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Jaspan VN, Greenberg GS, Parihar S, Park CM, Somers VK, Shapiro MD, Lavie CJ, Virani SS, Slipczuk L. The Role of Sleep in Cardiovascular Disease. Curr Atheroscler Rep 2024; 26:249-262. [PMID: 38795275 PMCID: PMC11192677 DOI: 10.1007/s11883-024-01207-5] [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] [Accepted: 05/01/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE OF REVIEW Sleep is an important component of cardiovascular (CV) health. This review summarizes the complex relationship between sleep and CV disease (CVD). Additionally, we describe the data supporting the treatment of sleep disturbances in preventing and treating CVD. RECENT FINDINGS Recent guidelines recommend screening for obstructive sleep apnea in patients with atrial fibrillation. New data continues to demonstrate the importance of sleep quality and duration for CV health. There is a complex bidirectional relationship between sleep health and CVD. Sleep disturbances have systemic effects that contribute to the development of CVD, including hypertension, coronary artery disease, heart failure, and arrhythmias. Additionally, CVD contributes to the development of sleep disturbances. However, more data are needed to support the role of screening for and treatment of sleep disorders for the prevention of CVD.
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Affiliation(s)
- Vita N Jaspan
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Garred S Greenberg
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Siddhant Parihar
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Christine M Park
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Virend K Somers
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Michael D Shapiro
- Center for Preventive Cardiology, Section On Cardiovascular Medicine, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Carl J Lavie
- Ochsner Clinical School, John Ochsner Heart and Vascular Institute, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Salim S Virani
- Office of the Vice Provost (Research), The Aga Khan University, Karachi, Pakistan
- Division of Cardiology, The Texas Heart Institute/Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Leandro Slipczuk
- Division of Cardiology, Montefiore Health System/Albert Einstein College of Medicine, Bronx, NY, USA.
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DiCaro MV, Lei K, Yee B, Tak T. The Effects of Obstructive Sleep Apnea on the Cardiovascular System: A Comprehensive Review. J Clin Med 2024; 13:3223. [PMID: 38892933 PMCID: PMC11172971 DOI: 10.3390/jcm13113223] [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: 05/04/2024] [Revised: 05/23/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Obstructive sleep apnea (OSA) is an increasingly relevant cause of cardiovascular morbidity worldwide. Although the association between OSA and the cardiovascular system is well-known, the extent of its effects is still a topic of interest, including pathophysiologic mechanisms, cardiovascular sequelae, and OSA therapies and their effects. Commonly described mechanisms of cardiovascular etiologies revolve around sympathetic activation, inflammation, and intermittent hypoxia resulting from OSA. Ultimately, these effects lead to manifestations in the cardiovascular system, such as arrhythmias, hypertension, and heart failure, among others. The resulting sequelae of OSA may also have differential effects based on gender and age; several studies suggest female gender to have more susceptibility to cardiovascular mortality, as well as an increase in age. Furthermore, several therapies for OSA, both established and emerging, show a reduction in cardiovascular morbidity and may even reduce cardiovascular burden. Namely, the establishment of CPAP has led to improvement in hypertension and cardiac function in patients with heart failure and even reduced the progression of early stages of atherosclerosis. Effective management of OSA decreases abnormal neural sympathetic activity, which results in better rhythm control and blood pressure control, both in waking and sleep cycles. With newer therapies for OSA, its effects on the cardiovascular system may be significantly reduced or even reversed after long-term management. The vast extent of OSA on the cardiovascular system, as well as current and future therapeutic strategies, will be described in detail in this review.
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Affiliation(s)
| | | | | | - Tahir Tak
- Department of Medicine, Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV 89102, USA; (M.V.D.); (K.L.); (B.Y.)
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Roldán Sevilla A, Díaz Cambriles T, Villena Garrido MV, Fontenla A, Santos Sanchez AI, Villagraz Tecedor L, Asensio Nogueira J, Huertas Nieto S, García Fernández FJ. Seasonal influence on sleep apnoea recorded daily by pacemakers. Sleep Breath 2023; 27:2181-2189. [PMID: 36973595 DOI: 10.1007/s11325-023-02789-1] [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: 10/16/2022] [Revised: 10/16/2022] [Accepted: 02/01/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE Obstructive sleep apnoea (OSA) and cardiac conduction disorders are pathologies with a rising prevalence due to increased life expectancy. Upper airway patency is affected by environmental factors that may be associated with seasonal periods. The ability to record the degree of nocturnal apnoea on a daily basis may provide a more accurate picture of seasonal variability. METHODS This study used an observational, cross-sectional design recruiting consecutive patients with Sorin/Livanova/Microport® pacemakers. The study assessed the seasonal influence on the daily degree of nocturnal apnoea over a minimum period of 180 days. The respiratory events were recorded using a pacemaker-integrated detection algorithm based on transthoracic impedance variation. A generalised linear repeated measure mixed model was used to study the seasonal effect. RESULTS A sample of 101 subjects with a mean of 227 valid nights was compiled. Summer was associated with higher RDI (respiratory disturbance index) values and winter with lower values. The mean daily RDI ratio in summer was 1.099 times higher than in winter. CONCLUSIONS Slight seasonal influences on the degree of nocturnal apnoea were detected through the daily observation of an unselected sample of pacemaker wearers. The degree of apnoea is higher in warmer months and lower in colder months.
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Affiliation(s)
- Alvaro Roldán Sevilla
- Cardiology Division, Internal Medicine Department, Santos Reyes Hospital, Avenida Ruperta Baraya S/N, Aranda de Duero, Burgos, Spain.
- Clinical Cardiology Unit, Cardiology Department, Burgos University Hospital, Burgos, Spain.
| | - Trinidad Díaz Cambriles
- Sleep Disorders Unit, Pneumology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - María Victoria Villena Garrido
- Sleep Disorders Unit, Pneumology Department, University Hospital 12 de Octubre, Madrid, Spain
- Department of Medicine, Complutense de Madrid University, Madrid, Spain
| | - Adolfo Fontenla
- Electrophysiology Unit and hemodynamics Unit, Cardiology Department, University Hospital Quirónsalud Madrid, Pozuelo de Alarcón, Spain
| | | | - Lola Villagraz Tecedor
- Electrophysiology Unit, Cardiology Department, Burgos University Hospital, Burgos, Spain
| | - Juan Asensio Nogueira
- Clinical Cardiology Unit, Cardiology Department, Burgos University Hospital, Burgos, Spain
| | - Sergio Huertas Nieto
- Electrophysiology Unit and hemodynamics Unit, Cardiology Department, University Hospital Quirónsalud Madrid, Pozuelo de Alarcón, Spain
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Champ-Rigot L, Cornille AL, Ferchaud V, Morello R, Pellissier A, Ollitrault P, Saloux E, Moirot P, Milliez P. Usefulness of sleep apnea monitoring by pacemaker sensor in elderly patients with diastolic dysfunction. Respir Med Res 2023; 84:101025. [PMID: 37734232 DOI: 10.1016/j.resmer.2023.101025] [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: 09/02/2022] [Revised: 04/21/2023] [Accepted: 05/06/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Automated detection of sleep apnea (SA) by pacemaker (PM) has been proposed and exhibited good agreement with polysomnography to detect severe SA. We aimed to evaluate the usefulness of SA monitoring algorithm in elderly patients with diastolic dysfunction. METHODS Consecutive patients referred to the Caen University Hospital for PM implantation between May 2016 and December 2018 presenting isolated diastolic dysfunction were eligible for the study. The respiratory disturbance index (RDI) measured by the PM, and the mean monthly RDI (RDIm), were compared to the apnea hypopnea index (AHI) assessed with portable monitor for severe SA diagnosis. RESULTS During the study period, 68 patients were recruited, aged of 80.4 ± 8.2 years. 63 patients underwent polygraphy with a portable monitor: 57 presented SA (83.8%), including 16 with severe SA (23.5%). Eight were treated with continuous positive airway pressure (CPAP). We found the RDI cutoff value of 22 events/h to predict severe SA, with 71.4% sensitivity and 65.2%, specificity. The RDIm cutoff value to detect severe SA was 19 events/h, with a sensitivity of 60% and a specificity of 66%. There was a significant reduction in RDI (p = 0.041), RDIm (p = 0.039) and AHI (p = 0.002) after CPAP. Supraventricular arrhythmias were frequent in all patients, regardless of SA severity, considering either episodes occurrence or total burden. CONCLUSION In a population of elderly patients with PM and diastolic dysfunction, the SA monitoring algorithm was able to detect severe SA, with good diagnostic performance values, but also to provide follow-up data for the patients treated with CPAP.
