Affiliation(s)
- Scott D Rothenberger
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Martino TA, Young ME. Influence of the Cardiomyocyte Circadian Clock on Cardiac Physiology and Pathophysiology. J Biol Rhythms 2015; 30:183-205. [DOI: 10.1177/0748730415575246] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Cardiac function and dysfunction exhibit striking time-of-day-dependent oscillations. Disturbances in both daily rhythms and sleep are associated with increased risk of heart disease, adverse cardiovascular events, and worsening outcomes. For example, the importance of maintaining normal daily rhythms is highlighted by epidemiologic observations that night shift workers present with increased incidence of cardiovascular disease. Rhythmicity in cardiac processes is mediated by a complex interaction between extracardiac (e.g., behaviors and associated neural and humoral fluctuations) and intracardiac influences. Over the course of the day, the intrinsic properties of the myocardium vary at the levels of gene and protein expression, metabolism, responsiveness to extracellular stimuli/stresses, and ion homeostasis, all of which affect contractility (e.g., heart rate and force generation). Over the past decade, the circadian clock within the cardiomyocyte has emerged as an essential mechanism responsible for modulating the intrinsic properties of the heart. Moreover, the critical role of this mechanism is underscored by reports that disruption, through genetic manipulation, results in development of cardiac disease and premature mortality in mice. These findings, in combination with reports that numerous cardiovascular risk factors (e.g., diet, diabetes, aging) distinctly affect the clock in the heart, have led to the hypothesis that aberrant regulation of this mechanism contributes to the etiology of cardiac dysfunction and disease. Here, we provide a comprehensive review on current knowledge regarding known roles of the heart clock and discuss the potential for using these insights for the future development of innovative strategies for the treatment of cardiovascular disease.
Collapse
Affiliation(s)
- Tami A. Martino
- Cardiovascular Research Group, Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Martin E. Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
30
|
Mansukhani MP, Wang S, Somers VK. Chemoreflex physiology and implications for sleep apnoea: insights from studies in humans. Exp Physiol 2014; 100:130-5. [PMID: 25398715 DOI: 10.1113/expphysiol.2014.082826] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/07/2014] [Indexed: 12/31/2022]
Abstract
NEW FINDINGS What is the topic of this review? This review summarizes chemoreflex physiology in health and disease, with specific focus on chemoreflex-mediated pathophysiology in obstructive and central sleep apnoea. What advances does it highlight? Chemoreflex mechanisms are thought to contribute significantly to the pathophysiology and adverse outcomes seen in sleep apnoea. Clinical implications of altered chemoreflex function in sleep apnoea from recent studies in humans, including cardiac arrhythmias, coronary artery disease, systolic/diastolic heart failure and sudden cardiac death are highlighted. Activation of the chemoreflex in response to hypoxaemia results in an increase in sympathetic neural outflow. This process is predominantly mediated by the peripheral chemoreceptors in the carotid bodies and is potentiated by the absence of the sympatho-inhibitory influence of ventilation during apnoea, as is seen in patients with sleep apnoea. In these patients, repetitive nocturnal hypoxaemia and apnoea elicit sympathetic activation, which may persist into wakefulness and is thought to contribute to the development of systemic hypertension and cardiac and vascular dysfunction. Chemoreflex activation could possibly lead to adverse cardiovascular outcomes, such as nocturnal myocardial infarction, systolic and/or diastolic heart failure, cardiac arrhythmias and sudden death in patients with sleep apnoea. This review summarizes chemoreflex physiology in health and disease, with specific focus on chemoreflex-mediated pathophysiology in obstructive and central sleep apnoea. Measurement of the chemoreflex response may serve as a potential avenue for individualized screening for cardiovascular disease. Whether modulation of this response in sleep apnoea may aid in the prevention and treatment of adverse cardiovascular consequences will require further study.
