1
|
Testelmans D, Kalkanis A, Papadopoulos D, Demolder S, Buyse B. Central sleep apnea: emphasizing recognition and differentiation. Expert Rev Respir Med 2024:1-12. [PMID: 38878064 DOI: 10.1080/17476348.2024.2369256] [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: 03/25/2024] [Accepted: 06/13/2024] [Indexed: 06/19/2024]
Abstract
INTRODUCTION Central sleep apnea (CSA) is a sleep-related breathing disorder in which the effort to breathe is intermittently diminished or absent. CSA is a common disorder among patients with different cardiovascular disorders, including heart failure. In addition, a growing number of medications have been shown to induce CSA and CSA can emerge after initiation of treatment for obstructive sleep apnea. Accumulating evidence shows that CSA is a heterogeneous disorder with individual differences in clinical and biological characteristics and/or underlying pathophysiological mechanisms. AREAS COVERED This narrative review offers an overview of the diagnostic aspects and classification of CSA, with an emphasis on heart failure patients, patients with CSA due to a medication and treatment-emergent CSA. The importance of evaluation of prognostic biomarkers in patients with different types of CSA is discussed. This narrative review synthesizes literature on CSA sourced from the PubMed database up to February 2024. EXPERT OPINION CSA presents a remarkably diverse disorder, with treatment modalities exhibiting potentially varied efficacy across its various phenotypes. This highlights the imperative for tailored management strategies that are rooted in phenotype classification.
Collapse
Affiliation(s)
- Dries Testelmans
- Department of Pneumology, Leuven University Center for Sleep and Wake disorders, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Alexandros Kalkanis
- Department of Pneumology, Leuven University Center for Sleep and Wake disorders, University Hospitals Leuven, Leuven, Belgium
| | - Dimitrios Papadopoulos
- Department of Pneumology, Leuven University Center for Sleep and Wake disorders, University Hospitals Leuven, Leuven, Belgium
| | - Saartje Demolder
- Department of Pneumology, Leuven University Center for Sleep and Wake disorders, University Hospitals Leuven, Leuven, Belgium
| | - Bertien Buyse
- Department of Pneumology, Leuven University Center for Sleep and Wake disorders, University Hospitals Leuven, Leuven, Belgium
- Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| |
Collapse
|
2
|
Bhagavan H, Wei AD, Oliveira LM, Aldinger KA, Ramirez JM. Chronic intermittent hypoxia elicits distinct transcriptomic responses among neurons and oligodendrocytes within the brainstem of mice. Am J Physiol Lung Cell Mol Physiol 2024; 326:L698-L712. [PMID: 38591125 DOI: 10.1152/ajplung.00320.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/22/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
Chronic intermittent hypoxia (CIH) is a prevalent condition characterized by recurrent episodes of oxygen deprivation, linked to respiratory and neurological disorders. Prolonged CIH is known to have adverse effects, including endothelial dysfunction, chronic inflammation, oxidative stress, and impaired neuronal function. These factors can contribute to serious comorbidities, including metabolic disorders and cardiovascular diseases. To investigate the molecular impact of CIH, we examined male C57BL/6J mice exposed to CIH for 21 days, comparing with normoxic controls. We used single-nucleus RNA sequencing to comprehensively examine the transcriptomic impact of CIH on key cell classes within the brainstem, specifically excitatory neurons, inhibitory neurons, and oligodendrocytes. These cell classes regulate essential physiological functions, including autonomic tone, cardiovascular control, and respiration. Through analysis of 10,995 nuclei isolated from pontine-medullary tissue, we identified seven major cell classes, further subdivided into 24 clusters. Our findings among these cell classes, revealed significant differential gene expression, underscoring their distinct responses to CIH. Notably, neurons exhibited transcriptional dysregulation of genes associated with synaptic transmission, and structural remodeling. In addition, we found dysregulated genes encoding ion channels and inflammatory response. Concurrently, oligodendrocytes exhibited dysregulated genes associated with oxidative phosphorylation and oxidative stress. Utilizing CellChat network analysis, we uncovered CIH-dependent altered patterns of diffusible intercellular signaling. These insights offer a comprehensive transcriptomic cellular atlas of the pons-medulla and provide a fundamental resource for the analysis of molecular adaptations triggered by CIH.NEW & NOTEWORTHY This study on chronic intermittent hypoxia (CIH) from pons-medulla provides initial insights into the molecular effects on excitatory neurons, inhibitory neurons, and oligodendrocytes, highlighting our unbiased approach, in comparison with earlier studies focusing on single target genes. Our findings reveal that CIH affects cell classes distinctly, and the dysregulated genes in distinct cell classes are associated with synaptic transmission, ion channels, inflammation, oxidative stress, and intercellular signaling, advancing our understanding of CIH-induced molecular responses.
Collapse
Affiliation(s)
- Hemalatha Bhagavan
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Aguan D Wei
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Luiz M Oliveira
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, United States
| | - Kimberly A Aldinger
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, United States
- Department of Pediatrics, University of Washington, Seattle, Washington, United States
- Department of Neurology, University of Washington, Seattle, Washington, United States
| | - Jan-Marino Ramirez
- Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, Washington, United States
- Department of Pediatrics, University of Washington, Seattle, Washington, United States
- Department of Neurological Surgery, University of Washington, Seattle, Washington, United States
| |
Collapse
|
3
|
Tamisier R, Damy T, Bailly S, Goutorbe F, Davy JM, Lavergne F, Palot A, Verbraecken JA, d'Ortho MP, Pépin JL, d'Ortho MP, Pépin JL, Davy JM, Damy T, Tamisier R. FACE study: 2-year follow-up of adaptive servo-ventilation for sleep-disordered breathing in a chronic heart failure cohort. Sleep Med 2024; 113:412-421. [PMID: 37612192 DOI: 10.1016/j.sleep.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a common comorbidity in patients with heart failure (HF) and is associated with worse prognosis. OBJECTIVES This study evaluated the effects of adaptive servo-ventilation (ASV) on morbidity and mortality in a large heterogeneous population of HF patients with different etiologies/phenotypes. METHODS Consecutive HF patients with predominant central sleep apnea (± obstructive sleep apnea) indicated for ASV were included; the control group included patients who refused or stopped ASV before three months follow-up. Six homogenous clusters were determined using the latent class analysis (LCA) method. The primary endpoint was time to composite first event (all-cause death, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening of chronic HF). RESULTS Of 503 patients at baseline, 324 underwent 2-year follow-up. Compared to control group, 2-year primary endpoint event-free survival was significantly greater in patients in ASV group only in univariable analysis (1.67, 95% [1.12-2.49]; p = 0.01). Secondary endpoints, event-free of cardiovascular death or heart failure-related hospitalization and all-cause death or all-cause hospitalization were positively impacted by ASV (univariate and multivariable analysis). LCA identified two groups, with preserved and mid-range left ventricular ejection fraction (LVEF) and severe hypoxia, in whom ASV increase prognosis benefit. CONCLUSIONS Patients with HF and SDB are a highly heterogeneous group identified using LCA. Systematic deep phenotyping is essential to ensure that ASV is prescribed to those benefit from therapy, as ASV use in patients with severe hypoxic burden and those with HFpEF was associated with a significant reduction in cardiovascular events and mortality. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT01831128.
