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Pec J, Buchner S, Fox H, Oldenburg O, Stadler S, Maier LS, Arzt M, Wagner S. Inflammation and Fibrosis in Sleep-Disordered Breathing after Acute Myocardial Infarction. Biomedicines 2024; 12:154. [PMID: 38255259 PMCID: PMC10813793 DOI: 10.3390/biomedicines12010154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND After acute myocardial infarction (AMI), inflammatory processes promote tissue remodeling at the infarct site. Procollagen III amino-terminal propeptide (PIIINP) is a circulating biomarker of type III collagen synthesis that has been shown to be associated with changes in left ventricular ejection fraction (LVEF) and predicts the occurrence of heart failure after AMI. We hypothesize that sleep-disordered breathing (SDB) promotes inflammation and myocardial fibrosis, leading to reduced myocardial salvage. Therefore, in patients with first-time AMI successfully treated with percutaneous coronary intervention (PCI), we aimed to investigate whether circulating levels of high-sensitivity C-reactive protein (hs-CRP) and PIIINP are elevated in patients with SDB compared to patients without SDB. METHODS AND RESULTS This cross-sectional analysis included a total of 88 eligible patients with first AMI and PCI pooled from two prospective studies and stratified according to the apnea-hypopnea index (AHI, with SDB: AHI ≥ 15 h-1). We analyzed circulating levels of hs-CRP and PIIINP 3-5 days after PCI. Patients with SDB had significantly higher levels of hs-CRP (18.3 mg/L [95% CI, 8.0-42.6] vs. 5.8 mg/L [95% CI, 4.2-19.8], p = 0.002) and PIIINP (0.49 U/mL [95% CI, 0.40-0.60] vs. 0.33 U/mL [95% CI, 0.28-0.43], p < 0.001). In a multivariable linear regression model accounting for important clinical confounders, SDB significantly predicted circulating levels of hs-CRP (p = 0.028). Similarly, only SDB was independently associated with PIIINP (p < 0.001). Only obstructive but not central AHI correlated with circulating levels of hs-CRP (p = 0.012) and PIIINP (p = 0.006) levels. CONCLUSIONS The presence of obstructive SDB after AMI was independently associated with increased circulating levels of hs-CRP and PIIINP. Our results emphasize the important role of SDB as a common comorbidity and indicate increased inflammation and myocardial fibrosis in these patients.
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Affiliation(s)
- Jan Pec
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany (L.S.M.); (M.A.); (S.W.)
| | - Stefan Buchner
- Department of Internal Medicine, Cham Hospital, 93413 Cham, Germany
| | - Henrik Fox
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center NRW, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Center for Cardiology, Ludgerus-Kliniken, 48153 Münster, Germany;
| | - Stefan Stadler
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany (L.S.M.); (M.A.); (S.W.)
| | - Lars S. Maier
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany (L.S.M.); (M.A.); (S.W.)
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany (L.S.M.); (M.A.); (S.W.)
| | - Stefan Wagner
- Department of Internal Medicine II, University Hospital Regensburg, 93053 Regensburg, Germany (L.S.M.); (M.A.); (S.W.)
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Wang Y, Huang Y, Xia M, Salanitro M, Kraemer JF, Toncar T, Fietze I, Schöbel C, Penzel T. Effect of phrenic nerve stimulation on patients with central sleep apnea: A meta-analysis. Sleep Med Rev 2023; 70:101819. [PMID: 37467524 DOI: 10.1016/j.smrv.2023.101819] [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: 11/01/2022] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
Patients with central sleep apnea (CSA) have a lower quality of life and higher morbidity and mortality. Phrenic nerve stimulation (PNS) is a novel treatment for CSA that has been shown to be safe. However, the effects of PNS on sleep changes are still under debate. This meta-analysis was performed to evaluate the efficacy of PNS in patients with CSA. PubMed, Scopus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science databases were searched for relevant studies published. We performed random-effects meta-analyses of the changes in apnea-hypopnea index (AHI), central apnea index (CAI), Arousal Index, percent of sleep with O2 saturation <90% (T90), Epworth Sleepiness Scale (ESS) and sleep efficiency. Ten studies with a total of 580 subjects were analyzed. Overall meta-analysis showed AHI [SMD: -2.24, 95% confidence interval (CI): was -3.11 to -1.36(p<0.00001)], CAI [SMD: -2.32, 95% CI: -3.17 to -1.47 (p<0.00001)] and Arousal Index (p = 0.0002, SMD (95% CI) -1.79 (-2.74 to -0.85)) significantly reduced after PNS. No significant changes were observed in T90, ESS and sleep efficiency (p > 0.05). Meta-analysis of observational studies demonstrated AHI, CAI and Arousal Index had a decreasing trend between before and after PNS (all, p<0.05). However, ESS and T90 did not change significantly after PNS (p > 0.05). Meta-analysis of RCTs showed that CSA patients had trends of a lower AHI (I2 = 0%), CAI (I2 = 74%), Arousal Index (I2 = 0%), T90 (I2 = 0%) and ESS (I2 = 0%) after PNS (all, p<0.05). The use of PNS appears to be safe and feasible in patients with CSA. However, larger, independent RCTs are required to investigate the efficacy and long-term effect of PNS and more attention should be paid to T90 and ESS.