Collapse
|
31
|
Hall AB, Ziadi MC, Leech JA, Chen SY, Burwash IG, Renaud J, deKemp RA, Haddad H, Mielniczuk LM, Yoshinaga K, Guo A, Chen L, Walter O, Garrard L, DaSilva JN, Floras JS, Beanlands RSB. Effects of short-term continuous positive airway pressure on myocardial sympathetic nerve function and energetics in patients with heart failure and obstructive sleep apnea: a randomized study. Circulation 2014; 130:892-901. [PMID: 24993098 DOI: 10.1161/circulationaha.113.005893] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Heart failure with reduced ejection fraction and obstructive sleep apnea (OSA), 2 states of increased metabolic demand and sympathetic nervous system activation, often coexist. Continuous positive airway pressure (CPAP), which alleviates OSA, can improve ventricular function. It is unknown whether this is due to altered oxidative metabolism or presynaptic sympathetic nerve function. We hypothesized that short-term (6-8 weeks) CPAP in patients with OSA and heart failure with reduced ejection fraction would improve myocardial sympathetic nerve function and energetics. METHODS AND RESULTS Forty-five patients with OSA and heart failure with reduced ejection fraction (left ventricular ejection fraction 35.8±9.7% [mean±SD]) were evaluated with the use of echocardiography and 11C-acetate and 11C-hydroxyephedrine positron emission tomography before and ≈6 to 8 weeks after randomization to receive short-term CPAP (n=22) or no CPAP (n=23). Work metabolic index, an estimate of myocardial efficiency, was calculated as follows: (stroke volume index×heart rate×systolic blood pressure÷Kmono), where Kmono is the monoexponential function fit to the myocardial 11C-acetate time-activity data, reflecting oxidative metabolism. Presynaptic sympathetic nerve function was measured with the use of the 11C-hydroxyephedrine retention index. CPAP significantly increased hydroxyephedrine retention versus no CPAP (Δretention: +0.012 [0.002, 0.021] versus -0.006 [-0.013, 0.005] min(-1); P=0.003). There was no significant change in work metabolic index between groups. However, in those with more severe OSA (apnea-hypopnea index>20 events per hour), CPAP significantly increased both work metabolic index and systolic blood pressure (P<0.05). CONCLUSIONS In patients with heart failure with reduced ejection fraction and OSA, short-term CPAP increased hydroxyephedrine retention, indicating improved myocardial sympathetic nerve function, but overall did not affect energetics. In those with more severe OSA, CPAP may improve cardiac efficiency. Further outcome-based investigation of the consequences of CPAP is warranted. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00756366.
Collapse
Affiliation(s)
- Allison B Hall
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Maria C Ziadi
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Judith A Leech
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Shin-Yee Chen
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Ian G Burwash
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Jennifer Renaud
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Robert A deKemp
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Haissam Haddad
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Lisa M Mielniczuk
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Keiichiro Yoshinaga
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Ann Guo
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Li Chen
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Olga Walter
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Linda Garrard
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Jean N DaSilva
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - John S Floras
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.)
| | - Rob S B Beanlands
- From the National Cardiac PET Center, Division of Cardiology, Department of Medicine (A.B.H., M.C.Z., S.C., I.G.B., J.R., R.A.d., H.H., L.M.M., K.Y., A.G., O.W., L.G., J.N.D., R.S.B.B.), and Cardiac Research Methods Center (L.C.), University of Ottawa Heart Institute, Ottawa, Canada; Diagnostico Medico Oronia, Non Invasive Cardiovascular Imaging Department, Rosario, Santa Fe, Argentina (M.C.Z.); Division of Respirology, Department of Medicine, Ottawa Hospital, University of Ottawa, Ottawa, Canada (J.A.L.); Department of Molecular Imaging, Hokkaido University Graduate School of Medicince, Sapporo, Japan (K.Y.); and Division of Cardiology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada (J.S.F.).
| |
Collapse
|
32
|
Abstract
Sleep-disordered breathing (SDB) is prevalent in patients with heart failure, and is associated with increased morbidity and mortality. SDB is proinflammatory, with nocturnal oxygen desaturations and hypercapnia appearing to play a pivotal role in the development of oxidative stress and sympathetic activation. Preliminary data suggest that attention to the diagnosis and management of SDB in patients with heart failure may improve outcomes. Ongoing research into the roles of comorbidities such as SDB as a treatment target may lead to better clinical outcomes and improved quality of life for patients with heart failure.