Collapse
Affiliation(s)
- Renaud Tamisier
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France.
| | - Thibaud Damy
- Service de Cardiologie, Centre de Référence Amyloses Cardiaques, GRC ARI, DHU ATVB, AP-HP, Hôpital Henri Mondor, Créteil, France; UFR médecine Université Paris-Est Créteil, France; Unité INSERM U981, Créteil, France
| | - Sébastien Bailly
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France
| | | | - Jean-Marc Davy
- Service de Cardiologie, CHU, Montpellier, France; UFR Médecine Université Montpellier, France
| | | | | | - Johan A Verbraecken
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium
| | - Marie-Pia d'Ortho
- Université de Paris, Neuro Diderot, Inserm, Paris, France; Département de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat, Paris, France
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France
| | - Marie-Pia d'Ortho
- Université de Paris, Neuro Diderot, Inserm, Paris, France; Département de Physiologie - Explorations Fonctionnelles, AP-HP, Hôpital Bichat, Paris, France
| | - Jean-Louis Pépin
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France
| | - Jean-Marc Davy
- Service de Cardiologie, CHU, Montpellier, France; UFR Médecine Université Montpellier, France
| | - Thibaud Damy
- Service de Cardiologie, Centre de Référence Amyloses Cardiaques, GRC ARI, DHU ATVB, AP-HP, Hôpital Henri Mondor, Créteil, France; UFR médecine Université Paris-Est Créteil, France; Unité INSERM U981, Créteil, France
| | - Renaud Tamisier
- Univ. Grenoble Alpes, Inserm 1300, HP2, Grenoble, France; Service Hospitalo-Universitaire Pneumologie et Physiologie, Pole Thorax et Vaisseaux, CHU de Grenoble Alpes, Grenoble, France
| |
Collapse
|
4
|
Luo YM, Chen YY, Liang SF, Wu LG, Wellman A, McEvoy RD, Steier J, Eckert DJ, Polkey MI. Central sleep apnea treated by a constant low-dose CO 2 supplied by a novel device. J Appl Physiol (1985) 2023; 135:977-984. [PMID: 37675475 DOI: 10.1152/japplphysiol.00312.2023] [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: 05/15/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/08/2023] Open
Abstract
CO2 inhalation has been previously reported as a treatment for central sleep apnea both when associated with heart failure or where the cause is unknown. Here, we evaluated a novel CO2 supply system using a novel open mask capable of comfortably delivering a constantly inspired fraction of CO2 ([Formula: see text]) during sleep. We recruited 18 patients with central sleep apnea (13 patients with cardiac disease, and 5 patients idiopathic) diagnosed by diaphragm electromyogram (EMG) recordings made during overnight full polysomnography (PSG) (night 1). In each case, the optimal [Formula: see text] was determined by an overnight manual titration with PSG (night 2). Titration commenced at 1% CO2 and increased by 0.2% increments until central sleep apnea (CSA) disappeared. Patients were then treated on the third night (night 3) with the lowest therapeutically effective concentration of CO2 derived from night 2. Comparing night 1 and night 3, both apnea-hypopnea index (AHI; 31 ± 14 vs. 6 ± 3 events/h, P < 0.01) and arousal index (22 ± 8 vs. 15 ± 8 events/h, P < 0.01) were significantly improved during CO2 treatment. Sleep efficiency improved from 71 ± 18 to 80 ± 11%, P < 0.05, and sleep latency was shorter (23 ± 18 vs. 10 ± 10 min, P < 0.01). Heart rate was not different between night 1 and night 3. Our data confirm the feasibility of our CO2 delivery system and indicate that individually titrated CO2 supplementation with a novel device including a special open mask can reduce sleep disordered breathing severity and improve sleep quality. Randomized controlled studies should now be undertaken to assess therapeutic benefit for patients with CSA.NEW & NOTEWORTHY A novel device using a special mask was developed and proved that CO2 therapy using the device could eliminate central sleep apnea (CSA) events and improve sleep quality including reducing arousal index in patients with heart failure. The device would become a useful clinical treatment for heart failure patients with CSA.
Collapse
Affiliation(s)
- Yuan-Ming Luo
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, People's Republic of China
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
- College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Yong-Yi Chen
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Shan-Feng Liang
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Lu-Guang Wu
- State Key Laboratory of Respiratory Disease, Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Andrew Wellman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - R Doug McEvoy
- College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Joerg Steier
- Lane Fox Respiratory Unit/Sleep Disorders Centre, London, United Kingdom
| | - Danny J Eckert
- College of Medicine and Public Health, Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael I Polkey
- Royal Brompton Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
5
|
MacArthur JAL, Yong GL, Dweck MR, Fairbairn TA, Weir-McCall J, Puyol-Antón E, Meldrum J, Blakelock P, Khan S, Morrice L, Sudlow CLM, Williams MC. Cardiovascular imaging research priorities. Open Heart 2023; 10:e002378. [PMID: 37586846 PMCID: PMC10432634 DOI: 10.1136/openhrt-2023-002378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/21/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES Two interlinked surveys were organised by the British Heart Foundation Data Science Centre, which aimed to establish national priorities for cardiovascular imaging research. METHODS First a single time point public survey explored their views of cardiovascular imaging research. Subsequently, a three-phase modified Delphi prioritisation exercise was performed by researchers and healthcare professionals. Research questions were submitted by a diverse range of stakeholders to the question 'What are the most important research questions that cardiovascular imaging should be used to address?'. Of these, 100 research questions were prioritised based on their positive impact for patients. The 32 highest rated questions were further prioritised based on three domains: positive impact for patients, potential to reduce inequalities in healthcare and ability to be implemented into UK healthcare practice in a timely manner. RESULTS The public survey was completed by 354 individuals, with the highest rated areas relating to improving treatment, quality of life and diagnosis. In the second survey, 506 research questions were submitted by diverse stakeholders. Prioritisation was performed by 90 researchers or healthcare professionals in the first round and 64 in the second round. The highest rated questions were 'How do we ensure patients have equal access to cardiovascular imaging when it is needed?' and 'How can we use cardiovascular imaging to avoid invasive procedures'. There was general agreement between healthcare professionals and researchers regarding priorities for the positive impact for patients and least agreement for their ability to be implemented into UK healthcare practice in a timely manner. There was broad overlap between the prioritised research questions and the results of the public survey. CONCLUSIONS We have identified priorities for cardiovascular imaging research, incorporating the views of diverse stakeholders. These priorities will be useful for researchers, funders and other organisations planning future research.