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Affiliation(s)
- Laure Champ-Rigot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France.
| | - Anne-Laure Cornille
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Virginie Ferchaud
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Rémy Morello
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Unité de biostatistique et recherche clinique, 14000 Caen, France
| | - Arnaud Pellissier
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Pierre Ollitrault
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Eric Saloux
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
| | - Pierre Moirot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Pneumologie, 14000 Caen, France
| | - Paul Milliez
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Cardiologie, 14000 Caen, France
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Mehra R, Chung MK, Olshansky B, Dobrev D, Jackson CL, Kundel V, Linz D, Redeker NS, Redline S, Sanders P, Somers VK. Sleep-Disordered Breathing and Cardiac Arrhythmias in Adults: Mechanistic Insights and Clinical Implications: A Scientific Statement From the American Heart Association. Circulation 2022; 146:e119-e136. [PMID: 35912643 PMCID: PMC10227720 DOI: 10.1161/cir.0000000000001082] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Sleep-disordered breathing (SDB), characterized by specific underlying physiological mechanisms, comprises obstructive and central pathophysiology, affects nearly 1 billion individuals worldwide, and is associated with excessive cardiopulmonary morbidity. Strong evidence implicates SDB in cardiac arrhythmogenesis. Immediate consequences of SDB include autonomic nervous system fluctuations, recurrent hypoxia, alterations in carbon dioxide/acid-base status, disrupted sleep architecture, and accompanying increases in negative intrathoracic pressures directly affecting cardiac function. Day-night patterning and circadian biology of SDB-induced pathophysiological sequelae collectively influence the structural and electrophysiological cardiac substrate, thereby creating an ideal milieu for arrhythmogenic propensity. Cohort studies support strong associations of SDB and cardiac arrhythmia, with evidence that discrete respiratory events trigger atrial and ventricular arrhythmic events. Observational studies suggest that SDB treatment reduces atrial fibrillation recurrence after rhythm control interventions. However, high-level evidence from clinical trials that supports a role for SDB intervention on rhythm control is not available. The goals of this scientific statement are to increase knowledge and awareness of the existing science relating SDB to cardiac arrhythmias (atrial fibrillation, ventricular tachyarrhythmias, sudden cardiac death, and bradyarrhythmias), synthesizing data relevant for clinical practice and identifying current knowledge gaps, presenting best practice consensus statements, and prioritizing future scientific directions. Key opportunities identified that are specific to cardiac arrhythmia include optimizing SDB screening, characterizing SDB predictive metrics and underlying pathophysiology, elucidating sex-specific and background-related influences in SDB, assessing the role of mobile health innovations, and prioritizing the conduct of rigorous and adequately powered clinical trials.
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Katsuki S, Ota S, Yoda S, Onimaru H, Dohi K, Izumizaki M. Effects of ANP and BNP on the generation of respiratory rhythms in brainstem-spinal cord preparation isolated from newborn rats. Biomed Res 2022; 43:127-135. [PMID: 35989288 DOI: 10.2220/biomedres.43.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Natriuretic peptides (NPs) are a family of peptide hormones produced in cardiac muscle cells and consist mainly of three types: atrial NP (ANP), B-type (or brain) NP (BNP), and C-type NP. We herein report the effects of ANP and BNP on central respiratory activity in brainstem-spinal cord preparation isolated from newborn rats. Bath application of these peptides (100 nM) induced a weak transient depression of the respiratory rhythm followed by recovery. Respiratory-related neurons in the rostral ventrolateral medulla showed a tendency for transient hyperpolarization followed by recovery during the application of ANP or BNP. The application of a membrane-permeable cGMP, 8-Br-cGMP (10 or 20 μM), did not induce significant effects on respiratory rhythm, suggesting no involvement of guanylyl cyclase in effects of ANP or BNP. We also examined effects of BNP on respiratory depression induced by the sedative dexmedetomidine, which exerts an inhibitory influence on respiratory rhythm. When pretreated with 50 nM BNP, the inhibitory effect of 100 nM dexmedetomidine was significantly reduced. Our findings suggest that ANP and BNP act as mild excitatory agents with sustained effects on respiratory rhythm after an initial transient depression.
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Affiliation(s)
- Shino Katsuki
- Department of Physiology, Showa University School of Medicine.,Department of Emergency, Disaster and Critical Care Medicine, Showa University
| | - Shinichiro Ota
- Department of Physiology, Showa University School of Medicine
| | - Shunya Yoda
- Department of Physiology, Showa University School of Medicine
| | - Hiroshi Onimaru
- Department of Physiology, Showa University School of Medicine
| | - Kenji Dohi
- Department of Emergency, Disaster and Critical Care Medicine, Showa University
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Gunta SP, Jakulla RS, Ubaid A, Mohamed K, Bhat A, López-Candales A, Norgard N. Obstructive Sleep Apnea and Cardiovascular Diseases: Sad Realities and Untold Truths regarding Care of Patients in 2022. Cardiovasc Ther 2022; 2022:6006127. [PMID: 36017216 PMCID: PMC9388301 DOI: 10.1155/2022/6006127] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/13/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Obstructive sleep apnea (OSA) is one of the most common and serious sleep-related breathing disorders with a high prevalence among patients with cardiovascular (CV) diseases. Despite its widespread presence, OSA remains severely undiagnosed and untreated. CV mortality and morbidity are significantly increased in the presence of OSA as it is associated with an increased risk of resistant hypertension, heart failure, arrhythmias, and coronary artery disease. Evaluation and treatment of OSA should focus on recognizing patients at risk of developing OSA. The use of screening questionnaires should be routine, but a formal polysomnography sleep study is fundamental in establishing and classifying OSA. Recognition of OSA patients will allow for the institution of appropriate therapy that should alleviate OSA-related symptoms with the intent of decreasing adverse CV risk. In this review, we focus on the impact OSA has on CV disease and evaluate contemporary OSA treatments. Our goal is to heighten awareness among CV practitioners.
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Affiliation(s)
- Satya Preetham Gunta
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Roopesh Sai Jakulla
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Aamer Ubaid
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Kareem Mohamed
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Abid Bhat
- Department of Sleep Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Angel López-Candales
- Department of Cardiovascular Diseases, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Nicholas Norgard
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, Missouri, USA
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Khan A, Clay RD, Singh A, Lal C, Tereshchenko LG. Ventricular Arrhythmias in Patients with Implanted Cardiac Devices at High Risk of Obstructive Sleep Apnea. Medicina (B Aires) 2022; 58:medicina58060757. [PMID: 35744020 PMCID: PMC9229375 DOI: 10.3390/medicina58060757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background and Objectives: Patients with pre-existing cardiac disease have a higher prevalence of Obstructive Sleep Apnea (OSA). OSA has been associated with an increased risk of supraventricular and ventricular arrhythmia. We screened subjects with implanted pacemakers and automated implantable cardioverter defibrillators (AICD) for OSA with the Berlin Questionnaire and compared the incidence of ventricular arrhythmias and automated implantable cardioverter defibrillator (AICD) firing between high and low OSA risk groups. Materials and Methods: We contacted 648 consecutive patients from our arrhythmia clinic to participate in the study and performed final analyses on 171 subjects who consented and had follow-up data. Data were abstracted from the electronic health record for the incidence of non-sustained ventricular tachycardia (NSVT), ventricular tachycardia (VT), ventricular fibrillation (VF) and AICD firing and then compared between those at high versus low risk of OSA using the Berlin Questionnaire and multivariate negative binomial regression. Results: The average follow-up period was 24.2 ± 4.4 months. After adjusting for age, gender and history of heart failure, those subjects at high risk of OSA had a higher burden of NSVT vs. those with a low risk of OSA (33.4 ± 96.2 vs. 5.82 ± 17.1 episodes, p = 0.003). A predetermined subgroup analysis of AICD recipients also demonstrated a significantly higher burden of NSVT in the high vs. low OSA risk groups (66.2 ± 128.6 vs. 18.9 ± 36.7 episodes, p = 0.033). There were significant differences in the rates of VT, VF or AICD shock burden between the high and low OSA risk groups and in the AICD subgroup analysis. Conclusions: There was increased ventricular ectopy among pacemaker and AICD recipients at high risk of OSA, but the prevalence of VT, VF or AICD shocks was similar to those with low risk of OSA.
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Affiliation(s)
- Akram Khan
- Division of Pulmonary, Allergy & Critical Care Medicine, Oregon Health & Science University, Portland, OR 97239, USA;
- Correspondence: ; Tel.: +503-494-4493
| | - Ryan D. Clay
- Division of Pulmonary, Allergy & Critical Care Medicine, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Asha Singh
- Department of Neurology, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Chitra Lal
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Larisa G. Tereshchenko
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave JJN3-01, Cleveland, OH 44195, USA;
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Ben Messaoud R, Khouri C, Pépin JL, Cracowski JL, Tamisier R, Barbieri F, Heidbreder A, Joyeux-Faure M, Defaye P. Implantable cardiac devices in sleep apnoea diagnosis: A systematic review and meta-analysis. Int J Cardiol 2021; 348:76-82. [PMID: 34906614 DOI: 10.1016/j.ijcard.2021.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/06/2021] [Accepted: 12/09/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND A particularly high burden of sleep apnoea is reported in patients treated with cardiac implants such as pacemakers and defibrillators. Sleep apnoea diagnosis remains a complex procedure mainly based on sleep and respiratory indices captured by polysomnography (PSG) or respiratory polygraphy (PG). AIM We aimed to evaluate the performance of implantable cardiac devices for sleep apnoea diagnosis compared to reference methods. METHOD Systematic structured literature searches were performed in PubMed, Embase and. Cochrane Library was performed to identify relevant studies. Quantitative characteristics of the studies were summarized and a qualitative synthesis was performed by a randomized bivariate meta-analysis and completed by pre-specified sensitivity analyses for different implant types and brands. RESULTS 16 studies involving 999 patients met inclusion criteria and were included in the meta-analysis. The majority of patients were men, of mean age of 64 ± 4.6 years. Sensitivity of cardiac implants for sleep apnoea diagnosis ranged from 60 to 100%, specificity from 50 to 100% with a prevalence of sleep apnoea varying from 22 to 91%. For an apnoea-hypopnoea index threshold ≥30 events/h during polysomnography (corresponding to severe sleep apnoea), the overall performance of the implants was relevant with a sensitivity of 78% and a specificity of 79%. Subgroup analyses on implant type and brand provided no additional information owing to the small number of studies. CONCLUSION The respiratory disturbance index provided by cardiac implants is clinically relevant and might improve access to sleep apnoea diagnosis in at-risk cardiovascular populations. PROSPERO Registration number: CRD42020181656.