Collapse
Affiliation(s)
- Robert J Mentz
- Duke University Medical Center, Duke Clinical Research Institute, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Mona Fiuzat
- Duke University Medical Center, Duke Clinical Research Institute, 2301 Erwin Road, Durham, NC 27710, USA
| |
Collapse
|
33
|
Palma JA, Urrestarazu E, Lopez-Azcarate J, Alegre M, Fernandez S, Artieda J, Iriarte J. Increased sympathetic and decreased parasympathetic cardiac tone in patients with sleep related alveolar hypoventilation. Sleep 2013; 36:933-40. [PMID: 23729937 DOI: 10.5665/sleep.2728] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess autonomic function by heart rate variability (HRV) during sleep in patients with sleep related alveolar hypoventilation (SRAH) and to compare it with that of patients with obstructive sleep apnea (OSA) and control patients. DESIGN Cross-sectional study. SETTING Sleep Unit, University Hospital of University of Navarra. PATIENTS Fifteen idiopathic and obesity related-SRAH patients were studied. For each patient with SRAH, a patient with OSA, matched in age, sex, body mass index (BMI), minimal oxygen saturation (SatO2), and mean SatO2 was selected. Control patients were also matched in age, sex, and BMI with patients with OSA and those with SRAH, and in apnea/hypopnea index (AHI) with patients with SRAH. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Time- and frequency-domain HRV measures (R-R, standard deviation of normal-to-normal RR interval [SDNN], very low frequency [VLF], low frequency [LF], high frequency [HF], LF/HF ratio) were calculated across all sleep stages as well as during wakefulness just before and after sleep during a 1-night polysomnography. In patients with SRAH and OSA, LF was increased during rapid eye movement (REM) when compared with control patients, whereas HF was decreased during REM and N1-N2 sleep stages. The LF/HF ratio was equally increased in patients with SRAH and OSA during REM and N1-N2. Correlation analysis showed that LF and HF values during REM sleep were correlated with minimal SatO2 and mean SatO2. CONCLUSIONS Patients with SRAH exhibited an abnormal cardiac tone during sleep. This fact appears to be related to the severity of nocturnal oxygen desaturation. Moreover, there were no differences between OSA and SRAH, supporting the hypothesis that autonomic changes in OSA are primarily related to a reduced nocturnal oxygen saturation, rather than a consequence of other factors such as nocturnal respiratory events.
Collapse
Affiliation(s)
- Jose-Alberto Palma
- Sleep Unit and Clinical Neurophysiology Section, University Clinic of Navarra, Pamplona, Spain
| | | | | | | | | | | | | |
Collapse
|
34
|
Impact of continuous positive airway pressure treatment on left ventricular ejection fraction in patients with obstructive sleep apnea: a meta-analysis of randomized controlled trials. PLoS One 2013; 8:e62298. [PMID: 23650511 PMCID: PMC3641077 DOI: 10.1371/journal.pone.0062298] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Accepted: 03/19/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It has been known for a long time that obstructive sleep apnea (OSA) is associated with a decreased left ventricular ejection fraction (LVEF). Continuous positive airway pressure (CPAP) is the gold standard treatment for OSA; however, it is unknown whether or not CPAP treatment will improve the LVEF. The aim of the current study was to assess whether or not CPAP treatment improves the LVEF. A meta-analysis was conducted to determine the effect of CPAP treatment on the LVEF among patients with OSA. METHODS A literature search of PubMed, the Web of Science, and Cochrane Collaboration's database were utilized to identify eligible reports for this trial. Ten randomized controlled trails were examined and the meta-analysis was performed using STATA 11. RESULTS A significant improvement in the LVEF was observed after CPAP treatment (weighted mean difference(WMD) = 3.59, 95% CI = 1.74-5.44; P<0.001). Subgroup analysis revealed that patients with OSA and heart failure had a significant improvement in the LVEF after CPAP treatment (WMD = 5.18, 95% CI = 3.27-7.08; P<0.001); however, the LVEF of patients with OSA only increased 1.11% and there was no statistical significance (WMD = 1.11, 95% CI = -1.13-3.35; P = 0.331). Furthermore, based on univariate meta-regression analysis, only the baseline AHI had a statistically significant correlation with the LVEF. CONCLUSIONS Our meta-analysis supports the notion that CPAP may improve the LVEF among patients with OSA.
