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Gerontas A, Avgerinos D, Charitakis K, Maragou H, Drosatos K. 1821-2021: Contributions of physicians and researchers of Greek descent in the advancement of clinical and experimental cardiology and cardiac surgery. Front Cardiovasc Med 2023; 10:1231762. [PMID: 37600045 PMCID: PMC10436502 DOI: 10.3389/fcvm.2023.1231762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
While the role of Greeks in the development of early western medicine is well-known and appreciated, the contributions of modern Greek medical practitioners are less known and often overlooked. On the occasion of the 200-year anniversary of the Greek War of Independence, this review article sheds light onto the achievements of modern scientists of Greek descent in the development of cardiology, cardiac surgery, and cardiovascular research, through a short history of the development of these fields and of the related institutions in Greece. In the last decades, the Greek cardiology and Cardiac Surgery communities have been active inside and outside Greece and have a remarkable presence internationally, particularly in the United States. This article highlights the ways in which Greek cardiology and cardiovascular research has been enriched by absorbing knowledge produced in international medical centers, academic institutes and pharmaceutical industries in which generations of Greek doctors and researchers trained prior to their return to the homeland; it also highlights the achievements of medical practitioners and researchers of Greek descent who excelled abroad, producing ground-breaking work that has left a permanent imprint on global medicine.
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Affiliation(s)
- Apostolos Gerontas
- School of Applied Natural Sciences, Coburg University, Coburg, Germany
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Dimitrios Avgerinos
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
| | - Konstantinos Charitakis
- Department of Internal Medicine, Division of Cardiology, University of Texas Health Science Center, Houston, TX, United States
| | - Helena Maragou
- School of Liberal Arts and Sciences, The American College of Greece, Athens, Greece
| | - Konstantinos Drosatos
- ARISTEiA-Institute for the Advancement of Research and Education in Arts, Sciences and Technology, McLean, VA, United States
- Metabolic Biology Laboratory, Cardiovascular Center, Department of Pharmacology and Systems Physiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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Tokavanich N, Leelapatana P, Prechawat S, Rungpradubvong V, Mongkonsritrakoon W, Vallabhajosyula S, Prasitlumkum N, Thongprayoon C, Cheungpasitporn W, Chokesuwattanaskul R. Benefit of Atrial Overdrive Pacing in Patients with Sleep Apnea: A Meta-Analysis. J Clin Med 2021; 10:jcm10184065. [PMID: 34575176 PMCID: PMC8464753 DOI: 10.3390/jcm10184065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/30/2021] [Accepted: 09/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sleep apnea is one of the most common conditions around the world. This disorder can significantly impact cardiovascular morbidity and mortality. Atrial overdrive pacing (AOP) is a treatment modality that can potentially decrease respiratory events. There is currently a lack of evidence to confirm the benefits of AOP. We aimed to assess the impact of AOP in patients with obstructive sleep apnea (OSA), central sleep apnea (CSA), and mixed type. METHODS A literature search for studies that reported the impact on apnea-hypopnea index (AHI) by cardiac implantable electronic devices with different pacing modes was conducted using MEDLINE, Embase, and Cochrane Database from inception through July 2020. Pooled standard mean difference with 95%CI was calculated using a random-effects model. RESULTS Fifteen studies, including thirteen randomized studies and two observational studies containing 440 patients, were identified. The standard mean difference in apnea-hypopnea index of atrial overdrive pacing demonstrated less duration of apnea/hypopnea in patients with atrial overdrive pacing (AOP) (SMD -0.29, 95%CI: -0.48, -0.10, I2 = 57%). Additional analysis was performed to assess the effect of atrial overdrive pacing in patients with or without severe sleep apnea syndrome (mean AHI < 30 defined as non-severe). There was no statistically significant difference in standardized mean in AHI in both subgroups between AOP and control groups (SMD -0.25, severe sleep apnea syndrome SMD -0.03, I2 = 0.00%). CONCLUSIONS AOP was associated with a statistically significant reduction in AHI, but the magnitude of reduction was small. AOP may potentially be used as an adjunctive treatment with other modalities in treating patients with sleep apnea.
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Affiliation(s)
- Nithi Tokavanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (P.L.); (S.P.); (V.R.)
- Correspondence: (N.T.); (R.C.)
| | - Pattranee Leelapatana
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (P.L.); (S.P.); (V.R.)
| | - Somchai Prechawat
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (P.L.); (S.P.); (V.R.)
| | - Voravut Rungpradubvong
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (P.L.); (S.P.); (V.R.)
| | - Wimwipa Mongkonsritrakoon
- Department of Pediatric, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand;
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA;
| | - Narut Prasitlumkum
- Division of Cardiology, University of California Riverside, Riverside, CA 92521, USA;
| | - Charat Thongprayoon
- Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (C.T.); (W.C.)
| | | | - Ronpichai Chokesuwattanaskul
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; (P.L.); (S.P.); (V.R.)
- Center of Excellence in Arrhythmia Research Chulalongkorn University, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: (N.T.); (R.C.)
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3
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Jiang Z, Chen J, Chen J, Lei Z, Chen H, Wu J, Bai X, Wanyan P, Yu Q. Anti-inflammatory effects of paeoniflorin caused by regulation of the hif1a/miR-210/caspase1/GSDMD signaling pathway in astrocytes: a novel strategy for hypoxia-induced brain injury in rats. Immunopharmacol Immunotoxicol 2021; 43:410-418. [PMID: 34114917 DOI: 10.1080/08923973.2021.1924194] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Context: Hypoxia-induced injury is a classic symptom of obstructive sleep apnea hypopnea syndrome (OSAHS), which is a risk factor of various diseases, such as hypertension, heart failure and stroke. However, there is no effective therapy for hypoxia-induced injury or OSAHS due to the elusive mechanism involved.Objective: This study aimed to assess the effects of paeoniflorin on hypoxia-induced injury and explore the underlying mechanism.Materials and methods: Hypoxic models of SD rats and CTX-TNA2 cells were used to assess the effect of paeoniflorin, and the expressions of hif1a, miR-210, caspase1 and GSDMD were detected using western blots and RT-PCR. Plasmid transfection was performed to explore the role of miR-210 in the effect of paeoniflorin.Results: Firstly, we confirmed that hypoxia induced severe neuronal injury and an enhancement of inflammation in the rat brain, with elevated expression of caspase1, IL1b and IL18. In addition, the results showed an activation of astrocytes and an increased level of pyroptosis under hypoxic conditions, which suggested a critical role of pyroptosis in hypoxiainduced injury of the brain. Furthermore, we found that compared with the controls, paeoniflorin treatment improved hypoxia-induced pyroptosis in astrocytes. Moreover, we detected the activation of hif1a/miR-210 signaling in the effects of paeoniflorin on astrocytes. As expected, the expression of hif1a and miR-210 was significantly upregulated in astrocytes when exposed to hypoxia, while paeoniflorin treatment reversed these enhancements. After transfection of miR-210 mimics, the attenuation of pyroptosis induced by paeoniflorin was suppressed, which was accompanied by an increase of ROS levels, as well as LDH release, indicating a critical role of miR-210 in pyroptosis in astrocytes.Conclusions: Our findings demonstrated that paeoniflorin improved hypoxia-induced pyroptosis in astrocytes via depressing hif1a/miR-210/caspase1/GSDMD signaling, providing robust evidence for the treatment of hypoxic injury and OSAHS.HighlightsHypoxia induces severe injury and inflammatory response in the rat brain;Hypoxia enhanced pyroptotic level and led to an activation of astrocytes.;Paeoniflorin alleviates hypoxia-induced pyroptosis in astrocytes;Transfection of miR-210 mimics suppressed the effects of paeoniflorin on hypoxia-induced pyroptosis in astrocytes.