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Affiliation(s)
- Youmeng Wang
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany.
| | - Ying Huang
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Mengdi Xia
- Department of Nephrology, The Second Clinical Medical Institution of North Sichuan Medical College (Nanchong Central Hospital) and Nanchong Key Laboratory of Basic Science & Clinical Research on Chronic Kidney Disease, Nanchong, 637000, Sichuan Province, China.
| | - Matthew Salanitro
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Jan F Kraemer
- Department of Physics, Humboldt Universität zu Berlin, Berlin, Germany
| | - Theresa Toncar
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Ingo Fietze
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
| | - Christoph Schöbel
- Universitätsmedizin Essen, Ruhrlandklinik - Westdeutsches Lungenzentrum, am Universitätsklinikum Essen GmbH, Tüschener Weg 40, 45239, Essen, Germany
| | - Thomas Penzel
- Sleep Medicine Center, Charité-Universitätsmedizin, Charitéplatz 1, 10117, Berlin, Germany
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Fox H, Rudolph V, Munt O, Malouf G, Graml A, Bitter T, Oldenburg O. Early identification of heart failure deterioration through respiratory monitoring with adaptive servo-ventilation. J Sleep Res 2023; 32:e13749. [PMID: 36222010 DOI: 10.1111/jsr.13749] [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: 05/18/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 02/03/2023]
Abstract
Cardiac decompensation is associated with worse prognosis in patients with heart failure. Reliable methods to predict cardiac decompensation events are not yet available. Sleep-disordered breathing (SDB) is a frequent comorbidity in heart failure, and it has been shown to correlate with heart failure severity. This prospective observational trial investigated SDB characteristics in patients with heart failure with the aim to identify patterns that may predict early cardiac decompensation. Patients with heart failure with diagnosed SDB and hospitalised for cardiac decompensation were prospectively enrolled and treated with adaptive servo-ventilation (ASV). SDB characteristics, daily body weight and clinical cardiac decompensation events were collected over a 1-year follow-up. Clinical events were categorised by an independent clinical event committee. A total of 43 patients were enrolled (81% male, mean [SD] age 71 [11] years, body mass index 30 kg/m2 , 95% New York Heart Association function class III or IV, mean [SD] left ventricular ejection fraction 37% [11%], median apnea-hypopnoea index [AHI] of 37 events/h). A total of 48 cardiac decompensation events were recorded during the 1-year study period. Respiratory rate was found to be significantly lower in patients with cardiac decompensation. The AHI and applied inspiratory pressure ASV-device support were significantly increased 10 days before a clinical cardiac decompensation event. Device usage was also found to be significantly decreased 2 nights before cardiac decompensation. Device-derived respiratory data in ASV therapy devices for SDB may therefore serve as a monitoring tool to predict early clinical cardiac decompensation events. Prediction and avoidance of cardiac decompensation, in turn, may attenuate serious health consequences in patients with heart failure.