Collapse
|
35
|
Jurysta F, Kempenaers C, Lanquart JP, Noseda A, van de Borne P, Linkowski P. Long-term CPAP treatment partially improves the link between cardiac vagal influence and delta sleep. BMC Pulm Med 2013; 13:29. [PMID: 23628083 PMCID: PMC3685543 DOI: 10.1186/1471-2466-13-29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/18/2013] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) treatment improves the risk of cardiovascular events in patients suffering from severe sleep apnea-hypopnea syndrome (SAHS) but its effect on the link between delta power band that is related to deep sleep and the relative cardiac vagal component of heart rate variability, HF(nu) of HRV, is unknown. Therefore, we tested the hypothesis that CPAP restores the link between cardiac autonomic activity and delta sleep across the night. METHODS Eight patients suffering from severe SAHS before and after 4 ± 3 years of nasal CPAP treatment were matched with fourteen healthy controls. Sleep EEG and ECG were analysed to obtain spectral sleep and HRV components. Coherence analysis was applied between HF(nu) and delta power bands across the first three sleep cycles. RESULTS Sleep characteristics and spectral HRV components were similar between untreated patients, treated patients and controls, with the exception of decreased Rapid Eye Movement duration in untreated patients. Coherence and gain values between HF(nu) and delta EEG variability were decreased in untreated patients while gain values normalized in treated patients. In patients before and during long-term CPAP treatment, phase shift and delay between modifications in HF(nu) and delta EEG variability did not differ from controls but were not different from zero. In healthy men, changes in cardiac vagal activity appeared 9 ± 7 minutes before modifications in delta sleep. CONCLUSIONS Long-term nasal CPAP restored, in severe SAHS, the information between cardiovascular and sleep brainstem structures by increasing gain, but did not improve its tightness or time shift.
Collapse
Affiliation(s)
- Fabrice Jurysta
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Chantal Kempenaers
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Jean-Pol Lanquart
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - André Noseda
- Chest Department, Erasme Academic Hospital-ULB, Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiology and Hypertension Clinic, Erasme Academic Hospital - ULB, Brussels, Belgium
| | - Paul Linkowski
- Sleep Laboratory and Laboratory of Psychiatric Research, Department of Psychiatry, Erasme Academic Hospital - ULB, Brussels, Belgium
| |
Collapse
|
36
|
Yagishita-Tagawa Y, Yumino D, Takagi A, Serizawa N, Hagiwara N. Association between sleep apnea and overnight hemodynamic changes in hospitalized heart failure patients with and without paroxysmal nocturnal dyspnea. J Cardiol 2013; 61:348-53. [PMID: 23507270 DOI: 10.1016/j.jjcc.2012.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/04/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Paroxysmal nocturnal dyspnea (PND) is a common symptom for patients with acute decompensated heart failure (ADHF). Some symptoms of PND are similar to those of sleep apnea (SA) which might be associated with overnight worsening hemodynamics in failing hearts. However, the association between PND, SA, and overnight change in hemodynamics in patients with heart failure remains uncertain. METHODS We studied 28 consecutive patients with reduced ejection fraction who were hospitalized with ADHF. Plasma atrial natriuretic peptide (ANP) levels were measured before and after overnight sleep study. PND was defined as having an episode of PND prior to hospitalization for ADHF. RESULTS Ten (36%) patients had a history of PND. Respiratory disturbance index (the frequency and severity of sleep apnea) was an independent factor associated with a history of PND (odds ratio 1.24, 95% confidence interval 1.05-1.47, p=0.011). In those without PND, plasma ANP levels decreased from before sleep to after waking, whereas in those with PND it increased (p=0.011). In addition, overnight change in plasma ANP levels was independently associated with respiratory disturbance index (p=0.035). CONCLUSION These results thus suggest that in patients with ADHF, SA might be a predisposing cause of PND in association with overnight worsening hemodynamics.