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Affiliation(s)
- Raoua Ben Messaoud
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France.
| | - Charles Khouri
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; Regional Pharmacovigilance Center, Grenoble Alpes University Hospital, Grenoble, France.
| | - Jean Louis Pépin
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels division, Grenoble Alpes University Hospital, Grenoble, France.
| | - Jean Luc Cracowski
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; Regional Pharmacovigilance Center, Grenoble Alpes University Hospital, Grenoble, France.
| | - Renaud Tamisier
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels division, Grenoble Alpes University Hospital, Grenoble, France.
| | - Fabian Barbieri
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Austria.
| | - Anna Heidbreder
- Sleep Disorders Clinic, Department of Neurology, Medical University Innsbruck, Austria.
| | - Marie Joyeux-Faure
- HP2 Laboratory, Inserm U1300, Grenoble Alpes University, Grenoble, France; EFCR Laboratory, Thorax and Vessels division, Grenoble Alpes University Hospital, Grenoble, France.
| | - Pascal Defaye
- Arrhythmia Unit, Cardiology Department, Grenoble Alpes University Hospital, Grenoble, France.
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Abstract
Es hat sich viel getan in der Welt der Schlafmedizin in der Kardiologie, weshalb eine vollwertige Überarbeitung des Positionspapiers „Schlafmedizin in der Kardiologie“ erforderlich wurde. In der aktuellen neuartigen Version finden sich nicht nur alle verfügbaren Studien, Literaturstellen und Updates zu Pathophysiologie, Diagnostik- und Therapieempfehlungen, sondern auch Ausblicke auf neue Entwicklungen und zukünftige Forschungserkenntnisse. Dieses überarbeitete Positionspapier gibt Empfehlungen für Diagnostik und Therapie von Patienten mit kardiovaskulären Erkrankungen mit schlafassoziierten Atmungsstörungen und erteilt darüber hinaus einen fundierten Überblick über verfügbare Therapien und Evidenzen, gibt aber ebenso Ratschläge wie mit Komorbiditäten umzugehen ist. Insbesondere enthält dieses überarbeitete Positionspapier aktualisierte Stellungnahmen zu schlafassoziierten Atmungsstörungen bei Patienten mit koronarer Herzerkrankung, Herzinsuffizienz, arterieller Hypertonie, aber auch für Patienten mit Vorhofflimmern. Darüber hinaus finden sich erstmals Empfehlungen zur Telemedizin als eigenes, neues Kapitel. Dieses Positionspapier bietet Kardiologen sowie Ärzten in der Behandlung von kardiovaskulären Patienten die Möglichkeit einer evidenzbasierten Behandlung der wachsend bedeutsamen und mit zunehmender Aufmerksamkeit behafteten Komorbidität schlafassoziierter Atmungsstörungen. Und nicht zuletzt besteht mit diesem neuen Positionspapier eine enge Verknüpfung mit dem neuen Curriculum Schlafmedizin der Deutschen Gesellschaft für Kardiologie, weshalb dieses Positionspapier eine Orientierung für die erworbenen Fähigkeiten des Curriculums im Umgang von kardiovaskulären Patienten mit schlafassoziierten Atmungsstörungen darstellt.
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Cazco MDP, Lorenzi-Filho G. Síndrome de apnea obstructiva del sueño y sus consecuencias cardiovasculares. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Laczay B, Faulx MD. Obstructive Sleep Apnea and Cardiac Arrhythmias: A Contemporary Review. J Clin Med 2021; 10:jcm10173785. [PMID: 34501232 PMCID: PMC8432034 DOI: 10.3390/jcm10173785] [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: 07/22/2021] [Revised: 08/20/2021] [Accepted: 08/20/2021] [Indexed: 12/28/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent disorder with a growing incidence worldwide that closely mirrors the global obesity epidemic. OSA is associated with enormous healthcare costs in addition to significant morbidity and mortality. Much of the morbidity and mortality related to OSA can be attributed to an increased burden of cardiovascular disease, including cardiac rhythm disorders. Awareness of the relationship between OSA and rhythm disorders is variable among physicians, a fact that can influence patient care, since the presence of OSA can influence the incidence, prevalence, and successful treatment of multiple rhythm disorders. Herein, we provide a review of this topic that is intentionally broad in scope, covering the relationship between OSA and rhythm disorders from epidemiology and pathophysiology to diagnosis and management, with a particular focus on the recognition of undiagnosed OSA in the general clinical population and the intimate relationship between OSA and atrial fibrillation.
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Obstructive Sleep Apnea and Arrhythmias in the Elderly. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00212-3] [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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Yeghiazarians Y, Jneid H, Tietjens JR, Redline S, Brown DL, El-Sherif N, Mehra R, Bozkurt B, Ndumele CE, Somers VK. Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e56-e67. [PMID: 34148375 DOI: 10.1161/cir.0000000000000988] [Citation(s) in RCA: 382] [Impact Index Per Article: 127.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Obstructive sleep apnea (OSA) is characterized by recurrent complete and partial upper airway obstructive events, resulting in intermittent hypoxemia, autonomic fluctuation, and sleep fragmentation. Approximately 34% and 17% of middle-aged men and women, respectively, meet the diagnostic criteria for OSA. Sleep disturbances are common and underdiagnosed among middle-aged and older adults, and the prevalence varies by race/ethnicity, sex, and obesity status. OSA prevalence is as high as 40% to 80% in patients with hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, and stroke. Despite its high prevalence in patients with heart disease and the vulnerability of cardiac patients to OSA-related stressors and adverse cardiovascular outcomes, OSA is often underrecognized and undertreated in cardiovascular practice. We recommend screening for OSA in patients with resistant/poorly controlled hypertension, pulmonary hypertension, and recurrent atrial fibrillation after either cardioversion or ablation. In patients with New York Heart Association class II to IV heart failure and suspicion of sleep-disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable. In patients with tachy-brady syndrome or ventricular tachycardia or survivors of sudden cardiac death in whom sleep apnea is suspected after a comprehensive sleep assessment, evaluation for sleep apnea should be considered. After stroke, clinical equipoise exists with respect to screening and treatment. Patients with nocturnally occurring angina, myocardial infarction, arrhythmias, or appropriate shocks from implanted cardioverter-defibrillators may be especially likely to have comorbid sleep apnea. All patients with OSA should be considered for treatment, including behavioral modifications and weight loss as indicated. Continuous positive airway pressure should be offered to patients with severe OSA, whereas oral appliances can be considered for those with mild to moderate OSA or for continuous positive airway pressure-intolerant patients. Follow-up sleep testing should be performed to assess the effectiveness of treatment.
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Abstract
Obstructive sleep apnea (OSA) presents as repetitive interruptions of ventilation >10 seconds during sleep as a result of upper airway obstruction resulting in increased respiratory effort. Intermittent hypoxia causes physiologic changes resulting in increased catecholamine production, increased total peripheral resistance, tachycardia, and increased venous return, leading to increased cardiac output, hypertension, tachyarrhythmias, left ventricular hypertrophy, and heart failure. OSA causes an abnormal dip on 24-hour ambulatory blood pressure monitoring. Definitive diagnosis is made by polysomnography. Continuous positive airway pressure (CPAP) remains the first-line treatment. Effective treatment using CPAP reduces blood pressure and is indispensable for proper management of atrial fibrillation.