Collapse
Affiliation(s)
| | - Guo Liang Yong
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Timothy A Fairbairn
- Liverpool Centre for Cardiovascular Science, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Jonathan Weir-McCall
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Esther Puyol-Antón
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Julian Meldrum
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Phillip Blakelock
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Samaira Khan
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Lynn Morrice
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Cathie L M Sudlow
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
| | - Michelle C Williams
- British Heart Foundation Data Science Centre, Health Data Research UK, London, UK
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Jaffuel D, Bouchaut Y, Mallet JP, Vidal C, Molinari N, Bourdin A, Roubille F. Dapagliflozin initiation in chronic heart failure patients improves central sleep apnoea. ERJ Open Res 2023; 9:00123-2023. [PMID: 37377653 PMCID: PMC10291304 DOI: 10.1183/23120541.00123-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/30/2023] [Indexed: 06/29/2023] Open
Abstract
Dapagliflozin decreases central sleep apnoea in central sleep apnoea patients, thereby sparing the initiation of ventilatory therapy https://bit.ly/41e2fm0.
Collapse
Affiliation(s)
- Dany Jaffuel
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Yannick Bouchaut
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
- Department of Cardiology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
| | - Jean-Pierre Mallet
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - Célia Vidal
- IDESP, INSERM, PreMEdical INRIA, Univ Montpellier, CHU Montpellier, Montpellier, France
- Groupe Adène, Montpellier, France
| | - Nicolas Molinari
- IDESP, INSERM, PreMEdical INRIA, Univ Montpellier, CHU Montpellier, Montpellier, France
- Groupe Adène, Montpellier, France
| | - Arnaud Bourdin
- Department of Pneumology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | - François Roubille
- PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Montpellier, France
- Department of Cardiology, Arnaud de Villeneuve, Regional University Hospital of Montpellier, Montpellier, France
| |
Collapse
|
7
|
Carey SA, van Zyl JS, Williams S, Alam A, Maliakkal N, Shakoor HI, Jamil AK, Felius J, Germany R, Afzal A. The Utility of Home Sleep Apnea Testing in the Advanced Heart Failure Populations. Am J Cardiol 2023; 191:8-13. [PMID: 36621055 DOI: 10.1016/j.amjcard.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/14/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
Untreated sleep disorders form a risk of coronary artery disease, hypertension, obesity, and diabetes mellitus. Access to polysomnography is limited, especially during the COVID-19 pandemic, with home sleep apnea testing (HSAT) being a potentially viable alternative. We describe an HSAT protocol in patients with advanced heart failure (HF). In a single-center, observational analysis between 2019 and 2021 in patients with advanced HF and heart transplant (HT), 135 screened positive on the STOP-Bang sleep survey and underwent a validated HSAT (WatchPAT, ZOLL-Itamar). HSAT was successful in 123 patients (97.6%), of whom 112 (91.1%; 84 HF and 28 HT) tested positive for sleep apnea. A total of 91% of sleep apnea cases were obstructive, and 63% were moderate to severe. Multivariable linear regression showed that the apnea hypopnea index was 34% lower in the HT group than in the HF group (p = 0.046) after adjusting for gender, and that this effect persisted in White patients but not among African-Americans. Patient characteristics were similar between groups, with coronary artery disease, diabetes mellitus, and hypertension as the most prevalent co-morbidities. In conclusion, sleep apnea remains prevalent in patients with HF with a high co-morbidity burden. HSAT is a feasible and effective tool for screening and diagnosis in this population.
Collapse
Affiliation(s)
- Sandra A Carey
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Johanna S van Zyl
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Texas A&M University Health Science Center College of Medicine, Dallas, Texas
| | - Sarah Williams
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Amit Alam
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Texas A&M University Health Science Center College of Medicine, Dallas, Texas
| | - Neville Maliakkal
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Hira I Shakoor
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas
| | - Aayla K Jamil
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Texas A&M University Health Science Center College of Medicine, Dallas, Texas
| | - Joost Felius
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Dallas, Texas; Texas A&M University Health Science Center College of Medicine, Dallas, Texas
| | | | - Aasim Afzal
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; The Heart Hospital Baylor Plano, Baylor Scott & White Health, Plano, Texas
| |
Collapse
|
8
|
Prevalence and clinical characteristics of sleep-disordered breathing in patients with heart failure of different left ventricular ejection fractions. Sleep Breath 2023; 27:245-253. [PMID: 35394577 DOI: 10.1007/s11325-022-02611-4] [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: 12/22/2021] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
Abstract
PURPOSES The prevalence of sleep-disordered breathing (SDB) is high in patients with heart failure (HF), while the prevalence of SDB in HF with different left ventricular ejection fractions (LVEF) has rarely been reported. We aimed to explore the prevalence and clinical characteristics of SDB in patients with HF having different LVEF. METHODS Patients with stable HF were consecutively enrolled. All patients underwent portable overnight cardiorespiratory polygraphy and echocardiography. According to their LVEF, the patients were divided into the HFrEF (HF with reduced EF, EF < 40%), HFmrEF (HF with mid-range EF, 40 ≤ EF < 50), and HFpEF groups (HF with preserved EF, EF ≥ 50%). The prevalence and clinical data of SDB among the 3 groups were then compared. RESULTS A total of 252 patients, including 134 men, were enrolled in the study. The prevalence of SDB in patients with HF was 70%. Obstructive sleep apnea (OSA) was diagnosed in 48% and central sleep apnea (CSA) in 22%. The prevalence of SDB in the HFrEE, HFmrEF, and HFpEF groups was 86%, 86%, and 62%, respectively (P = 0.001). The prevalence of OSA among the 3 groups was 42%, 47%, and 49%, respectively (P = 0.708), while the prevalence of CSA among the 3 groups was 44%, 40%, and 13% (P < 0.001). Logistic regression analysis revealed that age and BMI were independent risk factors for OSA in patients with HF, while LVEF and smoking were independent risk factors for CSA in patients with HF. Correlational analyses revealed that LVEF was negatively correlated with apnea-hypopnea index (AHI) (r = -0.309, P < 0.001) and central apnea index (CAI) ( r = -0.558, P < 0.001), while there was no significant correlation with obstructive apnea index (OAI). The ROC curve revealed that LVEF could predict the occurrence of CSA and SDB, with AUC = 0.683 (95%CI 0.600-0.767, P < 0.001) and AUC = 0.630 (95%CI 0.559-0.702, P = 0.001), but not of OSA. CONCLUSIONS SDB was highly common in HF, and the prevalence of SDB was different in HF with different LVEF, mainly due to the difference in cardiac functions. The prevalence and severity of SDB in HFrEF and HFmrEF were significantly higher than those in HFpEF, which was mainly related to the increase in CSA. When HFmrEF was similar to HFrEF in cardiac functions, the prevalence, type, and severity of SDB were similar between the two groups. Changes in LVEF had a significant impact on CAI, but not on OAI. LVEF can predict the occurrence of CSA and SDB to a certain extent.