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Affiliation(s)
- Zhenxiu Jiang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Department of Neurology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jun Chen
- Department of Neurology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jiangjun Chen
- Department of Neurology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zelin Lei
- Department of Respiration, The First Hospital of Lanzhou University, Lanzhou, China
| | - Hailin Chen
- School of Basic Medical Science, Lanzhou University, Lanzhou, China
| | - Jiqiang Wu
- Department of Respiration, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xue Bai
- Department of Respiration, The First Hospital of Lanzhou University, Lanzhou, China
| | - Pingping Wanyan
- Department of Nephrology, The Second Hospital of Lanzhou University, Lanzhou, China
| | - Qin Yu
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Department of Respiration, The First Hospital of Lanzhou University, Lanzhou, China
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Shah FA, Moronta S, Braford M, Greene N. Obstructive Sleep Apnea and Pulmonary Hypertension: A Review of Literature. Cureus 2021; 13:e14575. [PMID: 34035997 PMCID: PMC8135661 DOI: 10.7759/cureus.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a disease process involving recurrent pharyngeal collapse during sleep, resulting in apneic episodes. Clinically, symptoms can include snoring, sudden awakening with a choking-like sensation, excessive somnolence, non-restorative sleep, difficulty in starting or maintaining sleep, and fatigue. It results in impaired gas exchange, subsequently causing various cardiovascular, metabolic, and neurocognitive pathologies. Historically, OSA has been underdiagnosed and undertreated, especially in women. OSA is associated with WHO (World Health Organization) class III pulmonary hypertension (PH) or PH due to lung disease. PH is a concerning complication of OSA and thought to occur in roughly 20% of individuals with OSA. The pathogenesis of PH in OSA can include pulmonary artery vasoconstriction and remodeling. Patients suffering from OSA who develop PH tend to have worse cardiovascular and pulmonary changes. We present a thorough review of the literature examining the interplay between OSA and PH.
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Affiliation(s)
- Farhan A Shah
- Internal Medicine, Lewis Gale Medical Center, Salem, USA
| | - Shaidy Moronta
- Internal Medicine, Edward Via College of Osteopathic Medicine, Salem, USA
| | - Michalla Braford
- Internal Medicine, Edward Via College of Osteopathic Medicine, Salem, USA
| | - Nelson Greene
- Pulmonary and Critical Care, Lewis Gale Medical Center, Salem, USA
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Martí-Almor J, Jiménez-López J, Casteigt B, Conejos J, Valles E, Farré N, Flor MF. Obstructive Sleep Apnea Syndrome as a Trigger of Cardiac Arrhythmias. Curr Cardiol Rep 2021; 23:20. [PMID: 33611699 DOI: 10.1007/s11886-021-01445-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW Obstructive sleep apnea syndrome (OSAS) has a high prevalence in western countries. Many papers have been published with the purpose of demonstrating that OSAS acts as an arrhythmia trigger and is responsible for an increase in cardiovascular morbidity and mortality. The aim of this study was to review our knowledge on this topic. RECENT FINDINGS There is a lot of evidence demonstrating the relationship between OSAS and arrhythmias, but there remains a lack of an interventional randomized trial to demonstrate that by treating OSAS we can reduce arrhythmia burden. OSAS is a highly prevalent illness in western countries and is clearly related to an increase in cardiovascular mortality and morbidity. Cardiac arrhythmias are triggered by a repetitive hypoxemia, hypercapnia, acidosis, intrathoracic pressure fluctuations, reoxygenation, and arousals during apnea and hypopnea episodes. Early diagnosis and treatment of these patients can reduce further cardiovascular morbidity and mortality.
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Affiliation(s)
- Julio Martí-Almor
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain.
| | - Jesús Jiménez-López
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Benjamin Casteigt
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Javier Conejos
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Ermengol Valles
- Arrhythmia Unit, Cardiology Department, Parc de Salut Mar, Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Núria Farré
- Heart Failure Unit, Cardiology Department, Parc de Salut Mar, Universitat Autònoma de Barcelona and Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Miquel Félez Flor
- Multidisciplinary Unit of Sleep Medicine, Parc de salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
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Glassy M, Pezeshkian N, Yang Y, Srivatsa UN. Cause for Pause: Obstructive Sleep Apnea. Am J Med 2018; 131:141-143. [PMID: 29079399 DOI: 10.1016/j.amjmed.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Matthew Glassy
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento
| | - Nayereh Pezeshkian
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento
| | - Yingbo Yang
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento
| | - Uma N Srivatsa
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of California Davis School of Medicine, Sacramento.
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7
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Vizzardi E, Sciatti E, Bonadei I, D'Aloia A, Curnis A, Metra M. Obstructive sleep apnoea-hypopnoea and arrhythmias: new updates. J Cardiovasc Med (Hagerstown) 2018; 18:490-500. [PMID: 25000252 DOI: 10.2459/jcm.0000000000000043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Obstructive sleep apnoea-hypopnoea (OSAH) is a prevalent condition characterized by repetitive pharyngeal collapse during sleep, leading to hypoxemia, hypercapnia, and persistent inspiratory efforts against an occluded airway until arousal. Several studies demonstrated that OSAH exerts acute and chronic effects on the cardiovascular system. Thus, although being a respiratory problem, the most important consequences of OSAH are cardiovascular, among which there are arrhythmias. The purpose of this review is to systematically analyse what has been recently published about the relationship between OSAH and every cardiac arrhythmia separately. METHODS We searched Pubmed, Scopus, Web of Science and Cochrane Collaboration databases for 'OSAHS arrhythmias', 'OSAH arrhythmias' and 'OSA arrhythmias'. We analyse 1298 articles and meta-analyses, excluding already edited reviews. RESULTS Arrhythmias, especially of ventricular origin, are frequent in OSAH. Ventricular premature beats, couplets and ventricular tachycardia runs are even more frequent in patients suffering from heart failure. They may be due to left heart remodelling, overwork and ischaemia and can explain at least some sudden deaths occurring between midnight and 6 a.m. Sinus pauses and atrioventricular blocks are increased according to the severity of the disturbance and may be reduced by continuous positive airway pressure therapy, preventing pace-maker implantation. Finally, atrial fibrillation, resistance against antiarrhythmic drugs and recurrences after surgical procedures are strongly related to OSAH. CONCLUSION Arrhythmias are frequent in OSAH. Treatment of OSAH may reduce some of them. An implantable cardioverter-defibrillator and continuous positive airway pressure should be considered in some patients.