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Affiliation(s)
- Joseph A Diamond
- Department of Cardiology, Long Island Jewish Hospital, Northwell Health, 270-05 76th Avenue Room 2008, New Hyde Park, NY 11040, USA.
| | - Haisam Ismail
- Department of Cardiology, Long Island Jewish Hospital, Northwell Health, 270-05 76th Avenue Room 2008, New Hyde Park, NY 11040, USA
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16
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The variability and burden of severe sleep apnea and the relationship with atrial fibrillation occurrence: analysis of pacemaker-detected sleep apnea. Sleep Breath 2021; 26:307-313. [PMID: 34028644 PMCID: PMC8857144 DOI: 10.1007/s11325-021-02385-1] [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: 11/19/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 11/26/2022]
Abstract
Study objectives This was a pilot study to evaluate the long-term variability and burden of respiratory disturbance index (RDI) detected by pacemaker and to investigate the relationship between RDI and atrial fibrillation (AF) event in patients with pacemakers. Methods This was a prospective study enrolling patients implanted with a pacemaker that could calculate the night-to-night RDI. The mean follow-up was 348 ± 34 days. The RDI variability was defined as the standard deviation of RDI (RDI-SD). RDI burden was referred to as the percentage of nights with RDI ≥ 26. The patient with RDI ≥ 26 in more than 75% nights was considered to have a high sleep apnea (SA) burden. An AF event was defined as a daily AF duration > 6 h. Results Among 30 patients, the mean RDI of the whole follow-up period was 24.5 ± 8.6. Nine (30%) patients were diagnosed with high SA burden. Patients with high SA burden had a higher BMI (26.7 ± 4.8 vs 23.2 ± 3.9, p = 0.036), a higher prevalence of hypertension (86% vs 39%, p = 0.031), and a larger left ventricular diastolic diameter (49.2 mm vs 46.7 mm, p = 0.036). The RDI-SD in patients with a higher burden was significantly greater than that in the patients with less burden (10.7 ± 4.9 vs 5.7 ± 1.4, p = 0.036). Linear regression showed that participants with a higher RDI tended to have a higher SD (R = 0.661; p < 0.001). The mean RDI (OR = 1.118, 95%CI 1.008–1.244, p = 0.044) was associated with AF occurrence. Conclusion Using a metric such as burden of severe SA may be more appropriate to demonstrate a patient’s true disease burden.
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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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18
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Mazza A, Bendini MG, Leggio M, De Cristofaro R, Valsecchi S, Boriani G. Continuous monitoring of sleep-disordered breathing with pacemakers: Indexes for risk stratification of atrial fibrillation and risk of stroke. Clin Cardiol 2020; 43:1609-1615. [PMID: 33179808 PMCID: PMC7724201 DOI: 10.1002/clc.23489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sleep apnea (SA) is a risk factor for atrial fibrillation (AF). Advanced pacemakers are now able to calculate indexes of SA severity. HYPOTHESIS We investigated the changes in pacemaker-measured indexes of SA, we assessed their predictive value for AF occurrence and the associated risk of stroke and death at long-term. METHODS We enrolled 439 recipients of a pacemaker endowed with an algorithm for the calculation of a Respiratory Disturbance Index (RDI). The RDI variability was measured over the first 12 months after implantation, as well as its potential association with the occurrence of AF, defined as device-detected cumulative AF burden ≥6 hoursours in a day. RESULTS The individual RDI mean was 30 ± 18 episodes/h, and the RDI maximum was 59 ± 21 episodes/h. RDI ≥30 episodes/h was detected in 351 (80%) patients during at least one night. The proportion of nights with RDI ≥30 episodes/h was 14% (2%-36%). AF ≥6 hours was detected in 129 (29%) patients during the first 12 months. The risk of AF was higher in patients with RDI maximum ≥63 episodes/h (HR:1.74; 95%CI: 1.22-2.48; P = .001) and with RDI mean ≥ 46 episodes/h (HR:1.63; 95%CI: 1.03-2.57; P = .014). The risk of all-cause death or stroke was higher in patients with AF burden ≥6 hours (HR:1.75; 95%CI: 1.06-2.86; P = .016). Moreover, among patients with no previous history of AF the risk was higher in those with RDI maximum ≥63 episodes/h (HR:1.96; 95%CI: 1.06-3.63; P = .031). CONCLUSIONS Pacemaker-detected SA showed a considerable variability during follow-up. We confirmed the association between RDI and higher risk of AF, and we observed an association between higher RDI maximum and all-cause death or stroke among patients with no previous history of AF.
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Affiliation(s)
- Andrea Mazza
- Cardiology DivisionS. Maria della Stella HospitalOrvietoItaly
| | | | - Massimo Leggio
- Department of Medicine and Rehabilitation, Cardiac Rehabilitation Operative Unit, S. Filippo Neri HospitalRomeItaly
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
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Boriani G, Pisanò ECL, Pieragnoli P, Locatelli A, Capucci A, Talarico A, Zecchin M, Rapacciuolo A, Piacenti M, Indolfi C, Arias MA, Diemberger I, Checchinato C, La Rovere MT, Sinagra G, Emdin M, Ricci RP, D'Onofrio A. Prognostic value of implantable defibrillator-computed respiratory disturbance index: The DASAP-HF study. Heart Rhythm 2020; 18:374-381. [PMID: 33283757 DOI: 10.1016/j.hrthm.2020.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sleep apnea, as measured by polysomnography, is associated with adverse outcomes in heart failure. The DASAP-HF (Diagnosis and Treatment of Sleep Apnea in Patient With Heart Failure) study previously demonstrated that the respiratory disturbance index (RDI) computed by the ApneaScan algorithm (Boston Scientific) accurately identifies severe sleep apnea in implantable cardioverter-defibrillator (ICD) patients. OBJECTIVE The purpose of the long-term study phase was to assess the incidence of clinical events after 24 months and investigate the association with RDI values. METHODS Patients with left ventricular ejection fraction ≤35% implanted with an ICD were enrolled and followed-up for 24 months. The RDI calculated at 1 month after implantation was used to stratify patients (below or above 30 episodes/h). The endpoints were all-cause death and a combination of all-cause death or cardiovascular hospitalization. RESULTS Of the 265 enrolled patients, 224 had usable RDI values. Severe sleep apnea (RDI ≥30 episodes/h) was diagnosed in 115 patients (51%). These patients were more frequently male (84% vs 72%; P = .030) and had higher creatinine levels. During median follow-up of 25 months, 19 patients (8%) died. Cardiovascular hospitalizations were reported in 19 patients (8%). The risk of all-cause death was higher in patients with RDI ≥30 episodes/h (hazard ratio [HR] 3.33; 95% confidence interval [CI] 1.35-8.21; P = .023), as well as the risk of all-cause death or cardiovascular hospitalization (HR 1.94; 95% CI 1.01-3.76; P = .048). At multivariate analysis, independent predictors of death were RDI ≥30 episodes/h (HR 4.02; 95% CI 1.16-13.97; P = .029) and creatinine levels (HR 2.36; 95% CI 1.26-4.42; P = .008). CONCLUSION In heart failure patients implanted with an ICD, higher RDI values are associated with death and cardiovascular hospitalizations. Device-detected severe sleep apnea independently predicts death.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Igor Diemberger
- University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | - Maria Teresa La Rovere
- Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, Pavia
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20
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Clapp B, Amin M, Dodoo C, Harper B, Liggett E, Davis B. New Onset Cardiac Arrhythmias after Metabolic and Bariatric Surgery. JSLS 2020; 24:e2020.00067. [PMID: 33414612 PMCID: PMC7732367 DOI: 10.4293/jsls.2020.00067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Metabolic and bariatric surgery (MBS) has been shown to improve medical problems; however, there are known arrhythmias that can occur after MBS (i.e., sick sinus syndrome [SSS] and sinus bradyarrhythmias). While the literature in this area contains case reports, there is a lack of published data on a state or national level. We used a large state administrative database to evaluate the occurrence of cardiac arrhythmias after MBS. METHODS We studied the years 2016 to 2018 using the Texas Inpatient Public Use Data File. Inclusion criteria were patients who had a pacemaker installed and were ≥ 18 years. Quantitative variables were described using mean and standard deviation. Categorical variables were described using frequency and proportion. The student's t-test and chi-squared test were used to assess the differences across pacemaker installation. RESULTS There were a total of 79,807 (10.2%) who had a history of MBS and 31,072 (4%) patients who underwent pacemaker insertion, respectively. After excluding all patients < 18 years, the prevalence of pacemakers installed in patients with prior bariatric surgery was 0.8% (n = 257/30,823) or about 8 in every 1000 patients. Of note, bariatric patients who had a pacemaker placed were younger than non-bariatric patients (P < 0.001). The most common reason for pacemaker placement was SSS (51.5%), followed by atrioventricular block (13.1%), and then bradycardia at 8.5%. The most common arrhythmia overall was bradycardia. CONCLUSIONS Eight out of every 1000 patients with a pacemaker installed in the study period had a history of MBS. The most common arrhythmia was bradycardia and the most common reason for pacemaker placement was sick sinus syndrome. These results do not indicate causality but may demonstrate an association between MBS and arrhythmias. Bariatric patients undergo pacemaker placement at a younger age. The relationship between bariatric surgery and cardiac arrhythmias warrants further study.