Collapse
|
9
|
Ullah MI, Tamanna S, Bhagat R. High nocturnal periodic breathing reported by PAP adherence data predicts decompensation of heart failure. J Clin Sleep Med 2023; 19:431-441. [PMID: 36310394 PMCID: PMC9978441 DOI: 10.5664/jcsm.10346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/12/2022] [Accepted: 10/13/2022] [Indexed: 03/03/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) often coexists with heart failure (HF) and is commonly treated with positive airway pressure (PAP) therapy. Periodic breathing (PB) may be present in HF and is an indicator of poor prognosis, but there is no easy way to detect PB in an outpatient setting. However, it can be detected by analyzing PAP usage data. The study aimed to assess if high PB% detected by PAP machine could predict impending HF exacerbation and if better PAP adherence is associated with reduced hospitalization and mortality. METHODS We retrospectively reviewed medical records of 115 patients with OSA from the sleep clinic of our VA Medical Center. The cross-sectional data on demographics, labs, PAP adherence, PB% in the previous 30 days, echocardiogram in the previous 6 months, and hospitalizations and mortality in the subsequent 180 days were extracted. Based on left ventricular ejection fraction (LVEF), patients were classified into (1) HF with normal-midrange LVEF (LVEF ≥40%, n = 74) and (2) HF with reduced LVEF (LVEF < 40%, n = 41). Pairwise correlation and linear regressions were done to assess predictors of PB%. Binomial and logistic regressions assessed the relationship of PB% and PAP adherence with hospitalization from HF and all-cause mortality. RESULTS In the HF with reduced LVEF group, the mean PB% was 2.6 times higher (P < .001) and PAP adherence was 29% lower (P < .001). PB% positively correlated with brain natriuretic peptide level (r = .447, P < .01) and number of hospitalizations (r = .331, P < .01). Higher PB% negatively correlated with LVEF (r = -.423, P < .01) and estimated glomerular filtration rate (r = -.246, P < .01). Every 10% increase in PAP adherence decreased odds of hospitalization by 0.78 times (P < .001) and odds of death by 0.86 (P = .043). CONCLUSIONS High PB% detected by PAP machine data is a predictor of impending HF exacerbation and hospitalization. Improved PAP adherence and optimization of medical therapy may reduce hospitalization and all-cause mortality. CITATION Ullah MI, Tamanna S, Bhagat R. High nocturnal periodic breathing reported by PAP adherence data predicts decompensation of heart failure. J Clin Sleep Med. 2023;19(3):431-441.
Collapse
Affiliation(s)
- Mohammad I. Ullah
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Sadeka Tamanna
- Department of Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
| | - Rajesh Bhagat
- Department of Medicine, G.V. (Sonny) Montgomery VA Medical Center, Jackson, Mississippi
| |
Collapse
|
10
|
Schmid JP. When engineering meets medicine: «Loop gain» analysis vs visual diagnosis of exertional oscillatory ventilation. Eur J Prev Cardiol 2023; 30:zwad047. [PMID: 36790365 DOI: 10.1093/eurjpc/zwad047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Affiliation(s)
- Jean-Paul Schmid
- Department of Cardiology, Clinic Gais, CH-9056 Gais, Switzerland
| |
Collapse
|
11
|
Bonsignore MR, La Rovere MT. Sympathetic activation in patients with heart failure and central sleep apnoea: is it friend or foe? Eur Respir J 2023; 61:61/2/2202170. [PMID: 36758996 DOI: 10.1183/13993003.02170-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 02/11/2023]
Affiliation(s)
- Maria R Bonsignore
- PROMISE Department, University of Palermo, Palermo, Italy
- IRIB-CNR, Palermo, Italy
- Respiratory Division, V Cervello Hospital, Ospedali Riuniti Villa Sofia Cervello, Palermo, Italy
| | - Maria Teresa La Rovere
- Department of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Istituto Scientifico di Montescano, Montescano, Italy
| |
Collapse
|
12
|
Hill L, Meyer T, McKane S, Lainscak M, Ahmed QA. Transvenous phrenic nerve stimulation to treat central sleep apnoea in patients with heart failure may improve sleep, quality of life, and symptoms. Eur J Cardiovasc Nurs 2022:6706603. [PMID: 36125322 DOI: 10.1093/eurjcn/zvac086] [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: 04/29/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND AND AIM Sleep disorder breathing is an important non-cardiovascular comorbidity in patients with heart failure (HF). However, central sleep apnoea (CSA) remains poorly diagnosed and treated. This post-hoc analysis examined symptoms and quality of life in patients with CSA and HF following 12 months of transvenous phrenic nerve stimulation (TPNS) therapy. METHODS AND RESULT : Patients enrolled in remedē System Pivotal trial were invited to complete self-reported questionnaires. Symptoms and responses to three validated questionnaires were examined. Percentage of patients noting an impairment was calculated at baseline. At 12 months, % of patients experiencing improvement, no change, or worsening was calculated. Shifts from symptom presence at baseline to absence at 12 months was assessed for those symptoms experienced by ≥50% of patients at baseline. Seventy-five patients were included. Most frequently reported symptoms were fatigue and daytime sleepiness. Following 12 months of TPNS, a variety of subjective improvements were observed; 45% of patients indicating cessation of daytime sleepiness, 44% cessation of fatigue/weakness, and 52% no longer having difficulty falling/staying asleep. Specific questions related to tiredness/fatigue, motivation, and chance of dozing provided an insight into potential areas of improvement. Furthermore, at least 60% of patients reported resolution of insomnia/fragmented sleep and snoring on therapy. CONCLUSION Adult patients with CSA and HF experience distressing symptoms and limitations. TPNS was found to improve many of these. Awareness of key symptoms or limitations patients experience can be used to inform the development of a CSA-specific patient questionnaire to identify CSA sooner and aid treatment decisions.