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Affiliation(s)
- Enrico Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Study of Brescia, Brescia, Italy
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Moubarak G, Bouzeman A, de Geyer d'Orth T, Bouleti C, Beuzelin C, Cazeau S. Variability in obstructive sleep apnea: Analysis of pacemaker-detected respiratory disturbances. Heart Rhythm 2016; 14:359-364. [PMID: 27890735 DOI: 10.1016/j.hrthm.2016.11.033] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with several cardiovascular conditions. Some pacemakers feature specific algorithms detecting respiratory cycles and deriving indices well correlated with the identification of polysomnography-confirmed severe OSA. OBJECTIVES The purposes of this study were to analyze respiratory disturbances measured by a validated algorithm in clinical practice and to describe their variability over time and their association with atrial fibrillation. METHODS Fifty-eight patients implanted with dual-chamber LivaNova REPLY 200 DR or KORA 100 DR pacemakers measuring a respiratory disturbance index (RDI) were included. An RDI >20 events per hour of sleep is well correlated with severe OSA as determined by polysomnography. Patients with >10% nights with invalid RDI measurements were excluded. RESULTS The RDI could be measured during 98% of nights. During a mean follow-up of 187 ± 123 days, the individual mean RDI was 19.9 ± 12.7 and was superior to 20 in 24 patients (41%). An RDI >20 events/h in at least 1 night was observed in 52 patients (90%). The mean day-to-day RDI variability in individual patients was 19% ± 21%. Patients with the highest burden of severe OSA (as defined by ≥75% of nights with RDI >20 events/h) were older, had a higher prevalence of hypertension, and were more often implanted for atrioventricular block than patients with lower burden of severe OSA. No RDI burden or cutoff was a predictor of atrial fibrillation occurrence. CONCLUSION OSA is frequent in patients with a pacemaker and is reliably detected by pacemakers. OSA is highly variable and could probably be best analyzed in terms of burden.
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Affiliation(s)
- Ghassan Moubarak
- Department of Electrophysiology and Pacing, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - Abdeslam Bouzeman
- Department of Electrophysiology and Pacing, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | | | - Claire Bouleti
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Christine Beuzelin
- Department of Pulmonary Medicine, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Serge Cazeau
- Department of Electrophysiology and Pacing, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Patel N, Donahue C, Shenoy A, Patel A, El-Sherif N. Obstructive sleep apnea and arrhythmia: A systemic review. Int J Cardiol 2016; 228:967-970. [PMID: 27914359 DOI: 10.1016/j.ijcard.2016.11.137] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
There is a growing consensus in the scientific community that suggests a strong association between obstructive sleep apnea (OSA) and cardiovascular (CVD) conditions and events, including coronary artery disease, hypertension, arrhythmia, heart failure, and sudden cardiac death. We reviewed evidence on the relationship between OSA and arrhythmia. Our conclusion, based on our review of the literature, is that the evidence supports a strong link between OSA and cardiovascular mortality, which warrants treating OSA. Continuous positive airway pressure (CPAP) appears to reduce the CVD consequences of OSA. Future research is expected to clarify the benefits and optimal application of these treatment approaches.
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Affiliation(s)
- Nirav Patel
- Department of Medicine, SUNY Downstate, Brooklyn, NY, United States; Department of Cardiology, Brooklyn VA Center, Brooklyn, NY, United States; The Henry Low Heart Center, Hartford Hospital, Connecticut, United States.
| | | | - Abhishek Shenoy
- Department of Medicine, SUNY Downstate, Brooklyn, NY, United States
| | - Arpan Patel
- Windsor School of Medicine, St. Kitts, Saint Kitts and Nevis
| | - Nabil El-Sherif
- Department of Cardiology, Brooklyn VA Center, Brooklyn, NY, United States
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Netzer NC, Ancoli-Israel S, Bliwise DL, Fulda S, Roffe C, Almeida F, Onen H, Onen F, Raschke F, Martinez Garcia MA, Frohnhofen H. Principles of practice parameters for the treatment of sleep disordered breathing in the elderly and frail elderly: the consensus of the International Geriatric Sleep Medicine Task Force. Eur Respir J 2016; 48:992-1018. [DOI: 10.1183/13993003.01975-2015] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 05/03/2016] [Indexed: 12/11/2022]
Abstract
Sleep disordered breathing (SDB) is a leading cause of morbidity worldwide. Its prevalence increases with age. Due to the demographic changes in industrial societies, pulmonologists and sleep physicians are confronted with a rapidly growing number of elderly SDB patients. For many physicians, it remains unclear how current guidelines for SDB management apply to elderly and frail elderly patients. The goal of this consensus statement is to provide guidance based on published evidence for SDB treatment in this specific patient group.Clinicians and researchers with expertise in geriatric sleep medicine representing several countries were invited to participate in a task force. A literature search of PubMed from the past 12 years and a systematic review of evidence of studies deemed relevant was performed.Recommendations for treatment management of elderly and frail elderly SDB patients based on published evidence were formulatedviadiscussion and consensus.In the last 12 years, there have been surprisingly few studies examining treatment of SDB in older adults and even fewer in frail older adults. Studies that have been conducted on the management of SDB in the older patient population were rarely stratified for age. Studies in SDB treatment that did include age stratification mainly focused on middle-aged and younger patient groups. Based on the evidence that is available, this consensus statement highlights the treatment forms that can be recommended for elderly SDB patients and encourages treatment of SDB in this large patient group.
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Khalyfa A, Gileles-Hillel A, Gozal D. The Challenges of Precision Medicine in Obstructive Sleep Apnea. Sleep Med Clin 2016; 11:213-26. [DOI: 10.1016/j.jsmc.2016.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Anastasopoulos DL, Chalkias A, Iakovidou N, Xanthos T. Effect of cardiac pacing on sleep-related breathing disorders: a systematic review. Heart Fail Rev 2016; 21:579-90. [PMID: 27112558 DOI: 10.1007/s10741-016-9558-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep-related breathing disorders are commonly encountered in the middle-aged population, negatively affecting quality of life. Central sleep apnea is associated with congestive heart failure, whereas obstructive sleep apnea is related to different pathophysiologic mechanisms, such as the total or partial occlusion of upper airway tract. Both sleep-related disorders have been associated with increased morbidity, and hence, they have been a target of several treatment strategies. The aim of this systematic review is to evaluate the effect of different types of cardiac pacing on sleep-related breathing disorders in patients with or without heart failure. The PubMed and Cochrane Central Register of Controlled Trials were examined from April 2015 to January 2016. Of the initial 360 studies, 22 eligible trials were analyzed. The included studies were classified according to the type of sleep disorder and the intervention undertaken. The evidence shows that cardiac resynchronization therapy but not atrial overdrive pacing can reduce apneic events in central sleep apnea patients. However, their effect on obstructive sleep apnea is controversial. It can be assumed that pacing cannot be used alone as treatment of sleep-related breathing disorders. Further research is needed in order to elucidate the effect of these interventions in sleep apnea patients.
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Affiliation(s)
- Dimitrios L Anastasopoulos
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece.
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece.