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Affiliation(s)
- Benjamin Clapp
- Department of Surgery, Texas Tech Health Sciences Center, Paul Foster School of Medicine, El Paso, TX
| | - Mubashara Amin
- Department of Surgery, Texas Tech Health Sciences Center, Paul Foster School of Medicine, El Paso, TX
| | - Christopher Dodoo
- Department of Surgery, Texas Tech Health Sciences Center, Paul Foster School of Medicine, El Paso, TX
| | - Brittany Harper
- Department of Surgery, Texas Tech Health Sciences Center, Paul Foster School of Medicine, El Paso, TX
| | - Evan Liggett
- Department of Surgery, Texas Tech Health Sciences Center, Paul Foster School of Medicine, El Paso, TX
| | - Brian Davis
- Department of Surgery, Texas Tech Health Sciences Center, Paul Foster School of Medicine, El Paso, TX
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21
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Riaz S, Bhatti H, Sampat PJ, Dhamoon A. The Converging Pathologies of Obstructive Sleep Apnea and Atrial Arrhythmias. Cureus 2020; 12:e9388. [PMID: 32754415 PMCID: PMC7386049 DOI: 10.7759/cureus.9388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/25/2020] [Indexed: 11/05/2022] Open
Abstract
Obstructive sleep apnea (OSA) is highly prevalent in the United States (US). Along with epidemic rates of obesity, the rate of OSA cases is also on the rise. OSA is associated with multiple chronic health conditions, including hypertension, diabetes, stroke, myocardial ischemia, and heart rhythm disturbances. OSA is commonly treated with continuous positive airway pressure (CPAP) therapy. Several reports indicate that effective treatment of OSA can reduce the risk of cardiovascular diseases, including cardiac arrhythmias, especially atrial fibrillation (AF). CPAP therapy helps to maintain sinus rhythm after interventions such as electrical cardioversion and catheter ablation in patients with AF. However, more data is required to establish a relationship between OSA and other atrial arrhythmias as well to evaluate the effect of CPAP. This review will compile the latest evidence on the pathophysiology, management, and treatment of atrial arrhythmias associated with OSA.
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Affiliation(s)
- Sana Riaz
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Harneet Bhatti
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Parth J Sampat
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
| | - Amit Dhamoon
- Internal Medicine, State University of New York Upstate Medical University, Syracuse, USA
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22
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Yu MS, Ibrahim B, Riley RW, Liu SYC. Maxillomandibular Advancement and Upper Airway Stimulation: Extrapharyngeal Surgery for Obstructive Sleep Apnea. Clin Exp Otorhinolaryngol 2020; 13:225-233. [PMID: 32683836 PMCID: PMC7435433 DOI: 10.21053/ceo.2020.00360] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/16/2020] [Indexed: 12/14/2022] Open
Abstract
There are many ways to categorize surgery for obstructive sleep apnea (OSA), one of which is to distinguish between intrapharyngeal and extrapharyngeal procedures. While the general otolaryngologist treating OSA is familiar with intrapharyngeal procedures, such as uvulopalatopharyngoplasty and tongue base reduction, extrapharyngeal sleep operations such as maxillomandibular advancement (MMA) and upper airway stimulation (UAS) have evolved rapidly in the recent decade and deserve a dedicated review. MMA and UAS have both shown predictable high success rates with low morbidity. Each approach has unique strengths and limitations, and for the most complex of OSA patients, the two in combination complement each other. Extrapharyngeal airway operations are critical for achieving favorable outcomes for sleep surgeons.
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Affiliation(s)
- Myeong Sang Yu
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA.,Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Badr Ibrahim
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Robert Wayne Riley
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA
| | - Stanley Yung-Chuan Liu
- Division of Sleep Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford Hospital and Clinics, Stanford, CA, USA
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23
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Filchenko I, Bochkarev M, Kandinsky A, Korostovtseva L, Sviryaev Y, Konradi A. Continuous positive airway pressure therapy restores bradyarrhythmia with 10-second asystole in hypertensive obese patient with obstructive sleep apnea. HeartRhythm Case Rep 2020; 6:300-303. [PMID: 32577381 PMCID: PMC7300336 DOI: 10.1016/j.hrcr.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Irina Filchenko
- Almazov National Medical Research Centre, St. Petersburg, Russia.,Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | | | - Anton Kandinsky
- Almazov National Medical Research Centre, St. Petersburg, Russia
| | | | - Yuri Sviryaev
- Almazov National Medical Research Centre, St. Petersburg, Russia.,Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Alexandra Konradi
- Almazov National Medical Research Centre, St. Petersburg, Russia.,ITMO University, St. Petersburg, Russia
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24
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Increased respiratory disturbance index measured using an advanced device algorithm is associated with heart failure development. Heart Vessels 2020; 35:817-824. [PMID: 31897640 DOI: 10.1007/s00380-019-01551-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
Previous studies suggested that sleep-disordered breathing was associated with cardiovascular diseases such as heart failure (HF). Recently, algorithms of cardiac implantable electronic devices (CIEDs) have been developed to detect advanced sleep apnea (SA); the Apnea Scan (AP Scan) being an example. The purpose of this study was to investigate the association between respiratory disturbance index (RDI) measured using the AP Scan algorithm and HF development. We retrospectively studied consecutive patients with CIEDs equipped with the AP Scan algorithm which were implanted between December 1, 2011 and March 31, 2019. These patients were divided into 2 groups according to the trends of RDI: patients with a continually high RDI > 30 (severe SA group) and those without a continually high RDI (non-severe SA group). There were 16 and 46 patients in the severe and non-severe SA groups, respectively. Increased left ventricular end-diastolic and end-systolic dimensions were observed in the severe SA group. Regarding cardiovascular events, HF was observed in 8 patients (50.0%) in the severe SA group and 1 patient (2.2%) in the non-severe SA group; thus, there was a significantly higher proportion of patients with HF in the severe SA group. In conclusion, continually high RDI was associated with HF development in patients with CIEDs equipped with the AP Scan algorithm. Therefore, an elevated RDI may be a risk factor for the development of HF in patients with CIEDs.
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25
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Varga PC, Rosianu HS, Vesa ŞC, Hancu BGD, Beyer R, Pop CM. The impact of continuous positive airway pressure on cardiac arrhythmias in patients with sleep apnea. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:42. [PMID: 32582348 PMCID: PMC7306230 DOI: 10.4103/jrms.jrms_677_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 10/08/2019] [Accepted: 01/20/2020] [Indexed: 01/01/2023]
Abstract
Background Obstructive sleep apnea (OSA) can lead to cardiac complications: brady and tachyarrhythmias and sudden cardiac death. Continuous positive airway pressure (CPAP) is the gold standard for the treatment of OSA. The present study aims to demonstrate the efficiency of CPAP in the treatment of cardiac arrhythmias in patients with OSA. The study also recorded the frequency of arrhythmias in patients with untreated OSA and assessed the association between the severity of OSA and the occurrence of arrhythmias. Materials and Methods This is a prospective cohort study. Ninety-three patients with OSA were included, aged 60 (58-64) years, with female/male sex ratio of 1:4. They were subjected simultaneously to home respiratory polygraphy examination and Holter electrocardiogram monitoring, in two different stages: at diagnosis and at the 3-month checkup after CPAP treatment. The presence of supraventricular and ventricular arrythmias was noted. Respiratory parameter values were also recorded. Results Statistically significant decrease in the occurrence of supraventricular (P < 0.001) and ventricular extrasystoles (P < 0.001), atrial fibrillation (AF) (P = 0.03), nonsustained ventricular tachycardia (NSVT) (P = 0.03), and sinus pauses (P < 0.001) was observed 3 months after treatment with CPAP, compared with baseline. The apnea-hypopnea index (AHI) was correlated with the ventricular extrasystoles (r = 0.273; P = 0.008). The ejection fraction of the left ventricle was inversely correlated with the episodes of NSVT (r = -0.425; P < 0.001). AF was associated with the longest apnea (r = 0.215; P = 0.04). Cardiac activity pauses were correlated with AHI (r = 0.320; P = 0.002), longest apnea (r = 0.345; P = 0.01), and oxygen desaturation index (r = 0.325; P = 0.04). Conclusion The prevalence of cardiac arrhythmias in patients with OSA was reduced after 3 months of CPAP therapy. Cardiac arrhythmias were correlated with the severity of OSA.
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Affiliation(s)
- Paula Cornelia Varga
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, România.,Department of Cardiology, Heart Institute "Niculae Stancioiu," Cluj-Napoca, Romania
| | - Horia Stefan Rosianu
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, România.,Department of Cardiology, Heart Institute "Niculae Stancioiu," Cluj-Napoca, Romania
| | - Ştefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, România
| | - Bianca Gergely Domokos Hancu
- Department of Pulmonology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, România.,Pulmonology Clinic "Leon Daniello", Cluj-Napoca, Romania
| | - Ruxandra Beyer
- Department of Cardiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, România.,Department of Cardiology, Heart Institute "Niculae Stancioiu," Cluj-Napoca, Romania
| | - Carmen Monica Pop
- Department of Pulmonology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, România.,Pulmonology Clinic "Leon Daniello", Cluj-Napoca, Romania
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26
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Arrhythmias and sleep apnea: physiopathologic link and clinical implications. J Interv Card Electrophysiol 2020; 57:387-397. [DOI: 10.1007/s10840-020-00707-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/09/2020] [Indexed: 12/17/2022]
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27
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Marti-Almor J, Marques P, Jesel L, Garcia R, Di Girolamo E, Locati F, Defaye P, Venables P, Dompnier A, Barcelo A, Nägele H, Burri H. Incidence of sleep apnea and association with atrial fibrillation in an unselected pacemaker population: Results of the observational RESPIRE study. Heart Rhythm 2020; 17:195-202. [DOI: 10.1016/j.hrthm.2019.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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28
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Bocquillon V, Destors M, Guzun R, Doutreleau S, Pépin JL, Tamisier R. [Cardiac dysfunction and the obstructive sleep apnoea syndrome]. Rev Mal Respir 2019; 37:161-170. [PMID: 31866122 DOI: 10.1016/j.rmr.2019.07.011] [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: 12/06/2018] [Accepted: 07/04/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Cardiac insufficiency affects nearly 2% of the population with increased morbidity/mortality despite advances in therapeutic management. The sleep apnoea syndrome (SAS) is a risk factor for, and cause of aggravation of, myocardial dysfunction. BACKGROUND SAS is found in 70% of patients with chronic cardiac failure, 65% of patients with refractory hypertension, 60% of patients with cerebro-vascular accidents and 50% of patients with atrial fibrillation. The associated cardiovascular mortality is multiplied by a factor of 2 to 3. The pathophysiological mechanisms are intermittent nocturnal hypoxia, variations in CO2 levels, variations in intrathoracic pressure and repeated arrousals from sleep, concurrent with sympathetic hyperactivity, endothelial dysfunction and systemic inflammation. CONCLUSIONS SAS and cardiological management in patients presenting with myocardial dysfunction should be combined. It is necessary to pursue the scientific investigations with the aim of determining a precise care pathway and the respective places of each of the cardiological and pulmonary measures.