Collapse
Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, BT9 7BL, UK
| | - Timothy Meyer
- ZOLL Respicardia, Inc., 12400 Whitewater Dr #150, Minnetonka, MN 55343
| | - Scott McKane
- ZOLL Respicardia, Inc., 12400 Whitewater Dr #150, Minnetonka, MN 55343
| | - Mitja Lainscak
- Faculty of Medicine, University of Ljubljana, SI-1000 Ljubljana, Slovenia
- Division of Cardiology, General Hospital Murska Sobota, SI-9000 Murska Sobota, Slovenia
| | - Qanta A Ahmed
- Sleep Disorders Medicine, Division of Pulmonary Disease and Critical Care Medicine, Department of Medicine, NYU Langone Long Island Hospital, NYU Langone Long Island School of Medicine, New York, USA
| |
Collapse
|
13
|
Arzt M, Oldenburg O, Graml A, Schnepf J, Erdmann E, Teschler H, Schoebel C, Woehrle H. Prevalence and predictors of sleep-disordered breathing in chronic heart failure: the SchlaHF-XT registry. ESC Heart Fail 2022; 9:4100-4111. [PMID: 36052740 PMCID: PMC9773760 DOI: 10.1002/ehf2.14027] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 05/02/2022] [Accepted: 06/09/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is a condition with increasing prevalence. Sleep-disordered breathing (SDB) is an important co-morbidity in HFpEF. The SchlaHF-XT registry evaluated the sex-specific prevalence and predictors of SDB, including obstructive (OSA) and central sleep apnoea, in patients with HFpEF compared with heart failure with mildly reduced (HFmrEF) or reduced (HFrEF) ejection fraction. METHODS AND RESULTS Consecutive adults with chronic heart failure treated according to current guidelines were enrolled. The presence of moderate-to-severe SDB (apnoea-hypopnoea index ≥15/h) was determined using Type 3 polygraphic devices. Of 3289 patients included, 2032 had HFpEF, 559 had HFmrEF, and 698 had HFrEF, of whom 34, 21, 23, and 42%, respectively, were female. Prevalence of SDB in HFpEF was high, but significantly lower than in HFmrEF or HFrEF (36% vs. 41 and 48%, respectively). Rates of SDB in males and females were 41 and 28% in HFpEF, 44 and 30% in HFmrEF, and 50 and 40% in HFrEF. The proportion of males and females with SDB who had OSA was significantly greater in those with HFpEF vs. HFrEF. Male sex, older age, higher body mass index, and New York Heart Association functional Class III/IV were significant predictors of moderate-to-severe SDB in HFpEF patients. CONCLUSIONS Prevalence of SDB in HFpEF was high, but lower than in patients with HFmrEF or HFrEF. Moderate-to-severe SDB occurred more frequently in males than in females across the whole spectrum of heart failure. In both sexes, the proportion of OSA in SDB patients with HFpEF was higher than in those with HFrEF.
Collapse
Affiliation(s)
- Michael Arzt
- Department of Internal Medicine IIUniversity Hospital RegensburgRegensburgGermany
| | - Olaf Oldenburg
- Ludgerus‐Kliniken Münster, ClemenshospitalMünsterGermany
| | | | | | - Erland Erdmann
- Clinic III for Internal MedicineHeart Center University Hospital CologneCologneGermany
| | - Helmut Teschler
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital EssenUniversity Duisburg‐EssenEssenGermany
| | - Christoph Schoebel
- Department of Pneumology, Ruhrlandklinik, West German Lung Center, University Hospital EssenUniversity Duisburg‐EssenEssenGermany
| | - Holger Woehrle
- Sleep and Ventilation Center BlaubeurenLung Center UlmUlmGermany
| | | |
Collapse
|
14
|
Abstract
Breathing is a vital rhythmic motor behavior with a surprisingly broad influence on the brain and body. The apparent simplicity of breathing belies a complex neural control system, the breathing central pattern generator (bCPG), that exhibits diverse operational modes to regulate gas exchange and coordinate breathing with an array of behaviors. In this review, we focus on selected advances in our understanding of the bCPG. At the core of the bCPG is the preBötzinger complex (preBötC), which drives inspiratory rhythm via an unexpectedly sophisticated emergent mechanism. Synchronization dynamics underlying preBötC rhythmogenesis imbue the system with robustness and lability. These dynamics are modulated by inputs from throughout the brain and generate rhythmic, patterned activity that is widely distributed. The connectivity and an emerging literature support a link between breathing, emotion, and cognition that is becoming experimentally tractable. These advances bring great potential for elucidating function and dysfunction in breathing and other mammalian neural circuits.
Collapse
Affiliation(s)
- Sufyan Ashhad
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, USA;
| | - Kaiwen Kam
- Department of Cell Biology and Anatomy, Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | | | - Jack L Feldman
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California, USA;
| |
Collapse
|
15
|
Wang T, Yu FC, Wei Q, Xu X, Xie L, Ding N, Tong JY. Sleep-disordered breathing in heart failure patients with different etiologies. Clin Cardiol 2022; 45:778-785. [PMID: 35535628 PMCID: PMC9286328 DOI: 10.1002/clc.23840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/30/2022] [Accepted: 04/25/2022] [Indexed: 12/14/2022] Open
Abstract
Background The prevalence of sleep‐disordered breathing (SDB) is closely related to the severity of heart failure (HF), and the severity of HF is different in patients with HF of different etiologies. Hypothesis: This study aimed to explore the prevalence of SDB in patients with HFof different etiologies. Methods Hospitalized HF patients were consecutively enrolled. All patients underwent portable overnight cardiorespiratory polygraphy. Patients were divided into five groups according to the etiology of HF: ischemic, hypertensive, myocardial, valvular, and arrhythmic. The prevalence of SDB and clinical data was compared among the five groups. Results In total, 248 patients were enrolled in this study. The prevalence of SDB in HF was 70.6%, with the prevalence of obstructive sleep apnea (OSA) at 47.6% and central sleep apnea (CSA) at 23.0%. Patients were divided into five groups: ischemic, hypertensive, myocardial, valvular, and arrhythmic. The prevalence of SDB among the five groups was 75.3%, 81.4%, 77.8%, 51.9%, and 58.5% (p = .014), respectively. The prevalence of OSA among the five groups was 42.7%, 72.1%, 36.1%, 37.0%, and 49.1% (p = .009), whereas the CSA was 32.6%, 9.3%, 41.7%, 14.8%, and 9.4% (p < .001), respectively. Conclusions SDB is common in HF patients. The prevalence and types of SDB varied in HF with different etiologies, which may be related to the different severities of HF. SDB was highly prevalent in patients with ischemic, hypertensive, and myocardial HF. Hypertensive HF patients were mainly complicated with OSA, while myocardial HF patients were mainly complicated with CSA. Both conditions were highly prevalent in ischemic HF patients. The prevalence of SDB was relatively low in valvular and arrhythmic HF patients, and OSA was the main type.