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Affiliation(s)
- Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Volker Rudolph
- Heart Failure Department, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Oliver Munt
- ResMed Science Center, Resmed Germany Inc, Martinsried, Germany
| | - Gordon Malouf
- ResMed Science Center, Resmed Germany Inc, Martinsried, Germany
| | - Andrea Graml
- ResMed Science Center, Resmed Germany Inc, Martinsried, Germany
| | - Thomas Bitter
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Department of Pneumology and Ventilation Klinikum Braunschweig, Martinsried, Germany
| | - Olaf Oldenburg
- Clinic for General and Interventional Cardiology/Angiology, Herz- Und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.,Department of Cardiology, Clemenshospital Münster, Münster, Germany
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Fox H. Angiologie und schlafbezogene Atmungsstörungen: Neues im DGK-Positionspapier? AKTUELLE KARDIOLOGIE 2022. [DOI: 10.1055/a-1693-2439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungSchlafbezogene Atmungsstörungen (SBAS) stellen ein gesundheitliches Risiko dar; sie
beeinflussen Lebensqualität und Prognose negativ. Besonders gefährdet sind dabei
angiologische Patienten mit kardiovaskulären Begleiterkrankungen wie arterielle
Hypertonie, Herzinsuffizienz oder Vorhofflimmern. Dies zum einen, da die Diagnostik
wegen einer Überlagerung der Symptome häufig erschwert ist, zum anderen aber auch durch
eine unmittelbare Korrelation der Pathophysiologie beider Erkrankungen, die gegenseitig
ihren Progress begünstigen. Die sorgfältige Fahndung und Therapie einer SBAS ist somit
bei diesen Patienten besonders herausfordernd. Es stehen mit nicht invasiven
Beatmungsformen und implantierbaren Devices sowie der wachsenden telemedizinischen
Infrastruktur zunehmend Optionen zur Verfügung, welche die Symptomlast und die
gesundheitlichen Risiken reduzieren können. Deshalb fasst der folgende Artikel neue
Entwicklungen zu SBAS zusammen und gibt einen Überblick über aktuelle
Empfehlungen.
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Affiliation(s)
- Henrik Fox
- Zentrum für Herzinsuffizienz, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
- Klinik für Allgemeine und Interventionelle Kardiologie/Angiologie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
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5
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Sharma S, Stansbury R. Sleep-Disordered Breathing in Hospitalized Patients: A Game Changer? Chest 2022; 161:1083-1091. [PMID: 34673024 DOI: 10.1016/j.chest.2021.10.016] [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: 05/08/2021] [Revised: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022] Open
Abstract
Sleep disorders, including sleep apnea, have become a significant health issue in the United States. It is estimated that 22 million Americans have sleep apnea, with 80% of cases of moderate and severe OSA going undiagnosed. This number continues to increase with the obesity epidemic. Sleep-disordered breathing (SDB) is associated with multiple cardiopulmonary diseases and has been shown to affect disease outcomes adversely. Hospitalized patients have a disproportionately high prevalence of cardiovascular and respiratory diseases. Screening for SDB in hospitalized patients provides an opportunity to identify the disease in individuals whose disease otherwise may go unrecognized. Data suggest that identification of SDB in hospitalized individuals may have a positive impact on a patient's course after hospitalization. Unfortunately, sleep medicine currently remains an ambulatory practice. Hospital sleep medicine addresses this separation. Herein, we discuss our experience and the future potential of hospital sleep medicine programs.
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Affiliation(s)
- Sunil Sharma
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV.
| | - Robert Stansbury
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV
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Buchner S, Wester M, Hobelsberger S, Fisser C, Debl K, Hetzenecker A, Hamer OW, Zeman F, Maier LS, Arzt M. Obstructive sleep apnoea is associated with the development of diastolic dysfunction after myocardial infarction with preserved ejection fraction. Sleep Med 2022; 94:63-69. [DOI: 10.1016/j.sleep.2022.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/16/2022] [Accepted: 03/31/2022] [Indexed: 02/03/2023]
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Sekiguchi H, Tanino S, Serizawa N, Hagiwara N. A novel optimized adaptive servo-ventilation setting for a patient with severe heart failure based on the echocardiogram: a case report. Eur Heart J Case Rep 2022; 6:ytac074. [PMID: 35350723 PMCID: PMC8946633 DOI: 10.1093/ehjcr/ytac074] [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: 06/02/2021] [Revised: 07/05/2021] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Abstract
Background Adaptive servo-ventilation (ASV) is a non-invasive positive-pressure ventilation therapy considered beneficial for treating heart failure (HF) in patients with central sleep apnoea. However, to the best of our knowledge, there is no evidence indicating that this therapy increases the mortality in HF patients. We hypothesized that ASV settings are important for HF patients with reduced ejection fraction. Therefore, to determine the suitable ASV setting for such patients, we optimized these settings to improve the left ventricular (LV) output during the therapy. Case summary We present a case of HF caused by dilated cardiomyopathy in a 45-year-old man. He was hospitalized due to HF; his LV ejection fraction was ∼20%, and haemodynamics analysis revealed his HF grade was Forrester subset IV. During hospitalization, he was diagnosed with sleep apnoea; therefore, we induced ASV with our optimized setting using an echocardiogram evaluating stroke volume (SV). Using this method, we could determine the appropriate setting that increased his SV and improved his apnoea–hypopnoea index. At the 5th-year follow-up, he had no dyspnoea on effort (New York Heart Association Functional Classification I). He continued using the ASV with good adherence, and no hospitalization for ventricular arrhythmia and HF was reported. Discussion Our ASV optimized setting showed beneficial effects in an HF patient with reduced ejection fraction. This method improved the patient’s SV and apnoea–hypopnoea index, indicating that this novel method should be considered for HF patients with reduced ejection fraction.