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Affiliation(s)
- V Bocquillon
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - M Destors
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - R Guzun
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - S Doutreleau
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - J L Pépin
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France
| | - R Tamisier
- Inserm 1042, laboratoire HP2, Université Grenoble-Alpes, 38000 Grenoble, France; Pôle thorax et vaisseaux, clinique de physiologie sommeil et exercice, CHU de Grenoble-Alpes, 38000 Grenoble, France.
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Augusto JB, Antunes S, Ferreira JB, Faria D, Roque D, Beringuilho M, Ferreira H, Fialho I, Faustino M, Cabanelas N, Ferreira AR, Vasconcelos H, Santos MB, Freitas A, Madeira F, Gil V, Morais C. Utility of Pacemaker With Sleep Apnea Monitor to Predict Left Ventricular Overload and Acute Decompensated Heart Failure. Am J Cardiol 2019; 124:1720-1724. [PMID: 31606190 DOI: 10.1016/j.amjcard.2019.08.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/18/2019] [Accepted: 08/22/2019] [Indexed: 11/19/2022]
Abstract
Pacemakers with sleep apnea monitor (SAM) provide an easy tool to assess obstructive sleep apnea over long periods of time. The link between respiratory disturbances at night and the incidence of acute decompensated heart failure (ADHF) is not well established. We aimed at (1) determining the ability of SAM pacemakers to evaluate the extent of left ventricular overload and (2) assess the impact of respiratory disturbances at night on the occurrence of ADHF over 1-year of follow-up. We conducted a single-center prospective study. Consecutive patients with SAM pacemakers were comprehensively assessed. SAM automatically computes a respiratory disturbance index (RDI, apneas/hypopneas per hour - AH/h) in the previous night and the percentage of nights with RDI >20 AH/h in the previous 6 months. Thirty-seven patients were included (79.3 ± 11.2 years, 46% males). A high RDI in the previous night and a higher %nights with increased RDI were associated with increased NT-proBNP values (p = 0.008 and p = 0.013, respectively) and were the sole predictors of increased noninvasive pulmonary capillary wedge pressures (PCWP) in the morning of assessment (p = 0.031 and p = 0.044, respectively). Receiver operating characteristic curve analysis revealed an area under the curve of 0.804 (95% confidence interval 0.656 to 0.953, p = 0.002) for %nights with RDI >20 AH/h in the prediction of high PCWP. Patients with >12.5% of nights with RDI >20AH/h tended to have more ADHF during follow-up (log-rank p = 0.067). In conclusion, a high burden of apneas/hypopneas at night is associated with elevated NT-proBNP and PCWP values and an increased risk of ADHF over 1 year. These patients might benefit from early tailored clinical management.
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Affiliation(s)
- João B Augusto
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal; Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.
| | - Susana Antunes
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | | | - Daniel Faria
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - David Roque
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Marco Beringuilho
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Hilaryano Ferreira
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Inês Fialho
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Mariana Faustino
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Nuno Cabanelas
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Ana Rita Ferreira
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Hugo Vasconcelos
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Miguel Borges Santos
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - António Freitas
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Francisco Madeira
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Victor Gil
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal; Department of Cardiology, Hospital dos Lusíadas, Lisbon, Portugal
| | - Carlos Morais
- Department of Cardiology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Heart Rhythm 2019; 16:e128-e226. [DOI: 10.1016/j.hrthm.2018.10.037] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/13/2022]
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31
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Gonçalves IS, Agostinho JR, Silva G, Guimarães T, Bernardes A, Santos I, Pinto P, Bárbara C, de Sousa J, Pinto FJ, Marques P. Accuracy and utility of a pacemaker respiratory monitoring algorithm for the detection of obstructive sleep apnea in patients with atrial fibrillation. Sleep Med 2019; 61:88-94. [DOI: 10.1016/j.sleep.2019.01.051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/19/2019] [Accepted: 01/21/2019] [Indexed: 12/11/2022]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation 2019; 140:e382-e482. [DOI: 10.1161/cir.0000000000000628] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
| | | | | | | | - Kenneth A. Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- ACC/AHA Representative
| | - Michael R. Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
| | | | | | - José A. Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N. Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information
- HRS Representative
- Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. J Am Coll Cardiol 2019; 74:e51-e156. [DOI: 10.1016/j.jacc.2018.10.044] [Citation(s) in RCA: 151] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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34
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary. J Am Coll Cardiol 2019; 74:932-987. [DOI: 10.1016/j.jacc.2018.10.043] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ribeiro S, Bonito L, Guimarães MJ, Português J, Rodrigues B, Alves A, Durães C, Ferreira D, Sanfins V, Lourenço A. Importance of cardiac implantable eletronic devices in the diagnosis of Sleep Apnea Syndrome. Rev Port Cardiol 2019; 38:451-455. [PMID: 31320221 DOI: 10.1016/j.repc.2018.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 06/13/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sleep Apnea Syndrome (SAS) is a prevalent respiratory disease with marked expression in the population with cardiovascular disease. The diagnosis is based on polysomnography. In patients with cardiac implantable electronic devices (CIED), the prevalence of SAS may reach 60%. The objective of this study was to evaluate the value of DEC in the SAS screening. METHODS Prospective study that included patients with CIED with sleep apnea algorithm. The frequency response function was activated and simplified polygraphy was performed. The data of the device were collected on the day of the polygraph. RESULTS The sample included 29 patients, with a mean age of 76.1 years, 71.4% of the male gender. The prevalence of SAS was 77%. For SAS, the agreement between polysomnography and the Pacemaker was Kappa = 0.54 (p = 0.001), 95% CI (0.28, 0.81) (moderate agreement); for moderate to severe SAS, the agreement was Kappa = 0.73 (p <0.001), 95% CI (0.49, 0.976) (substantial agreement). Severe SAS was obtained: sensitivity 60%, specificity 100%, positive predictive value 100%, negative predictive value 60% and diagnostic accuracy 75%; for moderate to severe SAS: sensitivity of 90%, specificity of 83%, positive predictive values of 90% and negative of 87.5%, with a diagnostic accuracy of 87.5%. CONCLUSION SAS is highly prevalent in patients with CIED. The values obtained through these devices have a strong positive correlation with the Apnea-Hypopnea Índex, which makes them a good tool for the screening of severe SAS.
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Affiliation(s)
- Sílvia Ribeiro
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal.
| | - Laura Bonito
- Serviço de Medicina Interna, Centro Hospitalar Lisboa Central, Hospital de São José, Lisboa, Portugal
| | | | - João Português
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | | | - Assunção Alves
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | - Célia Durães
- Serviço de Pneumologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | - Daniela Ferreira
- Serviço de Pneumologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | - Victor Sanfins
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
| | - António Lourenço
- Serviço de Cardiologia, Hospital Nossa Senhora da Oliveira, Guimarães, Portugal
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Ribeiro S, Bonito L, Guimarães MJ, Português J, Rodrigues B, Alves A, Durães C, Ferreira D, Sanfins V, Lourenço A. Importance of cardiac implantable electronic devices in the diagnosis of sleep apnea syndrome. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2018.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Patel AR, Patel AR, Singh S, Singh S, Khawaja I. The Association Between Obstructive Sleep Apnea and Arrhythmias. Cureus 2019; 11:e4429. [PMID: 31245216 PMCID: PMC6559391 DOI: 10.7759/cureus.4429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/10/2019] [Indexed: 11/05/2022] Open
Abstract
Obstructive sleep apnea (OSA) is caused by intermittent episodes of partial or complete closure of the upper airway, leading to apneic episodes while the patient is asleep. Atrial fibrillation (AF) leads to more than 750,000 hospitalizations per year and accounts for an estimated 130,000 deaths each year. The death rate from AF as the primary or a contributing cause of death has been rising for more than two decades. The material reviewed in this paper focuses on the association between OSA and arrhythmias. It goes into the details of the epidemiology, pathophysiology, and types of arrhythmias and the therapies seen in association with OSA.