Collapse
Affiliation(s)
- Tao Wang
- Department of Cardiology, Zhongda Hospital, School of medicine, Southeast University, Nanjing, China
| | - Fu-Chao Yu
- Department of Cardiology, Zhongda Hospital, School of medicine, Southeast University, Nanjing, China
| | - Qin Wei
- Department of Cardiology, Zhongda Hospital, School of medicine, Southeast University, Nanjing, China
| | - Xuan Xu
- Department of Cardiology, Zhongda Hospital, School of medicine, Southeast University, Nanjing, China
| | - Liang Xie
- Department of Cardiology, Zhongda Hospital, School of medicine, Southeast University, Nanjing, China
| | - Ning Ding
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-Yi Tong
- Department of Cardiology, Zhongda Hospital, School of medicine, Southeast University, Nanjing, China
| |
Collapse
|
16
|
Pinna GD, Maestri R. Computer-Assisted Assessment of the Interaction Between Arousals, Breath-by-Breath Ventilation, and Chemical Drive During Cheyne-Stokes Respiration in Heart Failure Patients. Front Physiol 2022; 13:815352. [PMID: 35222084 PMCID: PMC8867072 DOI: 10.3389/fphys.2022.815352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Transient increases in ventilation induced by arousal from sleep during Cheyne-Stokes respiration in heart failure patients are thought to contribute to sustaining and exacerbating the ventilatory oscillation. The only possibility to investigate the validity of this notion is to use observational data. This entails some significant challenges: (i) accurate identification of both arousal onset and offset; (ii) detection of short arousals (<3 s); (iii) breath-by-breath analysis of the interaction between arousals and ventilation; (iv) careful control for important confounding factors. In this paper we report how we have tackled these challenges by developing innovative computer-assisted methodologies. The identification of arousal onset and offset is performed by a hybrid approach that integrates visual scoring with computer-based automated analysis. We use a statistical detector to automatically discriminate between dominant theta–delta and dominant alpha activity at each instant of time. Moreover, a statistical detector is used to validate visual scoring of K complexes, delta waves or artifacts associated with an EEG frequency shift, as well as frequency shifts to beta activity. A high-resolution (250 ms) state-transition diagram providing continuous information on the sleep-wake state of the subject is finally obtained. Based on this information, arousals are automatically identified as any state change from sleep to wakefulness lasting ≥2 s. The assessment of the interaction between arousals and ventilation is performed using a breath-by-breath, case-control approach. The arousal-associated change in ventilation is measured as the normalized difference between minute ventilation in the case breath (i.e., with arousal) and that in the control breath (i.e., without arousal), controlling for sleep stage and chemical drive. The latter is estimated by using information from pulse oximetry at the finger. In the last part of the paper, we discuss main potential sources of error inherent in the described methodologies.
Collapse
|
17
|
Abstract
Much of biology is rhythmical and comprises oscillators that can couple. These have optimized energy efficiency and have been preserved during evolution. The respiratory and cardiovascular systems contain numerous oscillators, and importantly, they couple. This coupling is dynamic but essential for an efficient transmission of neural information critical for the precise linking of breathing and oxygen delivery while permitting adaptive responses to changes in state. The respiratory pattern generator and the neural network responsible for sympathetic and cardiovagal (parasympathetic) tone generation interact at many levels ensuring that cardiac output and regional blood flow match oxygen delivery to the lungs and tissues efficiently. The most classic manifestations of these interactions are respiratory sinus arrhythmia and the respiratory modulation of sympathetic nerve activity. These interactions derive from shared somatic and cardiopulmonary afferent inputs, reciprocal interactions between brainstem networks and inputs from supra-pontine regions. Disrupted respiratory-cardiovascular coupling can result in disease, where it may further the pathophysiological sequelae and be a harbinger of poor outcomes. This has been well documented by diminished respiratory sinus arrhythmia and altered respiratory sympathetic coupling in animal models and/or patients with myocardial infarction, heart failure, diabetes mellitus, and neurological disorders as stroke, brain trauma, Parkinson disease, or epilepsy. Future research needs to assess the therapeutic potential for ameliorating respiratory-cardiovascular coupling in disease.
Collapse
Affiliation(s)
- James P Fisher
- Manaaki Manawa-The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Tymoteusz Zera
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
| | - Julian F R Paton
- Manaaki Manawa-The Centre for Heart Research, Department of Physiology, Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand.
| |
Collapse
|
18
|
Prigent A, Pellen C, Texereau J, Bailly S, Coquerel N, Gervais R, Liegaux JM, Luraine R, Renaud JC, Serandour AL, Pépin JL. CPAP telemonitoring can track Cheyne-Stokes respiration and detect serious cardiac events: The AlertApnée Study. Respirology 2021; 27:161-169. [PMID: 34873795 DOI: 10.1111/resp.14192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Case reports have suggested that continuous positive airway pressure (CPAP) telemonitoring can detect the onset of acute cardiac events such as decompensated heart failure (HF) or atrial fibrillation through an increase in the apnoea-hypopnoea index (AHI) and onset of Cheyne-Stokes Respiration (CSR). This study addressed whether long-term remote CPAP treatment telemonitoring revealing CSR can help detect serious cardiac events (SCEs) in obstructive sleep apnoea (OSA) patients. METHODS This monocentric prospective cohort study included adults receiving CPAP therapy for OSA with daily telemonitoring. Any sudden increase in AHI generated an alert for the home healthcare provider to download CPAP data to identify CSR. A medical consultation was scheduled if CSR was detected. RESULTS We included 555 adults (412 men; 57% with known cardiovascular comorbidities). During the 1-year follow-up, 78 CSR episodes were detected in 74 patients (CSR+). The main conditions associated with incident CSR were HF (24 patients [30.8%]), ventilatory instability (21, 26.9%), leaks (13, 16.7%), medications inducing central apnoeas (baclofen, ticagrelor, opioids) (7, 9.0%), arrhythmias (6, 7.7%) and renal failure (2, 2.6%). Fifteen (20.3%) CSR+ patients had a confirmed SCE. In univariable analysis, a CSR episode increased the risk of an SCE by 13.8-fold (5.7-35.6) (p < 0.0001), with an adjusted OR of 5.7 (2.0-16.8) in multivariable analysis. CONCLUSION Long-term telemonitoring of patients on CPAP treatment can alert CSR episodes and allows early detection of SCEs in patients with or without known cardiac comorbidities.