| | - Athanasios Chalkias
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
| | - Nicoletta Iakovidou
- National and Kapodistrian University of Athens, Medical School, MSc "Cardiopulmonary Resuscitation", Athens, Greece
- Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece
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13
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Wu X, Liu Z, Chang SC, Fu C, Li W, Jiang H, Jiang L, Li S. Screening and managing obstructive sleep apnoea in nocturnal heart block patients: an observational study. Respir Res 2016; 17:16. [PMID: 26879052 PMCID: PMC4754929 DOI: 10.1186/s12931-016-0333-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 02/09/2016] [Indexed: 11/22/2022] Open
Abstract
Background Nocturnal heart block often occurs in patients with obstructive sleep apnoea (OSA). It is more likely to be undiagnosed in heart block patients who are ignorant of the symptoms of sleep disorder. Berlin Questionnaire (BQ) is a highly reliable way to discover the risk factors of OSA, whereas the validity in sleep-related heart block patients is uncertain. We performed an observational study to address these issues and confirmed the potential protective effect of continuous positive airway pressure (CPAP). Methods Patients who were previously diagnosed with nocturnal heart block with R-R pauses exceeding 2 seconds were retrospective screened from the ECG centre of Zhongshan hospital. These recruited participants completed Berlin Questionnaire and underwent polysomnography synchronously with 24-hour Holter monitoring. A cross-sectional analysis was performed to confirm the association between nocturnal arrhythmia and OSA, as well as to assess the diagnostic accuracy of the BQ. Subsequently, subjects diagnosed with OSA (apnoea-hypopnoea index > 5) underwent 3 consecutive days of CPAP therapy. On the third day, patients repeated 24-hour Holter monitoring within the institution of CPAP. Results The symptoms of disruptive snoring and hypersomnolence in 72 enrolled patients were more related to the occurrence of nocturnal heart block (r = 0.306, 0.226, respectively, p = 0.015, 0.019) than syncope (r = 0.134, p = 0.282) and palpitations (r = 0.106, p = 0.119), which were prominent trait of our study population. The sensitivity, specificity, positive and negative predictive value of the BQ at a cut-off point of 5 of AHI for detecting OSA in heart block patients was 81.0 %, 44.4 %, 91.07 % and 25 %. Nocturnal heart block does not appear to occur exclusively in severe sleep apnoea. The frequent occurrence of arrhythmias in prominent oxygen desaturation supports the correlation between them. CPAP therapy resulted in significant decrease in the average number of episodes of heart block, from 148.58 ± 379.44 to 16.07 ± 58.52 (p < 0.05), same to the change of the longest RR pausing time (from 4.38 ± 2.95 s to 0.57 ± 1.05 s, p = 0.169) in 51 patients. The optimal therapy pressure to make the observed arrhythmia disappeared is 12 cm H2O. Conclusion Concerning high prevalence of OSA in heart block patients, BQ provided an economical and efficient screening method for OSA. For better management, CPAP therapy is feasible to prevent heart blocks avoiding unnecessary concomitant pacemaker implantation. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0333-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xu Wu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Zilong Liu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Su Chi Chang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Cuiping Fu
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Wenjing Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Hong Jiang
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Liyan Jiang
- Department of Respiratory Medicine, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, 200032, China.
| | - Shanqun Li
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China. .,Clinical Center for Sleep Breathing Disorder and Snoring, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Stopford E, Ravi K, Nayar V. The association of sleep disordered breathing with heart failure and other cardiovascular conditions. Cardiol Res Pract 2013; 2013:356280. [PMID: 24455403 PMCID: PMC3877588 DOI: 10.1155/2013/356280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 10/07/2013] [Accepted: 10/30/2013] [Indexed: 11/26/2022] Open
Abstract
An abundance of evidence exists in support of primary and secondary prevention for tackling the scourge of cardiovascular disease. Despite our wealth of knowledge, certain deficiencies still remain. One such example is the association between sleep disordered breathing (SDB) and cardiovascular disease. A clear body of evidence exists to link these two disease entities (independent of other factors such as obesity and smoking), yet our awareness of this association and its clinical implication does not match that of other established cardiovascular risk factors. Here, we outline the available evidence linking SDB and cardiovascular disease as well as discussing the potential consequences and management in the cardiovascular disease population.
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Affiliation(s)
- Elizabeth Stopford
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
| | - Karthik Ravi
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
| | - Vikrant Nayar
- Department of Cardiology, Pinderfields Hospital, Gate 47, Aberford Road, Wakefield WF1 4DG, UK
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Dimitriadis Z, Wiemer M, Scholtz W, Faber L, Piper C, Bitter T, Messaritakis I, Bullert K, Boergermann J, Kleikamp G, Prinz C, Horstkotte D, Oldenburg O. Sleep-disordered breathing in patients undergoing transfemoral aortic valve implantation for severe aortic stenosis. Clin Res Cardiol 2013; 102:895-903. [PMID: 23963651 DOI: 10.1007/s00392-013-0603-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 07/17/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND We examined the prevalence of sleep-disordered breathing (SDB) in patients with severe aortic valve stenosis (AS) and the impact of transfemoral aortic valve implantation (TAVI) on SDB. METHODS 79 patients underwent cardiorespiratory polygraphy (PG) before TAVI (CoreValve™), 62 of them a second PG after the procedure. RESULTS Forty-nine (62 %) patients had obstructive sleep apnea (OSA), 25 (32 %) central sleep apnea (CSA), and 5 (6 %) presented without significant SDB (apnea-hypopnea index (AHI) < 5/h). Among the 62 patients evaluated before and after TAVI, 36 (58 %) had OSA, 22 (36 %) CSA, and 4 patients (7 %) no SDB. AHI was significantly higher in CSA patients than in OSA patients (34.5 ± 18.3 vs. 18.0 ± 12.6/h, p < 0.001). Successful TAVI had a significant impact on CSA but not on OSA: CSA patients with optimal TAVI results experienced a significant reduction in central respiratory events (AHI 39.6 ± 19.6-23.1 ± 16.0/h, p = 0.035), while no changes were detected in OSA patients (AHI 18.8 ± 13.0-20.25 ± 13.4/h, p = 0.376). In contrast, in patients who developed at least moderate periprosthetic aortic regurgitation (AR > I), CSA increased significantly (AHI 26.3 ± 13.2-39.2 ± 18.4/h, p = 0.036), whereas no acute change was seen in patients with OSA (AHI 10.5 ± 7.8-12.5 ± 5.0/h, p = 0.5). CONCLUSION OSA and CSA are prevalent in more than 90 % of patients undergoing TAVI for severe aortic valve stenosis. Successful TAVI had no significant impact on OSA but improved CSA. In case of an acute change from pressure overload (aortic stenosis) to acute volume overload (aortic regurgitation after TAVI), central, but not obstructive, sleep apnea deteriorated.
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Affiliation(s)
- Zisis Dimitriadis
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany,
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Pataka A, Riha RL. Continuous Positive Airway Pressure and Cardiovascular Events in Patients with Obstructive Sleep Apnea. Curr Cardiol Rep 2013; 15:385. [DOI: 10.1007/s11886-013-0385-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Tracy CM, Epstein AE, Darbar D, DiMarco JP, Dunbar SB, Estes NAM, Ferguson TB, Hammill SC, Karasik PE, Link MS, Marine JE, Schoenfeld MH, Shanker AJ, Silka MJ, Stevenson LW, Stevenson WG, Varosy PD. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2012; 61:e6-75. [PMID: 23265327 DOI: 10.1016/j.jacc.2012.11.007] [Citation(s) in RCA: 560] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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19
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO. 2012 ACCF/AHA/HRS focused update incorporated into the ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation 2012; 127:e283-352. [PMID: 23255456 DOI: 10.1161/cir.0b013e318276ce9b] [Citation(s) in RCA: 378] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sahadevan J, Srinivasan D. Treatment of obstructive sleep apnea in patients with cardiac arrhythmias. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:520-8. [PMID: 22923098 DOI: 10.1007/s11936-012-0201-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OPINION STATEMENT Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing that is prevalent in the population and frequently under diagnosed. Usually presenting with respiratory symptoms, the most significant consequences of OSA are cardiovascular, including arrhythmias. The pathophysiology of OSA through multiple mechanisms may promote bradyarrhythmias, atrial fibrillation, premature ventricular complexes, ventricular arrhythmias, and sudden death. These mechanisms may acutely trigger nocturnal arrhythmias and may chronically affect electrical and structural myocardial changes, causing arrhythmias. Numerous epidemiological data have identified an increased risk for atrial fibrillation, ventricular fibrillation and sudden death in subjects with OSA. Diagnosis of OSA should be considered in patients with arrhythmias. However, not all patients with arrhythmias need to undergo formal testing for sleep apnea. Patients who are observed to have nocturnal arrhythmias should be considered for evaluation for possible OSA. Also, if the arrhythmia is refractory to standard therapy and if other clinical indicators of OSA are also present, there should be a low threshold for pursuing the diagnosis of sleep apnea. The principal therapy for OSA is continuous positive airway pressure (CPAP). Currently, there are limited data to support the efficacy of CPAP for arrhythmia prevention or treatment. Randomized trials are necessary to determine the efficacy of OSA treatment on arrhythmia prevention.