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Affiliation(s)
- Avani R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Amar R Patel
- Internal Medicine, Northern California Kaiser Permanente, Fremont, USA
| | - Shivank Singh
- Internal Medicine, Maoming People's Hospital, Maoming, CHN
| | - Shantanu Singh
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
| | - Imran Khawaja
- Pulmonary Medicine, Marshall University School of Medicine, Huntington, USA
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Gwag HB, Park Y, Lee SS, Kim JS, Park KM, On YK, Lee DI, Shin DG, Choi EK, Kang GH, Park HS, Park HW, Shim JM, Uhm JS, Kim J, Kim JH, Kang KW, Park SW, Oh YS, Cho Y, Lee YS, Park SJ. Rationale, design, and endpoints of the ‘DEvice-Detected CArdiac Tachyarrhythmic Events and Sleep-disordered Breathing (DEDiCATES)’ study: Prospective multicenter observational study of device-detected tachyarrhythmia and sleep-disordered breathing. Int J Cardiol 2019; 280:69-73. [DOI: 10.1016/j.ijcard.2019.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/09/2019] [Accepted: 01/14/2019] [Indexed: 01/31/2023]
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Taguchi Y, Matsushita K, Ishikawa T, Matsumoto K, Hosoda J, Iguchi K, Matsushita H, Kubota K, Sumita S, Ishigami T, Tamura K. Successful screening of sleep-disordered breathing using a pacemaker-based algorithm in Japan. J Cardiol 2019; 73:394-400. [PMID: 30630655 DOI: 10.1016/j.jjcc.2018.10.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent pacemakers with transthoracic impedance sensors have a specific algorithm identifying sleep apnea (SA). Our aim was to evaluate the algorithm in Japanese patients. METHODS Consecutive patients implanted with a pacemaker with sleep apnea monitoring algorithm at our hospital were enrolled prospectively. After implantation, patients underwent polysomnography (PSG). The respiratory disturbance index measured by pacemaker (RDI-PM) was extracted in the morning after PSG. RESULTS Forty-five patients were recruited; 78% of patients underwent overnight PSG completely, and among them RDI-PM was invalid for one patient. Then the analysis was performed in 34 patients. Moderate/severe SA (apnea hypopnea index, AHI≥15events/h) and severe SA (AHI≥30events/h) by PSG were diagnosed in 65% and 41% of patients. The mean AHI-PSG and RDI-PM were 30.4±22.6 and 21.7±14.2events/h, respectively. There was a significant positive correlation between AHI-PSG and RDI-PM (r=0.543; p=0.001). The correlation was stronger in the severe SA group (r=0.664; p=0.010), in a group whose apnea index was higher than hypopnea index (r=0.822; p=0.002), and in a group whose central sleep apnea (CSA) index was higher than obstructive sleep apnea index (r=0.977; p<0.001). RDI-PM cut-off value for identifying severe SA was 22 (area under the curve, 0.682; sensitivity, 64%; specificity, 75%). CONCLUSIONS The pacemaker-based algorithm is a useful screening tool for SA in Japanese individuals, especially in the severe SA group, apnea-dominant group, and CSA-dominant group.
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Affiliation(s)
- Yuka Taguchi
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Kohei Matsushita
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Toshiyuki Ishikawa
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan.
| | - Katsumi Matsumoto
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Junya Hosoda
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Kouhei Iguchi
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Hirooki Matsushita
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Kazumi Kubota
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Shinnichi Sumita
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Tomoaki Ishigami
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
| | - Kouichi Tamura
- Yokohama City University Graduate School of Medicine, Department of Medical Science and Cardio-renal Medicine, Yokohama, Japan
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Abstract
Obstructive sleep apnea (OSA) is common among patients with cardiac rhythm disorders. OSA may contribute to arrhythmias due to acute mechanisms, such as generation of negative intrathoracic pressure during futile efforts to breath, intermittent hypoxia, and surges in sympathetic activity. In addition, OSA may lead to heart remodeling and increases arrhythmia susceptibility. Atrial distension and remodeling, that has been shown to be associated with OSA, is a well-known anatomical substrate for atrial fibrillation (AF). AF is the arrhythmia most commonly described in patients with OSA. Several observational studies have shown that the treatment of OSA with continuous positive airway pressure (CPAP) reduces recurrence of AF after electrical cardioversion and catheter ablation. There is also evidence that nocturnal hypoxemia, a hallmark of OSA, predicts sudden cardiac death (SCD) independently of well-established cardiovascular risk factors. Among patients with an implantable cardiac defibrillator, those with OSA have a higher risk of receiving treatment for life-threatening arrhythmias. Nocturnal hypoxemia may also increase vagal tone, which increases susceptibility to bradycardic and conduction rhythm disorders that have also been described in patients with OSA. In conclusion, there are several biological pathways linking OSA and increased cardiac arrhythmogenesis propensity. However, the independent association is derived from observational studies and the direction of the association still needs clarification due to the lack of large clinical trials. This review focuses on the current scientific evidence linking OSA to cardiac rhythm disorders and point out future directions.
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Affiliation(s)
- Glaucylara Reis Geovanini
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Genetics and Molecular Cardiology Laboratory, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Geraldo Lorenzi-Filho
- Sleep Laboratory, Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Chen R, Chen K, Dai Y, Zhang S. Utility of transthoracic impedance and novel algorithm for sleep apnea screening in pacemaker patient. Sleep Breath 2018; 23:741-746. [PMID: 30470999 PMCID: PMC6700044 DOI: 10.1007/s11325-018-1755-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 12/04/2022]
Abstract
Background Pacing patients was revealed with a high prevalence of sleep disorder, but mostly undiagnosed. The pacemaker with transthoracic impedance sensor and novel algorithm could identify sleep apnea (SA) event. This study aimed to evaluate accuracy of pacemaker in sleep apnea diagnosis. Methods This is a prospective study which enrolled patients implanted with pacemakers integrated with transthoracic impedance sensor and SA-identified algorithm (AP Scan). All patients underwent a polysomnography (PSG). The apnea and hypopnea index (AHI) of the PSG (PSG-AHI) and the respiratory disturbance index (RDI) of the pacemaker (PM-RDI) were recorded on the same night. The correlation between two methods was evaluated by the kappa coefficient, receiver operating characteristic (ROC) curves, and Bland and Altman statistics. Results Sixty-four patients were enrolled, who had never been diagnosed with SAS or underwent PSG exam. After PSG examination, 76.4% patients were diagnosed as combining with SA (20% severe, 18.2% moderate, and 38.2% mild). RDI calculated by PM has a strong positive correlation with PSG-AHI (r = 0.76, p < 0.001, 95% CI 0.61–0.85). The optimal cutoff value of PM-RDI for advanced SAS (PSG-AHI ≥ 15) diagnosis was 26, with AUC of 0.89 (95% CI 0.77 to 0.96, p < 0.001). The best cutoff value for severe SA (PSG-AHI ≥ 30) identification was 41, with a sensitivity of 81.6%, a specificity of 88.6%. Conclusions Pacemaker patients present a high prevalence of undiagnosed SA. Detection of SA by pacemaker is feasible and accurate in SA screening and monitoring.
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Affiliation(s)
- RuoHan Chen
- Center of Arrhythmia, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road 167#, Xicheng Qu, Beijing, 100037, China
| | - KePing Chen
- Center of Arrhythmia, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road 167#, Xicheng Qu, Beijing, 100037, China.
| | - Yan Dai
- Center of Arrhythmia, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road 167#, Xicheng Qu, Beijing, 100037, China
| | - Shu Zhang
- Center of Arrhythmia, Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beilishi Road 167#, Xicheng Qu, Beijing, 100037, China
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Heart Rhythm 2018; 16:e227-e279. [PMID: 30412777 DOI: 10.1016/j.hrthm.2018.10.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Indexed: 12/22/2022]
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Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society. Circulation 2018; 140:e333-e381. [PMID: 30586771 DOI: 10.1161/cir.0000000000000627] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | | | - Kenneth A Ellenbogen
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,ACC/AHA Representative
| | - Michael R Gold
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative
| | | | | | - José A Joglar
- ACC/AHA Task Force on Clinical Practice Guidelines Liaison
| | | | | | | | | | | | | | - Cara N Pellegrini
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for detailed information.,HRS Representative.,Dr. Pellegrini contributed to this article in her personal capacity. The views expressed are her own and do not necessarily represent the views of the US Department of Veterans Affairs or the US government
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Tamisier R, Weiss JW, Pépin JL. Sleep biology updates: Hemodynamic and autonomic control in sleep disorders. Metabolism 2018; 84:3-10. [PMID: 29572132 DOI: 10.1016/j.metabol.2018.03.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 02/07/2023]
Abstract
Sleep disorders like obstructive sleep apnea syndrome, periodic limb movements in sleep syndrome, insomnia and narcolepsy-cataplexy are all associated with an increased risk of cardiovascular diseases. These disorders share an impaired autonomic nervous system regulation that leads to increased cardiovascular sympathetic tone. This increased cardiovascular sympathetic tone is, in turn, likely to play a major role in the increased risk of cardiovascular disease. Different stimuli, such as intermittent hypoxia, sleep fragmentation, decrease in sleep duration, increased respiratory effort, and transient hypercapnia may all initiate the pathophysiological cascade leading to sympathetic overactivity and some or all of these are encountered in these different sleep disorders. In this manuscript, we outline the different pathways leading to sympathetic over-activity in different sleep conditions. This augmented sympathetic tone is likely to play an important role in the development of cardiovascular disease in patients with sleep disorders, and it is further hypothesized to that sympathoexcitation contributes to the metabolic dysregulation associated with these sleep disorders.