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Affiliation(s)
- Haruki Sekiguchi
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjyuku, Tokyo 162-8666, Japan
- Division of Comprehensive Sleep Medicine, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
- Institute of General Medicine, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
- National Hospital Organization Yokohama Medical Center, Kanagawa 245-8575, Japan
- National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
| | - Sae Tanino
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjyuku, Tokyo 162-8666, Japan
| | - Naoki Serizawa
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjyuku, Tokyo 162-8666, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, The Heart Institute of Japan, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjyuku, Tokyo 162-8666, Japan
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Wester M, Pec J, Lebek S, Fisser C, Debl K, Hamer O, Poschenrieder F, Buchner S, Maier LS, Arzt M, Wagner S. Sleep-Disordered Breathing Is Associated With Reduced Left Atrial Strain Measured by Cardiac Magnetic Resonance Imaging in Patients After Acute Myocardial Infarction. Front Med (Lausanne) 2022; 9:759361. [PMID: 35252229 PMCID: PMC8888827 DOI: 10.3389/fmed.2022.759361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022] Open
Abstract
Aims Sleep disordered breathing (SDB) is known to cause left atrial (LA) remodeling. However, the relationship between SDB severity and LA dysfunction is insufficiently understood and may be elucidated by detailed feature tracking (FT) strain analysis of cardiac magnetic resonance images (CMR). After myocardial infarction (MI), both the left ventricle and atrium are subjected to increased stress which may be substantially worsened by concomitant SDB that could impair consequential healing. We therefore analyzed atrial strain in patients at the time of acute MI and 3 months after. Methods and Results 40 patients with acute MI underwent CMR and polysomnography (PSG) within 3–5 days after MI. Follow-up was performed 3 months after acute MI. CMR cine data were analyzed using a dedicated FT software. Atrial strain (ε) and strain rate (SR) for atrial reservoir ([εs]; [SRs]), conduit ([εe]; [SRe]) and booster function ([εa]; [SRa]) were measured in two long-axis views. SDB was defined by an apnea-hypopnea-index (AHI) ≥15/h. Interestingly, LA εs and εe were significantly reduced in patients with SDB and correlated negative with AHI as a measure of SDB severity at both baseline and follow-up. Intriguingly, patients that exhibited a reduced AHI at follow-up were more likely to have developed improved atrial reservoir and conduit strain (linear regression, p=0.08 for εs and εe). Patients with improved SDB (ΔAHI < −5/h) exhibited a mean improvement of LA reservoir strain of +7.2 ± 8.4% whereas patients with SDB deterioration (ΔAHI> + 5/h) showed a mean decrease of −5.3 ± 11.0% (p = 0.0131). Similarly, the difference for LA conduit function was +4.8 ± 5.9% (ΔAHI < −5/h) vs −3.6 ± 8.8% (ΔAHI> +5/h). Importantly, conventional volumetric parameters for atrial function (LA area, LA volume index) did not correlate with AHI at baseline or follow-up. Conclusion Our results show that LA function measured by CMR strain but not by volumetry is impaired in patients with SDB during acute cardiac injury. Consistent with a mechanistic association, improvement of SBD at follow-up resulted in improved LA strain. LA strain measurement might thus provide insight into atrial function in patients with SDB.