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Affiliation(s)
- Jayakumar Sahadevan
- Louis Stokes Cleveland VA Medical Center, 10701 East Blvd, Cleveland, OH, USA,
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Bordier P, Maurice-Tison S, Ramana NK. Overdrive ventricular pacing in pacemaker recipients with permanent atrial fibrillation and sleep apnea. J Clin Sleep Med 2012; 8:257-64. [PMID: 22701382 DOI: 10.5664/jcsm.1908] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
STUDY OBJECTIVES Cardiac pacing is ineffective in obstructive sleep apnea (SA), but it can alleviate central SA/Cheyne-Stokes respiration (CSA) in patients with heart failure (HF). We examined whether overnight overdrive ventricular pacing (OVP) has an effect on SA in pacemaker recipients with permanent atrial fibrillation (AF). METHODS An apnea-hypopnea index (AHI) ≥ 15 was confirmed in 28/38 patients screened by finger pulse oximetry during overnight ventricular pacing at a backup rate of 40 bpm (BUV40). These patients (23 men, 77.9 ± 7.6 y, BMI 27.6 ± 5.1 kg/m(2)) were randomly assigned to 2 consecutive nocturnal ventilation polygraphies with BUV40 versus OVP at 20 bpm above the mean nocturnal heart rate observed during screening. RESULTS During BUV40 versus OVP, (1) mean heart rate was 49 ± 8 versus 71 ± 8 bpm (p < 0.0001) and percent ventricular pacing 36% ± 38% versus 96% ± 6% (p < 0.0001); (2) AHI was 35.4 ± 11.9 versus 32.5 ± 15.5 (p = ns), central AHI 23.9 ± 11.8 versus 19.1 ± 12.7 (p < 0.001), and obstructive AHI 11.6 ± 13.1 versus 13.5 ± 15.9 (p = ns). In 15/28 patients without HF, mean left ventricular ejection fraction (LVEF) was 51% ± 17%, AHI was 37.6 ± 11.0 during BUV40 and 39.0 ± 11.5 during OVP, versus 32.8 ± 12.9 and 24.9 ± 16.5 in 13/28 patients with HF (p = 0.02) and mean LVEF 35% ± 15% (p = 0.01). Between the 2 subgroups, (1) central AHI was 23.6 ± 12.4 during BUV40 and 21.5 ± 14.0 during OVP versus 24.1 ± 11.6 and 16.2 ± 10.7 (p = 0.05); (2) obstructive AHI was 14.0 ± 13.7 during BUV40 and 17.6 ± 16.5 during OVP versus 8.8 ± 12.3 and 8.7 ± 14.3 (p = ns). CONCLUSIONS The prevalence of SA, predominantly central, was high in our pacemaker recipients with permanent AF. In those with HF, a single overnight OVP resulted in modest improvement in central events.
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Abstract
Sleep-disordered breathing (SDB), which includes obstructive sleep apnea (OSA) as its most extreme variant, is characterized by intermittent episodes of partial or complete obstruction of the upper airway, leading to cessation of breathing while asleep. Cardiac arrhythmias are common problems in OSA patients, although the true prevalence and clinical relevance of cardiac arrhythmias remains to be determined. The presence and complexity of tachyarrhythmias and bradyarrhythmias may influence morbidity, mortality and quality of life for patients with OSA. Although the exact mechanisms underlying the link between OSA and cardiac arrhythmias are not well established, they could be some of the same proposed mechanisms relating OSA to different cardiovascular diseases, such as repetitive pharyngeal collapse during sleep, which leads to markedly reduced or absent airflow, followed by oxyhemoglobin desaturation, persistent inspiratory efforts against an occluded airway and termination by arousal from sleep. These mechanisms elicit a variety of autonomic, hemodynamic, humoral and neuroendocrine responses that evoke acute and chronic changes in cardiovascular function. However, despite substantial research effort, the goals of determining in advance which patients will respond most favorably to certain treatment options (such as continuous positive airway pressure, tracheostomy or cardioversion) and the developing alternative treatments remain largely elusive. Therefore, this literature review aims to summarize a broad array of the pathophysiological mechanisms underlying the relationship between OSA and cardiac arrhythmias and the extent of this association from an epidemiological perspective, thereby attempting to assess the effects of OSA treatment on the presence of cardiac arrhythmias.
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Affiliation(s)
- Ahmad Salah Hersi
- King Fahad Cardiac Centre, College of Medicine, King Saud University, Riyadh 11472, Saudi Arabia.
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Shalaby A, Atwood CW, Selzer F, Suffoletto M, Gorcsan Iii J, Strollo P. Cardiac Resynchronization Therapy and Obstructive Sleep-Related Breathing Disorder in Patients with Congestive Heart Failure. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:593-603. [PMID: 21609340 DOI: 10.1111/j.1540-8159.2010.03015.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alaa Shalaby
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
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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.
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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
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Bhatia P, Abdelaziz MM, Katira R. Sleep-disordered breathing and heart failure. Br J Hosp Med (Lond) 2010; 70:704-7. [PMID: 20081616 DOI: 10.12968/hmed.2009.70.12.45507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sleep-disordered breathing is a spectrum of disorders. As our knowledge of sleep medicine is improving, the strong association of sleep-disordered breathing with cardiac disorders is being recognized. This article discusses the association of sleep-disordered breathing and heart failure.
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Therapie der Cheyne-Stokes-Atmung bei Herzinsuffizienz. SOMNOLOGIE 2009. [DOI: 10.1007/s11818-009-0443-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bordier P. Sleep apnoea in patients with heart failure: Part II: Therapy. Arch Cardiovasc Dis 2009; 102:711-20. [DOI: 10.1016/j.acvd.2009.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 06/17/2009] [Accepted: 06/18/2009] [Indexed: 11/24/2022]
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Baranchuk A, Healey JS, Simpson CS, Redfearn DP, Morillo CA, Connolly SJ, Fitzpatrick M. Atrial overdrive pacing in sleep apnoea: a meta-analysis. Europace 2009; 11:1037-40. [DOI: 10.1093/europace/eup165] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sinha AM, Bauer A, Skobel EC, Markus KU, Ritscher G, Noelker G, Breithardt OA, Brachmann J, Stellbrink C. Long-term effects of dynamic atrial overdrive pacing on sleep-related breathing disorders in pacemaker or cardioverter defibrillator recipients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32 Suppl 1:S219-22. [PMID: 19250100 DOI: 10.1111/j.1540-8159.2008.02289.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Sleep-related breathing disorders occur in 20-30% of Europeans and North Americans, including 10% of sleep apnea syndrome (SAS). A preliminary study suggested that atrial overdrive pacing with a fixed heart rate might alleviate SAS. However, it is not known whether dynamic atrial overdrive pacing alleviates SAS. METHODS Patients with indications for a dual chamber pacemaker or implantable cardioverter-defibrillator (ICD) were screened for SAS using the Pittsburgh Sleep Quality Index (PSQI) questionnaire. If PSQI was >5, cardio-respiratory polygraphy was performed before and 4 and 7 months after device implantation. Patients were randomized to algorithm ON-OFF (group A) or OFF-ON (group B) and the apnea-hypopnea index (AHI) was measured. RESULTS Out of 105 consecutive patients, 46 (44%) had a positive PSQI. This analysis included 12 patients (mean age = 61 +/- 10 years, body mass index 28.9 +/- 6.5 kg/m(2), left ventricular ejection fraction = 38.3 +/- 13.6%; 10 men). All patients suffered from obstructive or mixed SAS. There were no significant differences in PSQI or AHI between baseline and follow-up or between the two study groups. Therefore, the study was terminated ahead of schedule. CONCLUSIONS The prevalence of obstructive or mixed SAS was high in pacemaker or ICD recipients and reduced left ventricular ejection fraction. In these patients, long-term dynamic atrial overdrive pacing using did not improve PSQI or SAS. Therefore, patients with relevant obstructive or mixed SAS should not be offered atrial pacing therapy.