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Affiliation(s)
- Renaud Tamisier
- University Grenoble Alpes, HP2, Inserm 1042, Grenoble F-38042, France; Physiology Sleep and Exercise Clinic, Thorax and Vessel division, Grenoble Alpes hospital, Grenoble 38043, France.
| | - J Woodrow Weiss
- Pulmonary Physiology Laboratory, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, United States
| | - Jean Louis Pépin
- University Grenoble Alpes, HP2, Inserm 1042, Grenoble F-38042, France; Physiology Sleep and Exercise Clinic, Thorax and Vessel division, Grenoble Alpes hospital, Grenoble 38043, France
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Pépin JL, Tamisier R, Hwang D, Mereddy S, Parthasarathy S. Does remote monitoring change OSA management and CPAP adherence? Respirology 2018; 22:1508-1517. [PMID: 29024308 DOI: 10.1111/resp.13183] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 12/15/2022]
Abstract
It is increasingly recognized that the high prevalence of obstructive sleep apnoea (OSA), and its associated cardio-metabolic morbidities make OSA a burden for society. Continuous positive airway pressure (CPAP), the gold standard treatment, needs to be used for more than 4 h/night to be effective, but suffers from relatively poor adherence. Furthermore, CPAP is likely to be more effective if combined with lifestyle changes. Thus, the remote telemonitoring (TM) of OSA patients in terms of CPAP use, signalling of device problems, following disease progression, detection of acute events and monitoring of daily physical activity is an attractive option. In the present review, we aim to summarize the recent scientific data on remote TM of OSA patients, and whether it meets expectations. We also look at how patient education and follow-up via telemedicine is used to improve adherence and we discuss the influence of the profile of the healthcare provider. Then, we consider how TM might be extended to encompass the patient's cardio-metabolic health in general. Lastly, we explore how TM and the deluge of data it potentially generates could be combined with electronic health records in providing personalized care and multi-disease management to OSA patients.
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Affiliation(s)
- Jean L Pépin
- Laboratory for Hypoxia and Pathophysiology, University of Grenoble Alpes, Grenoble, France.,Inserm U1042 and Pole Thorax and Vaisseaux, Grenoble Alps University Hospital, Grenoble, France
| | - Renaud Tamisier
- Laboratory for Hypoxia and Pathophysiology, University of Grenoble Alpes, Grenoble, France.,Inserm U1042 and Pole Thorax and Vaisseaux, Grenoble Alps University Hospital, Grenoble, France
| | - Dennis Hwang
- Sleep Medicine, Southern California Permanente Medical Group, Kaiser Permanente Fontana Sleep Disorders Center, Fontana, California, USA
| | - Suresh Mereddy
- Department of Medicine, University of Arizona, Tucson, Arizona, USA.,University of Arizona Health Sciences, Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona, USA
| | - Sairam Parthasarathy
- Department of Medicine, University of Arizona, Tucson, Arizona, USA.,University of Arizona Health Sciences, Center for Sleep and Circadian Sciences, University of Arizona, Tucson, Arizona, USA
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Abstract
Le syndrome d'apnées obstructives du sommeil (SAOS) touche environ 4% des hommes et 2% des femmes d'âge moyen mais beaucoup de ces patients ne sont ni diagnostiqués ni traités. Une morbidité et une mortalité cardio et cérébrovasculaires sont associées aux apnées du sommeil. La notion de lien de causalité s'est confirmée ces dernières années sur des données épidémiologiques, expérimentales et thérapeutiques. La prévalence dans la population générale et l'impact sur la genèse et l'évolution de l'hypertension artérielle systémique et pulmonaire, des troubles du rythme cardiaque, de la maladie coronarienne, de l'insuffisance cardiaque et des accidents vasculaires cérébraux doivent inciter à diagnostiquer et à traiter précocement les troubles respiratoires du sommeil et si possible à les prévenir.
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Affiliation(s)
- Abdelmajid Bouzerda
- Service de Cardiologie, Premier Centre Médico-chirurgical, Université Cadi Ayyad, Faculté de Médecine et de Pharmacie de Marrakech, Maroc
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Type D Personality and Sleep Quality in Coronary Artery Disease Patients With and Without Obstructive Sleep Apnea: Mediating Effects of Anxiety and Depression. Int J Behav Med 2018; 25:171-182. [DOI: 10.1007/s12529-017-9708-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Champ-Rigot L, Ferchaud V, Prévost JN, Moirot P, Pellissier A, Legallois D, Alexandre J, Scanu P, Morello R, Saloux E, Milliez PU. Rationale and Design for a Monocentric Prospective Study: Sleep Apnea Diagnosis Using a Novel Pacemaker Algorithm and Link With Aldosterone Plasma Level in Patients Presenting With Diastolic Dysfunction (SAPAAD Study). CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546817751628. [PMID: 29343998 PMCID: PMC5764134 DOI: 10.1177/1179546817751628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 12/07/2017] [Indexed: 11/18/2022]
Abstract
Previous studies showed good agreement between pacemaker respiratory disturbance index (RDI) and polysomnography for diagnosis of severe sleep apnea (SA). The aim of this study is to investigate the diagnostic accuracy of RDI compared with apnea-hypopnea index (AHI) from a cardiorespiratory sleep study for the diagnosis of severe SA within patients requiring a pacemaker and meeting diastolic dysfunction criteria. Secondary objectives are as follows: correlation between plasma aldosterone level and SA severity, diagnostic accuracy of RDI for moderate SA, prevalence of SA among patients with diastolic dysfunction, occurrence of arrhythmias, and improvement of RDI with continuous positive airway pressure therapy. We designed a monocentric prospective nonrandomized study of prevalent cases to include 68 patients with a 6-month follow-up. Both RDI and AHI will be compared 2 months after implantation and after 1 month of continuous positive airway pressure treatment in patients with severe SA. This is the first study that examines diagnostic accuracy of pacemaker algorithm for the diagnosis of SA and correlation with plasma aldosterone levels in patients with diastolic dysfunction. Protocol version: V04. 04/04/2017 Trial registration: ClinicalTrials.gov NCT02751021.
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Affiliation(s)
- Laure Champ-Rigot
- Department of Cardiology, CHU de Caen, Caen, France
- EA4650, Université Caen Normandie, Caen, France
| | | | | | | | | | - Damien Legallois
- Department of Cardiology, CHU de Caen, Caen, France
- EA4650, Université Caen Normandie, Caen, France
| | - Joachim Alexandre
- Department of Cardiology, CHU de Caen, Caen, France
- EA4650, Université Caen Normandie, Caen, France
- Department of Pharmacology, CHU de Caen, Caen, France
| | | | - Remy Morello
- Department of Biostatistics and Clinical Research, CHU de Caen, Caen, France
| | - Eric Saloux
- Department of Cardiology, CHU de Caen, Caen, France
- EA4650, Université Caen Normandie, Caen, France
| | - Paul Ursmar Milliez
- Department of Cardiology, CHU de Caen, Caen, France
- EA4650, Université Caen Normandie, Caen, France
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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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Implantable cardioverter-defibrillator-computed respiratory disturbance index accurately identifies severe sleep apnea: The DASAP-HF study. Heart Rhythm 2017; 15:211-217. [PMID: 29017928 DOI: 10.1016/j.hrthm.2017.09.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Sleep apnea (SA) is a relevant issue in the management of patients with heart failure for risk stratification and for implementing treatment strategies. OBJECTIVE The purpose of this study was to evaluate in patients with implantable cardioverter-defibrillators (ICDs) the performance of the respiratory disturbance index (RDI) computed by the ApneaScan algorithm (Boston Scientific Inc., Natick, MA) as a discriminator of severe SA. METHODS ICD-indicated patients with left ventricular ejection fraction ≤35% were enrolled. One month after implantation, patients underwent a polysomnographic study. We evaluated the accuracy of the RDI for the prediction of severe SA (apnea-hypopnea index [AHI] ≥30 episodes/h) and the agreement between RDI and AHI during the sleep study night. RESULTS Two hundred sixty-five patients were enrolled to obtain the required sample of 173 patients with AHI and RDI data for analysis. The mean AHI was 21 ± 15 episodes/h and severe SA was diagnosed in 38 patients (22%), while the mean RDI was 33 ± 13 episodes/h. On the basis of the receiver operating characteristic curve analysis of RDI values, the area under the curve was 0.77 (95% confidence interval [CI] 0.70-0.83; P < .001). At an RDI value of 31 episodes/h, severe SA was detected with 87% (95% CI 72%-96%) sensitivity and 56% (95% CI 48%-66%) specificity. RDI closely correlated with AHI recorded during the same night (r = 0.74; 95% CI 0.57-0.84; P < .001), and the Bland-Altman agreement analysis revealed a bias of 11 episodes/h, with limits of agreement being -10 to 32 episodes/h. CONCLUSION The RDI accurately identified severe SA and demonstrated good agreement with AHI. Therefore, it may serve as an efficient tool for screening patients at risk of SA.
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