Collapse
|
37
|
Alshaer H, Fernie GR, Maki E, Bradley TD. Validation of an automated algorithm for detecting apneas and hypopneas by acoustic analysis of breath sounds. Sleep Med 2013; 14:562-71. [PMID: 23453251 DOI: 10.1016/j.sleep.2012.12.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 12/10/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is common and is associated with increased risk for cardiovascular disease. However, most patients remain undiagnosed due to lack of access to sleep laboratories. We therefore tested the validity of a single-channel monitoring setup that captures and analyzes breath sounds (BSs) to detect SDB. METHODS BS were recorded from 50 patients undergoing simultaneous polysomnography (PSG). Using custom-designed automatic software, BS were subjected to a set of pattern recognition rules to identify apneas and hypopneas from which the acoustic apnea-hypopnea index (AHI-a) was calculated. Apneas and hypopneas from PSG were scored blindly by three technicians according to two criteria; one relying solely on the drop of the respiratory signal by >90% for an apnea and by 50% to 90% for a hypopnea (TV50 criteria), and another that also required a desaturation or an arousal for a hypopnea (American Association of Sleep Medicine [AASM] criteria). PSG AHI (AHI-p) was calculated for each technician according to both criteria. RESULTS There was no significant difference between AHI-p scores according to TV50 and AASM criteria. AHI-a was strongly correlated with AHI-p according to both TV50 (R=94%) and AASM criteria (R=93%). Bland-Altman plot analysis revealed that 98% and 92% of AHI-a fell within the limits of agreement for AHI-p according to TV50 and AASM criteria, respectively. Based on a diagnostic cutoff of AHI-p≥10 for SDB, overall accuracy of AHI-a reached 88% and negative predictive value reached 100%. CONCLUSION Acoustic analysis of BS is a reliable method for quantifying AHI and diagnosing SDB compared to simultaneous PSG.
Collapse
Affiliation(s)
- Hisham Alshaer
- University Health Network Toronto Rehabilitation Institute, iDAPT - Intelligent Design for Adaptation, Participation and Technology, Canada.