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Giquello JA, Jeanneteau J, Treguer F, Soltner C, Granry JC. [Night cardiac rhythm and conduction disturbances revealing obstructive sleep apnoea syndrome]. Ann Cardiol Angeiol (Paris) 2009; 58:113-116. [PMID: 18579113 DOI: 10.1016/j.ancard.2008.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Accepted: 05/05/2008] [Indexed: 05/26/2023]
Abstract
There is a strong prevalence of sleep apnoea syndrome in general population. Cardiac arrhythmia and conduction disturbances during sleep may complicate this syndrome. We report the case of a 73-year-old patient to whom the sleep apnoea syndrome was diagnosed after varied heart blocks during the sleep. A treatment by continuous positive airway pressure (CPAP) permitted to correct these conduction disturbances and to avoid pacemaker implantation.
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Affiliation(s)
- J-A Giquello
- Service d'anesthésie-réanimation, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
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Lüthje L, Renner B, Kessels R, Vollmann D, Raupach T, Gerritse B, Tasci S, Schwab JO, Zabel M, Zenker D, Schott P, Hasenfuss G, Unterberg-Buchwald C, Andreas S. Cardiac resynchronization therapy and atrial overdrive pacing for the treatment of central sleep apnoea. Eur J Heart Fail 2009; 11:273-80. [PMID: 19147446 PMCID: PMC2645047 DOI: 10.1093/eurjhf/hfn042] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2008] [Revised: 11/09/2008] [Accepted: 11/20/2008] [Indexed: 01/08/2023] Open
Abstract
AIMS The combined therapeutic impact of atrial overdrive pacing (AOP) and cardiac resynchronization therapy (CRT) on central sleep apnoea (CSA) in chronic heart failure (CHF) so far has not been investigated. We aimed to evaluate the effect of CRT alone and CRT + AOP on CSA in CHF patients and to compare the influence of CRT on CHF between CSA positive and CSA negative patients. METHODS AND RESULTS Thirty patients with CRT indication underwent full night polysomnography, echocardiography, exercise testing, and neurohumoral evaluation before and 3 months after CRT implantation. In CSA positive patients (60%), two additional sleep studies were conducted after 3 months of CRT, with CRT alone or CRT + AOP, in random order. Cardiac resynchronization therapy resulted in significant improvements of NYHA class, left ventricular ejection fraction, N-terminal pro-brain natriuretic peptide, VO(2)max, and quality of life irrespective of the presence of CSA. Cardiac resynchronization therapy also reduced the central apnoea-hypopnoea index (AHI) (33.6 +/- 14.3 vs. 23.8 +/- 16.9 h(-1); P < 0.01) and central apnoea index (17.3 +/- 14.1 vs. 10.9 +/- 13.9 h(-1); P < 0.01) without altering sleep stages. Cardiac resynchronization therapy with atrial overdrive pacing resulted in a small but significant additional decrease of the central AHI (23.8 +/- 16.9 vs. 21.5 +/- 16.9 h(-1); P < 0.01). CONCLUSION In this study, CRT significantly improved CSA without altering sleep stages. Cardiac resynchronization therapy with atrial overdrive pacing resulted in a significant but minor additional improvement of CSA. Positive effects of CRT were irrespective of the presence of CSA.
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Affiliation(s)
- Lars Lüthje
- Kardiologie und Pneumologie, Georg-August-Universität, Göttingen, Germany.
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Abstract
This paper focuses on the underlying mechanisms contributing to sleep-disordered breathing. Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is characterized by repetitive narrowing or collapse of the pharyngeal airway during sleep. Conversely, central sleep apnea (CSA), highly prevalent in congestive heart failure, is distinguished by a lack of drive to breathe during sleep, resulting in repetitive periods of insufficient ventilation. Both lead to compromised gas exchange, impaired sleep continuity, and catecholamine surges and are associated with major comorbidities including excessive daytime sleepiness and increased risk of cardiovascular disease. Although OSA and CSA exist on a spectrum of sleep-disordered breathing, the 2 entities may overlap in their underlying pathophysiologies. This brief review summarizes the etiology and current understanding of OSA and CSA pathophysiology and the role that the cardiovascular system may play in contributing to disease pathology and highlights the likely substantial overlap that exists between the various forms of sleep-disordered breathing.
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Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T. Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing. J Am Coll Cardiol 2008; 52:686-717. [PMID: 18702977 DOI: 10.1016/j.jacc.2008.05.002] [Citation(s) in RCA: 600] [Impact Index Per Article: 37.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
MESH Headings
- Adult
- Arrhythmias, Cardiac/epidemiology
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/physiopathology
- Child
- Comorbidity
- Continuous Positive Airway Pressure
- Death, Sudden, Cardiac
- Disease Progression
- Endothelium, Vascular/physiopathology
- Heart Failure/epidemiology
- Heart Rate/physiology
- Humans
- Hypertension/physiopathology
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/physiopathology
- Hypertrophy, Left Ventricular/epidemiology
- Hypoxia/physiopathology
- Insulin Resistance/physiology
- Kidney Failure, Chronic/epidemiology
- Kidney Failure, Chronic/physiopathology
- Myocardial Ischemia/epidemiology
- Myocardial Ischemia/physiopathology
- Obesity/epidemiology
- Oxidative Stress/physiology
- Polysomnography
- Sleep Apnea, Central/diagnosis
- Sleep Apnea, Central/epidemiology
- Sleep Apnea, Central/physiopathology
- Sleep Apnea, Obstructive/diagnosis
- Sleep Apnea, Obstructive/epidemiology
- Sleep Apnea, Obstructive/physiopathology
- Sleep Apnea, Obstructive/therapy
- Stroke/epidemiology
- Sympathetic Nervous System/physiopathology
- Ventricular Dysfunction, Left/epidemiology
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Haan F. Was ist ambulant möglich – was ist stationär nötig? Herz 2008; 33:393-4. [DOI: 10.1007/s00059-008-3168-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Somers VK, White DP, Amin R, Abraham WT, Costa F, Culebras A, Daniels S, Floras JS, Hunt CE, Olson LJ, Pickering TG, Russell R, Woo M, Young T. Sleep apnea and cardiovascular disease: an American Heart Association/american College Of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council On Cardiovascular Nursing. In collaboration with the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health). Circulation 2008. [PMID: 18725495 DOI: 10.1161/circulationaha.107.189420] [Citation(s) in RCA: 801] [Impact Index Per Article: 50.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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37
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Treatment of sleep disordered breathing in congestive heart failure. Heart Fail Rev 2008; 14:195-203. [PMID: 18618242 DOI: 10.1007/s10741-008-9099-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 06/18/2008] [Indexed: 10/21/2022]
Abstract
In patients with congestive heart failure, sleep disordered breathing occurs commonly and is associated with an increased mortality. In addition to central sleep apnea (Cheyne-Stokes respiration), obstructive sleep apnea is more prevalent in patients with congestive heart failure than in the general population. As a result, a number of treatments have been investigated, with varying results. While many therapies may improve the severity of sleep disordered breathing, only positive pressure ventilation has been shown to improve cardiac function. Newer forms of positive pressure ventilation, such as adaptive servo-ventilation, appear to be even more effective at correcting central sleep apnea. Whether any of these treatments have an effect on transplant-free survival is presently unknown and awaits further study.