Collapse
Affiliation(s)
- Arnaud Prigent
- Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France.,Centre du sommeil, Polyclinique Saint-Laurent, Rennes, France
| | | | - Joëlle Texereau
- Respiratory Physiology Unit, Department of Respiratory Medicine, Cochin Hospital, AP-HP/Université de Paris, Paris, France.,Air Liquide Health Care, VitalAire France, Gentilly, France
| | - Sébastien Bailly
- HP2 Laboratory, Inserm U1300, Univ. Grenoble Alpes, Grenoble, France
| | - Nicolas Coquerel
- Service de cardiologie, Polyclinique Saint Laurent, Rennes, France
| | - Renaud Gervais
- Service de cardiologie, Polyclinique Saint Laurent, Rennes, France
| | - Jean-Marc Liegaux
- Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France.,Centre du sommeil, Polyclinique Saint-Laurent, Rennes, France
| | - Régis Luraine
- Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France.,Centre du sommeil, Polyclinique Saint-Laurent, Rennes, France
| | - Jean-Christophe Renaud
- Groupe Medical de Pneumologie, Polyclinique Saint-Laurent, Rennes, France.,Centre du sommeil, Polyclinique Saint-Laurent, Rennes, France
| | | | - Jean Louis Pépin
- HP2 Laboratory, Inserm U1300, Univ. Grenoble Alpes, Grenoble, France
| |
Collapse
|
19
|
Han B, Wang S, Li G, Wang X, Chen Z, Zhao G, Chen Y, Li M, Li Y, Zhang M, Ai S. [Objective sleep characteristics and risk factors for sleep apnea in heart failure patients with different left ventricular ejection fraction]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:1415-1419. [PMID: 34658358 DOI: 10.12122/j.issn.1673-4254.2021.09.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the objective sleep characteristics and the independent risk factors for sleep apnea in heart failure (HF) patients with different left ventricular ejection fractions (LVEF). METHODS A total of 107 patients with chronic HF hospitalized in the Department of Cardiology of our hospital from April, 2019 to October, 2020 were included in this study. According to the LVEF measured by echocardiography, the patients were divided into reduced ejection fraction (HFrEF) group (n=35), mid-range ejection fraction (HFmrEF) group (n=21), and preserved ejection fraction (HFpEF) group (n=51). The baseline demographic and clinical characteristics of the patients were recorded. To assess the objective sleep characteristics, whole night polysomnography was scheduled for all the patients. Spearman correlation and multinomial logistic regression analyses were used to explore the factors affecting objective sleep characteristics. RESULTS The patients in HFpEF group had significantly lower proportion of non-rapid eye movement sleep stage 1, apnea hypopnea index (AHI), and central sleep apnea (CSA) than those in HFrEF group (all P < 0.05). The baseline demographic data or sleep structures in HFmrEF group did not differ significantly from those in the other two groups. Spearman correlation analysis revealed significant correlations of the male sex, diuretics use, NT-proBNP, LVEF, and total cholesterol levels with the severity of AHI (all P < 0.05). After adjusting for potential confounders, multiple logistics regression analysis showed that age, drinking, and LVEF levels were independently associated with the severity of AHI (all P < 0.05). CONCLUSION Abnormal objective sleep architectures occur in all HF patients, manifested mainly by sleep apnea. The incidences of sleep apnea and CSA are lower in patients with HFpEF than in those with HFrEF. Age, drinking, and LVEF levels are independent risk factors for the occurrence and severity of sleep apnea.
Collapse
Affiliation(s)
- B Han
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - S Wang
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - G Li
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - X Wang
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Z Chen
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - G Zhao
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Y Chen
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - M Li
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - Y Li
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| | - M Zhang
- Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,King's College London British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London SE59NU, UK
| | - S Ai
- Department of Cardiology, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China.,Heart Center, First Affiliated Hospital of Xinxiang Medical University, Weihui 453100, China
| |
Collapse
|
20
|
Parekh A, Tolbert TM, Mooney AM, Ramos-Cejudo J, Osorio RS, Treml M, Herkenrath SD, Randerath WJ, Ayappa I, Rapoport DM. Endotyping Sleep Apnea One Breath at a Time: An Automated Approach for Separating Obstructive from Central Sleep Disordered Breathing. Am J Respir Crit Care Med 2021; 204:1452-1462. [PMID: 34449303 PMCID: PMC8865720 DOI: 10.1164/rccm.202011-4055oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale Determining whether an individual has obstructive or central sleep apnea is fundamental to selecting the appropriate treatment. Objectives Here we derive an automated breath-by-breath probability of obstruction, as a surrogate of gold-standard upper airway resistance, using hallmarks of upper airway obstruction visible on clinical sleep studies. Methods From five nocturnal polysomnography signals (airflow, thoracic and abdominal effort, oxygen saturation, and snore), nine features were extracted and weighted to derive the breath-by-breath probability of obstruction (Pobs). A development and initial test set of 29 subjects (development = 6, test = 23) (New York, NY) and a second test set of 39 subjects (Solingen, Germany), both with esophageal manometry, were used to develop Pobs and validate it against gold-standard upper airway resistance. A separate dataset of 114 subjects with 2 consecutive nocturnal polysomnographies (New York, NY) without esophageal manometry was used to assess the night-to-night variability of Pobs. Measurements and Main Results A total of 1,962,229 breaths were analyzed. On a breath-by-breath level, Pobs was strongly correlated with normalized upper airway resistance in both test sets (set 1: cubic adjusted [adj.] R2 = 0.87, P < 0.001, area under the receiver operating characteristic curve = 0.74; set 2: cubic adj. R2 = 0.83, P < 0.001, area under the receiver operating characteristic curve = 0.7). On a subject level, median Pobs was associated with the median normalized upper airway resistance (set 1: linear adj. R2 = 0.59, P < 0.001; set 2: linear adj. R2 = 0.45, P < 0.001). Median Pobs exhibited low night-to-night variability [intraclass correlation(2, 1) = 0.93]. Conclusions Using nearly 2 million breaths from 182 subjects, we show that breath-by-breath probability of obstruction can reliably predict the overall burden of obstructed breaths in individual subjects and can aid in determining the type of sleep apnea.