| | | | | | | |
Collapse
|
38
|
Affiliation(s)
- Takatoshi Kasai
- Sleep Research Laboratory, Centre for Sleep Health and Research, and Department of Medicine of the University Health Network Toronto Rehabilitation Institute, Ontario, Canada
| | | | | |
Collapse
|
39
|
The missing link between heart failure and sleep disordered breathing: Increased left ventricular wall stress. Int J Cardiol 2012; 157:294-7. [DOI: 10.1016/j.ijcard.2012.03.123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 03/10/2012] [Indexed: 12/23/2022]
|
40
|
Kufoy E, Palma JA, Lopez J, Alegre M, Urrestarazu E, Artieda J, Iriarte J. Changes in the heart rate variability in patients with obstructive sleep apnea and its response to acute CPAP treatment. PLoS One 2012; 7:e33769. [PMID: 22438995 PMCID: PMC3306298 DOI: 10.1371/journal.pone.0033769] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Accepted: 02/16/2012] [Indexed: 01/28/2023] Open
Abstract
Introduction Obstructive Sleep Apnea (OSA) is a major risk factor for cardiovascular disease. The goal of this study was to demonstrate whether the use of CPAP produces significant changes in the heart rate or in the heart rate variability of patients with OSA in the first night of treatment and whether gender and obesity play a role in these differences. Methods Single-center transversal study including patients with severe OSA corrected with CPAP. Only patients with total correction after CPAP were included. Patients underwent two sleep studies on consecutive nights: the first night a basal study, and the second with CPAP. We also analyzed the heart rate changes and their relationship with CPAP treatment, sleep stages, sex and body mass index. Twenty-minute segments of the ECG were selected from the sleep periods of REM, no-REM and awake. Heart rate (HR) and heart rate variability (HRV) were studied by comparing the R-R interval in the different conditions. We also compared samples from the basal study and CPAP nights. Results 39 patients (15 females, 24 males) were studied. The mean age was 50.67 years old, the mean AHI was 48.54, and mean body mass index was 33.41 kg/m2 (31.83 males, 35.95 females). Our results showed that HRV (SDNN) decreased after the use of CPAP during the first night of treatment, especially in non-REM sleep. Gender and obesity did not have any influence on our results. Conclusions These findings support that cardiac variability improves as an acute effect, independently of gender or weight, in the first night of CPAP use in severe OSA patients, supporting the idea of continuous use and emphasizing that noncompliance of CPAP treatment should be avoided even if it is just once.
Collapse
Affiliation(s)
- Ernesto Kufoy
- Clinical Neurophysiology Service, University Clinic of Navarra, Pamplona, Spain
| | - Jose-Alberto Palma
- Clinical Neurophysiology Service, University Clinic of Navarra, Pamplona, Spain
- Department of Neurology, University Clinic of Navarra, Pamplona, Spain
| | - Jon Lopez
- Neurophysiology Laboratory, Neurosciences Area, Centro de Investigación Médica Aplicada (CIMA), University of Navarra, Pamplona, Spain
| | - Manuel Alegre
- Clinical Neurophysiology Service, University Clinic of Navarra, Pamplona, Spain
- Neurophysiology Laboratory, Neurosciences Area, Centro de Investigación Médica Aplicada (CIMA), University of Navarra, Pamplona, Spain
| | - Elena Urrestarazu
- Clinical Neurophysiology Service, University Clinic of Navarra, Pamplona, Spain
- Neurophysiology Laboratory, Neurosciences Area, Centro de Investigación Médica Aplicada (CIMA), University of Navarra, Pamplona, Spain
| | - Julio Artieda
- Clinical Neurophysiology Service, University Clinic of Navarra, Pamplona, Spain
- Neurophysiology Laboratory, Neurosciences Area, Centro de Investigación Médica Aplicada (CIMA), University of Navarra, Pamplona, Spain
| | - Jorge Iriarte
- Clinical Neurophysiology Service, University Clinic of Navarra, Pamplona, Spain
- * E-mail:
| |
Collapse
|
41
|
Stein PK, Pu Y. Heart rate variability, sleep and sleep disorders. Sleep Med Rev 2011; 16:47-66. [PMID: 21658979 DOI: 10.1016/j.smrv.2011.02.005] [Citation(s) in RCA: 276] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/24/2011] [Accepted: 02/25/2011] [Indexed: 11/15/2022]
Abstract
Heart rate (HR) is modulated by the combined effects of the sympathetic and parasympathetic nervous systems. Therefore, measurement of changes in HR over time (heart rate variability or HRV) provides information about autonomic functioning. HRV has been used to identify high risk people, understand the autonomic components of different disorders and to evaluate the effect of different interventions, etc. Since the signal required to measure HRV is already being collected on the electrocardiogram (ECG) channel of the polysomnogram (PSG), collecting data for research on HRV and sleep is straightforward, but applications have been limited. As reviewed here, HRV has been applied to understand autonomic changes during different sleep stages. It has also been applied to understand the effect of sleep-disordered breathing, periodic limb movements and insomnia both during sleep and during the daytime. HRV has been successfully used to screen people for possible referral to a Sleep Lab. It has also been used to monitor the effects of continuous positive airway pressure (CPAP). A novel HRV measure, cardiopulmonary coupling (CPC) has been proposed for sleep quality. Evidence also suggests that HRV collected during a PSG can be used in risk stratification models, at least for older adults. Caveats for accurate interpretation of HRV are also presented.