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Kara T, Novak M, Nykodym J, Bybee KA, Meluzin J, Orban M, Novakova Z, Lipoldova J, Hayes DL, Soucek M, Vitovec J, Somers VK. Short-term Effects of Cardiac Resynchronization Therapy on Sleep-Disordered Breathing in Patients With Systolic Heart Failure. Chest 2008; 134:87-93. [DOI: 10.1378/chest.07-2832] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 51:e1-62. [PMID: 18498951 DOI: 10.1016/j.jacc.2008.02.032] [Citation(s) in RCA: 1098] [Impact Index Per Article: 68.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
PURPOSE OF REVIEW As heart failure continues to carry significant morbidity and mortality it is crucial to pursue new lines of therapy. Addressing sleep apnea, which is highly prevalent in these patients, offers just such an avenue. We discuss how sleep apnea may contribute to the propagation of heart failure, and how understanding its effects and reversing these effects might benefit heart failure patients. RECENT FINDINGS Continuous positive airway pressure ventilation, atrial pacing, and chronic resynchronization therapy have all been studied in sleep apnea. Some of these therapies have shown benefits in heart failure. This offers hope for improved outcomes, particularly with respect to mortality. Delineating how these therapies affect the heart's energetics and metabolism may also provide further understanding of the relationship between sleep apnea and heart failure. SUMMARY As both obstructive and central sleep apnea are highly prevalent in heart failure, treating these patients with continuous positive airway pressure, atrial pacing, or chronic resynchronization therapy may offer morbidity and mortality benefits. Much remains to be understood about the relationship between sleep apnea and heart failure, and understanding the interaction between the two at both the myocardial and clinical level is crucial.
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Affiliation(s)
- Anjali H Anselm
- University of Ottawa Heart Institute, Division of Cardiology, Ottawa, Ontario, Canada
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41
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ACC/AHA/HRS 2008 Guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm 2008; 5:e1-62. [PMID: 18534360 DOI: 10.1016/j.hrthm.2008.04.014] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Indexed: 01/27/2023]
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42
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Epstein AE, DiMarco JP, Ellenbogen KA, Estes NAM, Freedman RA, Gettes LS, Gillinov AM, Gregoratos G, Hammill SC, Hayes DL, Hlatky MA, Newby LK, Page RL, Schoenfeld MH, Silka MJ, Stevenson LW, Sweeney MO, Smith SC, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Faxon DP, Halperin JL, Hiratzka LF, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura RA, Ornato JP, Page RL, Riegel B, Tarkington LG, Yancy CW. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350-408. [PMID: 18483207 DOI: 10.1161/circualtionaha.108.189742] [Citation(s) in RCA: 935] [Impact Index Per Article: 58.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
One of the most common yet unidentified conditions in heart disease is sleep-disordered breathing (SDB). Although it is most prevalent in patients with heart failure, it has been epidemiologically and pathophysiologically linked to ischemic heart disease, hypertension, sudden cardiac death, atrial fibrillation, and stroke. There are two primary SDB syndromes: obstructive sleep apnea (OSA) and central sleep apnea (CSA; also known as Cheyne-Stokes respiration). The pathophysiologic mechanisms that underlie these disorders appear to be distinct but both involve recurrent cycles of excessive sympathetic activation, hypoxemias and hypercapnias, and increases in ventricular wall stress. Signs and symptoms may include daytime somnolence, snoring, difficult-to-control hypertension, and refractory arrhythmias or angina. In heart failure, half of patients will have SDB and most patients will exhibit evidence of both OSA and CSA, although one or the other may predominate. The current standard diagnostic method is overnight laboratory polysomnography. Primary therapies for OSA include lifestyle changes, various facial and oral appliances, head and neck surgery, and continuous positive airway pressure (CPAP). CPAP is the most effective form of therapy for OSA, with few side effects, but is limited by compliance because of comfort-related issues. In patients with cardiovascular disease who predominantly suffer from OSA, treatment recommendations should be based on current guidelines for OSA. For patients with heart failure with predominant CSA, the current cornerstone of therapy is the optimization of medical therapy and resynchronization therapy when indicated. When SDB persists despite optimal medical management, referral to a sleep medicine consultant should be considered.
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Oldenburg O, Faber L, Vogt J, Dorszewski A, Szabados F, Horstkotte D, Lamp B. Influence of cardiac resynchronisation therapy on different types of sleep disordered breathing. Eur J Heart Fail 2007; 9:820-6. [PMID: 17467333 DOI: 10.1016/j.ejheart.2007.03.009] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2006] [Revised: 02/16/2007] [Accepted: 03/22/2007] [Indexed: 12/01/2022] Open
Abstract
AIMS This study investigates the influence of cardiac resynchronisation therapy (CRT) on sleep disordered breathing (SDB) in patients with severe heart failure (HF). METHODS AND RESULTS Seventy-seven patients with HF (19 females; 62.6+/-10 years) eligible for CRT were screened for presence, type, and severity of SDB before and after CRT initiation (5.3+/-3 months) using cardiorespiratory polygraphy. NYHA class, frequency of nycturia, cardiopulmonary exercise, 6-minute walking test results, and echocardiography parameters were obtained at baseline and follow-up. Central sleep apnoea (CSA) was documented in 36 (47%), obstructive sleep apnoea (OSA) in 26 (34%), and no SDB in 15 (19%) patients. CRT improved clinical and haemodynamic parameters. SDB parameters improved in CSA patients only (apnoea hypopnoea index: 31.2+/-15.5 to 17.3+/-13.7/h, p<0.001; SaO2min: 81.8+/-6.6 to 84.8+/-3.3%, p=0.02, desaturation: 6.5+/-2.3 to 5.5+/-0.8%, p=0.004). Daytime capillary pCO2 was significantly lower in CSA patients compared to those without SDB with a trend towards increase with CRT (35.5+/-4.2 to 37.9+/-5.7 mm Hg, ns). After classifying short term clinical and haemodynamic CRT effects, improved SDB parameters in CSA occurred in responders only. CONCLUSIONS In patients with severe HF eligible for CRT, CSA is common and can be influenced by CRT, this improvement depends on good clinical and haemodynamic response to CRT.
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Affiliation(s)
- Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany.