Collapse
Affiliation(s)
- Ankit Parekh
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States;
| | - Thomas M Tolbert
- Mount Sinai School of Medicine, 5925, New York, New York, United States
| | - Anne M Mooney
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States
| | | | | | - Marcel Treml
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Simon-Dominik Herkenrath
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute for Pneumology at the University of Cologne, Solingen, Germany
| | - Winfried J Randerath
- Krankenhaus Bethanien gGmbH, Department of Pneumology, Allergology and Sleep Medicine, Solingen, Germany.,Institute of Pneumology at the University of Witten / Herdecke, Pneumology, Solingen, Germany
| | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, 5925, Pulmonary, Critical Care and Sleep Medicine, New York, New York, United States
| | - David M Rapoport
- Icahn School of Medicine at Mount Sinai, 5925, New York, New York, United States
| |
Collapse
|
21
|
Borrelli C, Gentile F, Sciarrone P, Spiesshoefer J, Navari A, Passino C, Emdin M, Giannoni A. Novel Drug Targets for Central Apneas in Heart Failure: On the Road. Am J Respir Crit Care Med 2021; 204:490-491. [PMID: 34086532 PMCID: PMC8480255 DOI: 10.1164/rccm.202104-0846le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Jens Spiesshoefer
- University Hospital RWTH Aachen Aachen, Germany.,Scuola Superiore Sant'Anna Pisa, Italy
| | | | - Claudio Passino
- Fondazione Toscana G. Monasterio Pisa, Italy.,Scuola Superiore Sant'Anna Pisa, Italy
| | - Michele Emdin
- Fondazione Toscana G. Monasterio Pisa, Italy.,Scuola Superiore Sant'Anna Pisa, Italy
| | - Alberto Giannoni
- Fondazione Toscana G. Monasterio Pisa, Italy.,Scuola Superiore Sant'Anna Pisa, Italy
| |
Collapse
|
22
|
Orr JE, Badr MS. Reply to Borrelli et al.: Novel Drug Targets for Central Apneas in Heart Failure: On the Road. Am J Respir Crit Care Med 2021; 204:491. [PMID: 34086535 PMCID: PMC8480252 DOI: 10.1164/rccm.202104-1076le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jeremy E Orr
- University of California San Diego Health San Diego, California
| | - M Safwan Badr
- Wayne State University School of Medicine Detroit, Michigan
| |
Collapse
|
23
|
Thornton CS, Pendharkar SR. Home sleep apnea testing for chronic heart failure: time to break the Cheyne? J Clin Sleep Med 2021; 17:1339-1341. [PMID: 33928904 DOI: 10.5664/jcsm.9334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Christina S Thornton
- Division of Respirology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sachin R Pendharkar
- Division of Respirology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Sleep Centre, Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
24
|
Tamisier R, Damy T, Bailly S, Davy JM, Verbraecken J, Lavergne F, Palot A, Goutorbe F, d'Ortho MP, Pépin JL. Adaptive servo ventilation for sleep apnoea in heart failure: the FACE study 3-month data. Thorax 2021; 77:178-185. [PMID: 34230094 PMCID: PMC8762030 DOI: 10.1136/thoraxjnl-2021-217205] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
Rationale Adaptive servo ventilation (ASV) is contraindicated in patients with systolic heart failure (HF) who have a left ventricular ejection fraction (LVEF) below 45% and predominant central sleep apnoea (CSA). However, the effects of ASV in other HF subgroups have not been clearly defined. Objective The European, multicentre, prospective, observational cohort trial, FACE, evaluated the effects of ASV therapy on morbidity and mortality in patients with HF with sleep-disordered breathing (SDB); 3-month outcomes in patient subgroups defined using latent class analysis (LCA) are presented. Methods Consecutive patients with HF with predominant CSA (±obstructive sleep apnoea) indicated for ASV were included from 2009 to 2018; the non-ASV group included patients who refused/were noncompliant with ASV. The primary endpoint was time to composite first event (all-cause death, lifesaving cardiovascular intervention or unplanned hospitalisation for worsening of chronic HF). Measurements and main results Baseline assessments were performed in 503 patients, and 482 underwent 3-month follow-up. LCA identified six discrete patient clusters characterised by variations in LVEF, SDB type, age, comorbidities and ASV acceptance. The 3- month rate of primary outcome events was significantly higher in cluster 1 patients (predominantly men, low LVEF, severe HF, CSA; 13.9% vs 1.5%–5% in other clusters, p<0.01). Conclusion For the first time, our data identified homogeneous patient clusters representing clinically relevant subgroups relating to SDB management in patients with HF with different ASV usage, each with a different prognosis. This may improve patient phenotyping in clinical practice and allow individualisation of therapy.
Collapse
Affiliation(s)
- Renaud Tamisier
- Université Grenoble Alpes, Laboratoire HP2 Inserm U1300, CHU Grenoble Alpes, Grenoble, France
| | - Thibaud Damy
- Hopital Henri Mondor, Creteil, Île-de-France, France.,Cardiology Department, French Referral Centre for Cardiac Amyloidosis, GRC Amyloid Research Institute, Assistance Publique - Hôpitaux de Paris, Paris, France.,UFR Médecine, Université Paris-Est Créteil, Paris, France
| | - Sebastien Bailly
- Université Grenoble Alpes, Laboratoire HP2 Inserm U1300, CHU Grenoble Alpes, Grenoble, France
| | - Jean-Marc Davy
- CHU Montpellier, Montpellier, Languedoc-Roussillon, France
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Centre, University Hospital Antwerp, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | | | - Alain Palot
- Hopital Saint Joseph, Marseille, Provence-Alpes-Côte d'Azur, France
| | | | - Marie-Pia d'Ortho
- Hôpital Bichat Claude-Bernard, Paris, Île-de-France, France.,Université de Paris, Neurodiderot, INSERM, Paris, France
| | - Jean Louis Pépin
- Université Grenoble Alpes, Laboratoire HP2 Inserm U1300, CHU Grenoble Alpes, Grenoble, France
| | | |
Collapse
|
25
|
Affiliation(s)
- Winfried Randerath
- Krankenhaus Berthanien, Institute for Pneumology at the University of Cologne, Solingen, Germany
| |
Collapse
|