Collapse
Affiliation(s)
- Phyllis K Stein
- Washington University, School of Medicine HRV Laboratory, 4625 Lindell Boulevard, Suite 402, Saint Louis, MO 63108, USA.
| | | |
Collapse
|
42
|
McKelvie RS, Moe GW, Cheung A, Costigan J, Ducharme A, Estrella-Holder E, Ezekowitz JA, Floras J, Giannetti N, Grzeslo A, Harkness K, Heckman GA, Howlett JG, Kouz S, Leblanc K, Mann E, O'Meara E, Rajda M, Rao V, Simon J, Swiggum E, Zieroth S, Arnold JMO, Ashton T, D'Astous M, Dorian P, Haddad H, Isaac DL, Leblanc MH, Liu P, Sussex B, Ross HJ. The 2011 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: Focus on Sleep Apnea, Renal Dysfunction, Mechanical Circulatory Support, and Palliative Care. Can J Cardiol 2011; 27:319-38. [DOI: 10.1016/j.cjca.2011.03.011] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 03/15/2011] [Indexed: 10/18/2022] Open
|
43
|
Interrelations entre ventilation mécanique et système nerveux autonome. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-011-0218-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
44
|
Kasai T, Bradley TD. Obstructive Sleep Apnea and Heart Failure. J Am Coll Cardiol 2011; 57:119-27. [PMID: 21211682 DOI: 10.1016/j.jacc.2010.08.627] [Citation(s) in RCA: 258] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 06/18/2010] [Accepted: 08/01/2010] [Indexed: 10/18/2022]
|
45
|
Kee K, Sands SA, Edwards BA, Berger PJ, Naughton MT. Positive Airway Pressure in Congestive Heart Failure. Sleep Med Clin 2010. [DOI: 10.1016/j.jsmc.2010.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
46
|
Abstract
Cardiovascular disease has been the leading cause of death since 1900. Strategies for cardiovascular disease and prevention have helped to reduce the burden of disease, but it remains an important public health challenge. Therefore, understanding the underlying pathophysiology and developing novel therapeutic approaches for cardiovascular disease is of crucial importance. Recognizing the link between sleep and cardiovascular disease may represent one such novel approach. Obstructive sleep apnea (OSA), a common form of sleep-disordered breathing, has a high and rising prevalence in the general adult population, attributable in part to the emerging epidemic of obesity and enhanced awareness. OSA has been independently linked to specific cardiovascular outcomes such as hypertension, stroke, myocardial ischemia, arrhythmias, fatal and nonfatal cardiovascular events, and all-cause mortality. Treatment of OSA may represent a novel target to reduce cardiovascular health outcomes.