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Stanchina ML, Ellison K, Malhotra A, Anderson M, Kirk M, Benser ME, Tosi C, Carlisle C, Millman RP, Buxton A. The impact of cardiac resynchronization therapy on obstructive sleep apnea in heart failure patients: a pilot study. Chest 2007; 132:433-9. [PMID: 17573498 PMCID: PMC2287194 DOI: 10.1378/chest.06-2509] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) has been shown to improve cardiac function and reduce Cheyne-Stokes respiration but has not been evaluated in patients with obstructive sleep apnea (OSA). In this pilot study, we investigated the impact of both CRT and CRT plus increased rate pacing in heart failure (ie, congestive heart failure [CHF]) patients with OSA. We hypothesized that through increased cardiac output CRT/pacing would reduce obstructive events and daytime symptoms of sleepiness. METHODS Full polysomnograms were performed on CHF patients who were scheduled for CRT, and those patients with an apnea-hypopnea index (AHI) of > 5 events per hour were approached about study enrollment. Patients had a pre-CRT implant baseline echocardiogram and an echocardiogram a mean (+/- SEM) duration of 6.6 +/- 1.4 months post-CRT implant; polysomnography; and responded to the Minnesota Living with Heart Failure questionnaire, the Epworth sleepiness scale, and the Functional Outcomes of Sleep Questionnaire. An additional third polysomnography was performed combining CRT with a pacing rate of 15 beats/min above the baseline sleeping heart rate within 1 week of the second polysomnography. Assessments for the change in cardiac output during the polysomnography were performed using circulation time to pulse oximeter as a surrogate. RESULTS Twenty-four patients were screened, and 13 patients (mean age, 68.6 years; body mass index, 28.7 kg/m(2)) had evidence of OSA. The mean AHI decreased from 40.9 +/- 6.4 to 29.5 +/- 5.9 events per hour with CRT (p = 0.04). The mean baseline ejection fraction was 22 +/- 1.7% and increased post-CRT to 33.6 +/- 2.0% (p < 0.05). The reduction in AHI with CRT closely correlated with a decrease in circulation time (r = 0.89; p < 0.001) with CRT. Increased rate pacing made no additional impact on the AHI or circulation time. CRT had a limited impact on sleep architecture or daytime symptom scores. CONCLUSIONS CRT improved cardiac function and reduced the AHI. Reduced circulatory delay likely stabilized ventilatory control systems and may represent a new therapeutic target in OSA.
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Affiliation(s)
- Michael L Stanchina
- Pulmonary, Critical Care, and Sleep Medicine Division, Rhode Island Hospital, 1285 South County Trail, East Greenwich, RI 02818, USA.
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Abstract
Noninvasive positive-pressure ventilation (NPPV) is the delivery of mechanical-assisted breathing without placement of an artificial airway such as an endotracheal tube or tracheostomy. During the first half of 20th century, negative-pressure ventilation (iron lung) provided mechanical ventilatory assistance. By the 1960s, however, invasive (ie, by means of an endotracheal tube) positive-pressure ventilation superseded negative-pressure ventilation as the primarily mode of support for ICU patients because of its superior delivery of support and better airway protection. Over the past decade, the use of NPPV has been integrated into the treatment of many medical diseases, largely because the development of nasal ventilation. Nasal ventilation has the potential benefit of providing ventilatory assistance with greater convenience, comfort, safety, and less cost than invasive ventilation. NPPV is delivered by a tightly fitted mask or helmet that covers the nares, face, or head. NPPV is used in various clinical settings and is beneficial in many acute medical situations. This article explores the trends regarding the use of noninvasive ventilation. It also provides a current perspective on applications in patients with acute and chronic respiratory failure, neuromuscular disease, congestive heart failure, and sleep apnea. Additionally, it discusses the general guidelines for application, monitoring, and avoidance of complications for NPPV.
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Affiliation(s)
- Timothy J Barreiro
- Northeastern Ohio Universities College of Medicine, Rootstown, Ohio 44272, USA.
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Chiong JR, Aronow WS, Khan IA, Nair CK, Vijayaraghavan K, Dart RA, Behrenbeck TR, Geraci SA. Secondary hypertension: current diagnosis and treatment. Int J Cardiol 2007; 124:6-21. [PMID: 17462751 DOI: 10.1016/j.ijcard.2007.01.119] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
Secondary hypertension affects a small but significant number of the hypertensive population and, unlike primary hypertension, is a potentially curable condition. The determinant for workup is dependent on the index of suspicion elicited during patient examination and treatment. Specific testing is available and must be balanced depending on the risk and cost of the workup and treatment with the benefits obtained if the secondary cause is eliminated. This article reviews common manifestations, workup, and the current treatments of the common causes of secondary hypertension.
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Garrigue S, Pépin JL, Defaye P, Murgatroyd F, Poezevara Y, Clémenty J, Lévy P. High Prevalence of Sleep Apnea Syndrome in Patients With Long-Term Pacing. Circulation 2007; 115:1703-9. [PMID: 17353437 DOI: 10.1161/circulationaha.106.659706] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Cardiovascular diseases leading to pacemaker implantations are suspected of being associated with a high rate of undiagnosed sleep apnea syndrome (SAS). We sought to determine the prevalence and consequences of SAS in pacemaker patients according to pacing indications: heart failure, symptomatic diurnal bradycardia, and atrioventricular block.
Methods and Results—
Ninety-eight consecutive patients (mean age, 64±8 years) not known to have sleep apnea were included; 29 patients were paced for dilated cardiomyopathy (29%), 33 for high-degree atrioventricular block (34%), and 36 for sinus node disease (37%). All underwent Epworth Sleepiness Scale assessment and polysomnography with the pacemaker programmed to right ventricular DDI pacing mode (lower pacing rate, 50 pulses per minute). SAS was defined as an apnea-hypopnea index ≥10/h. Mean Epworth Sleepiness Scale was in the normal range (7±4), although 13 patients (25%) had an abnormal score >11/h. Fifty-seven patients (59%) had SAS; of these, 21 (21.4%) had a severe SAS (apnea-hypopnea index >30/h). In patients with heart failure, 50% presented with SAS (mean apnea-hypopnea index, 11±7) compared with 68% of patients with atrioventricular block (mean apnea-hypopnea index, 24±29) and 58% with sinus node disease (mean apnea-hypopnea index, 19±23).
Conclusions—
In paced patients, there is an excessively high prevalence of undiagnosed SAS (59%). Whether treating SAS would have changed the need for pacing is unknown. Treatment effects should be further evaluated particularly because these patients are less symptomatic than typical SAS patients. In any case, SAS should be systematically searched for in paced patients owing to potential detrimental effects on their cardiovascular evolution.
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Affiliation(s)
- Stéphane Garrigue
- Department of Cardiac Electrophysiology and Clinical Pacing Hôpital, University of Bordeaux and Grenoble, Grenoble, France
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50
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Eckert DJ, Jordan AS, Merchia P, Malhotra A. Central sleep apnea: Pathophysiology and treatment. Chest 2007; 131:595-607. [PMID: 17296668 PMCID: PMC2287191 DOI: 10.1378/chest.06.2287] [Citation(s) in RCA: 289] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Central sleep apnea (CSA) is characterized by a lack of drive to breathe during sleep, resulting in repetitive periods of insufficient ventilation and compromised gas exchange. These nighttime breathing disturbances can lead to important comorbidity and increased risk of adverse cardiovascular outcomes. There are several manifestations of CSA, including high altitude-induced periodic breathing, idiopathic CSA, narcotic-induced central apnea, obesity hypoventilation syndrome, and Cheyne-Stokes breathing. While unstable ventilatory control during sleep is the hallmark of CSA, the pathophysiology and the prevalence of the various forms of CSA vary greatly. This brief review summarizes the underlying physiology and modulating components influencing ventilatory control in CSA, describes the etiology of each of the various forms of CSA, and examines the key factors that may exacerbate apnea severity. The clinical implications of improved CSA pathophysiology knowledge and the potential for novel therapeutic treatment approaches are also discussed.
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Affiliation(s)
- Danny J Eckert
- Division of Sleep Medicine, Sleep Disorders Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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