Collapse
Affiliation(s)
- Bernardo Selim
- Division of Pulmonary and Critical Care Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208057, New Haven, CT 06520-8057, USA
| | | | | |
Collapse
|
47
|
Ng ACC, Davis GM, Chow CM, Coats AJ, Sindone AP, Freedman B. Impact of sleep disordered breathing severity on hemodynamics, autonomic balance and cardiopulmonary functional status in chronic heart failure. Int J Cardiol 2010; 141:227-35. [DOI: 10.1016/j.ijcard.2008.11.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 11/28/2008] [Indexed: 11/30/2022]
|
48
|
Burton AR, Rahman K, Kadota Y, Lloyd A, Vollmer-Conna U. Reduced heart rate variability predicts poor sleep quality in a case-control study of chronic fatigue syndrome. Exp Brain Res 2010; 204:71-8. [PMID: 20502886 DOI: 10.1007/s00221-010-2296-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
Abstract
Parasympathetic function is important in the induction and maintenance of sleep. We examined whether nocturnal vagal modulation of heart rate is related to the poor sleep quality commonly reported in chronic fatigue syndrome (CFS). Heart rate (HR, as R-R intervals) was continuously monitored during sleep in 20 patients with CFS and 20 matched control subjects. Questionnaires assessed demographic information, symptoms, functional impairment, and subjective sleep quality. CFS was associated with more sleep problems in general and poorer subjective sleep quality on the study night (all p < 0.003), and reports of repeated awakening during the night were 7 times more likely compared to healthy subjects (p = 0.017). Time and frequency-domain parameters of HR variability during sleep were significantly lower in patients with CFS (all p < 0.006). Multiple regression analyses revealed that heart rate variability (HRV) parameters were the best predictors of subjective sleep measures. This study identified significant reductions in vagal modulation of heart rate during sleep in CFS. Low HRV strongly predicted sleep quality-suggesting a pervasive state of nocturnal sympathetic hypervigilance in CFS.
Collapse
Affiliation(s)
- A R Burton
- School of Psychiatry, University of NSW, Sydney, Australia
| | | | | | | | | |
Collapse
|
49
|
Van de Louw A, Médigue C, Papelier Y, Cottin F. Positive end-expiratory pressure may alter breathing cardiovascular variability and baroreflex gain in mechanically ventilated patients. Respir Res 2010; 11:38. [PMID: 20403192 PMCID: PMC2868796 DOI: 10.1186/1465-9921-11-38] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 04/19/2010] [Indexed: 01/31/2023] Open
Abstract
Background Baroreflex allows to reduce sudden rises or falls of arterial pressure through parallel RR interval fluctuations induced by autonomic nervous system. During spontaneous breathing, the application of positive end-expiratory pressure (PEEP) may affect the autonomic nervous system, as suggested by changes in baroreflex efficiency and RR variability. During mechanical ventilation, some patients have stable cardiorespiratory phase difference and high-frequency amplitude of RR variability (HF-RR amplitude) over time and others do not. Our first hypothesis was that a steady pattern could be associated with reduced baroreflex sensitivity and HF-RR amplitude, reflecting a blunted autonomic nervous function. Our second hypothesis was that PEEP, widely used in critical care patients, could affect their autonomic function, promoting both steady pattern and reduced baroreflex sensitivity. Methods We tested the effect of increasing PEEP from 5 to 10 cm H2O on the breathing variability of arterial pressure and RR intervals, and on the baroreflex. Invasive arterial pressure, ECG and ventilatory flow were recorded in 23 mechanically ventilated patients during 15 minutes for both PEEP levels. HF amplitude of RR and systolic blood pressure (SBP) time series and HF phase differences between RR, SBP and ventilatory signals were continuously computed by complex demodulation. Cross-spectral analysis was used to assess the coherence and gain functions between RR and SBP, yielding baroreflex-sensitivity indices. Results At PEEP 10, the 12 patients with a stable pattern had lower baroreflex gain and HF-RR amplitude of variability than the 11 other patients. Increasing PEEP was generally associated with a decreased baroreflex gain and a greater stability of HF-RR amplitude and cardiorespiratory phase difference. Four patients who exhibited a variable pattern at PEEP 5 became stable at PEEP 10. At PEEP 10, a stable pattern was associated with higher organ failure score and catecholamine dosage. Conclusions During mechanical ventilation, stable HF-RR amplitude and cardiorespiratory phase difference over time reflect a blunted autonomic nervous function which might worsen as PEEP increases.
Collapse
Affiliation(s)
- Andry Van de Louw
- Unité de Biologie Intégrative des Adaptations à l'Exercice (INSERM 902/EA 3872, Genopole), ZAC du Bras de Fer, 3 bis impasse Christophe Colomb, 91000 Evry, France.
| | | | | | | |
Collapse
|
50
|
|