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Affiliation(s)
- Michael Wester
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Jan Pec
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Simon Lebek
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Christoph Fisser
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Kurt Debl
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Okka Hamer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | | | - Stefan Buchner
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
- Department of Internal Medicine, Cham Hospital, Cham, Germany
| | - Lars S. Maier
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Michael Arzt
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wagner
- University Heart Center Regensburg, University Hospital Regensburg, Regensburg, Germany
- *Correspondence: Stefan Wagner
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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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10
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Summerer V, Arzt M, Fox H, Oldenburg O, Zeman F, Debl K, Buchner S, Stadler S. Occurrence of Coronary Collaterals in Acute Myocardial Infarction and Sleep Apnea. J Am Heart Assoc 2021; 10:e020340. [PMID: 34325518 PMCID: PMC8475663 DOI: 10.1161/jaha.120.020340] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In patients with acute myocardial infarction (MI), cardioprotective effects of obstructive sleep apnea are postulated on account of hypoxemic preconditioning. The aim of this single-center substudy was to investigate a potential association between obstructive sleep apnea and the presence of coronary collaterals in patients with first-time acute MI who have been enrolled in an ongoing, multicenter clinical trial. Methods and Results In TEAM-ASV I (Treatment of Sleep Apnea Early After Myocardial Infarction With Adaptive Servo-Ventilation Trial; NCT02093377) patients with first acute MI who received a coronary angiogram within 24 hours after onset of symptoms underwent polygraphy within the first 3 days. Coronary collaterals were classified visually by assigning a Cohen-Rentrop Score (CRS) ranging between 0 (no collaterals) and 3. Of 94 analyzed patients, 14% had significant coronary collaterals with a CRS ≥2. Apnea-Hypopnea Index (AHI) score was significantly higher in patients with CRS ≥2 compared with those with CRS <2 (31/hour [11-54] versus 13/hour [4-27]; P=0.032). A multivariable regression model revealed a significant association between obstructive AHI and CRS ≥2 that was independent of age, sex, body mass index, and culprit lesion left anterior descending artery (odds ratio [OR], 1.06; 95% CI, 1.01-1.12; P=0.023), but no significant association between coronary collaterals and central AHI (OR, 1.02; 95% CI, 0.97-1.08; P=0.443). Conclusions Patients with first-time acute MI had more extensive coronary collateralization with an increased AHI or rather an increased obstructive AHI. This finding supports the hypothesis that obstructive sleep apnea exerts potential cardioprotective effects, in addition to its known deleterious effects, in patients with acute MI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02093377.
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Affiliation(s)
- Verena Summerer
- Department of Internal Medicine II University Hospital Regensburg Regensburg Germany
| | - Michael Arzt
- Department of Internal Medicine II University Hospital Regensburg Regensburg Germany
| | - Henrik Fox
- Clinic for General and Interventional Cardiology/Angiology Heart and Diabetes Center NRW Ruhr University Bochum Bad Oeynhausen Germany
| | - Olaf Oldenburg
- Clinic for General and Interventional Cardiology/Angiology Heart and Diabetes Center NRW Ruhr University Bochum Bad Oeynhausen Germany.,Clinic for Cardiology Clemens Hospital Münster Münster Germany
| | - Florian Zeman
- Center for Clinical Studies, Biostatistics University Hospital Regensburg Regensburg Germany
| | - Kurt Debl
- Department of Internal Medicine II University Hospital Regensburg Regensburg Germany
| | - Stefan Buchner
- Department of Internal Medicine II University Hospital Regensburg Regensburg Germany.,Internal Medicine II - Cardiology Sana Clinics of the District of Cham Cham Germany
| | - Stefan Stadler
- Department of Internal Medicine II University Hospital Regensburg Regensburg Germany
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11
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Imanari S, Tomita Y, Kasagi S, Kawana F, Kimura Y, Ishiwata S, Narui K, Kasai T. Evaluation of the Apnea-Hypopnea Index Determined by Adaptive Servo-Ventilation Devices in Patients With Heart Failure and Sleep-Disordered Breathing. Front Cardiovasc Med 2021; 8:680053. [PMID: 34250041 PMCID: PMC8267007 DOI: 10.3389/fcvm.2021.680053] [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: 03/13/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Adaptive servo-ventilation (ASV) devices are designed to suppress central respiratory events, and therefore effective for sleep-disordered breathing (SDB) in patients with heart failure (HF) and provide information about their residual respiratory events. However, whether the apnea-hypopnea index (AHI), determined by the ASV device AutoSet CS (ASC), correlates with the AHI calculated by polysomnography (PSG) in patients with HF and SDB remains to be evaluated. Methods: Consecutive patients with SDB titrated on ASC were included in the study. We assessed the correlation between AHI determined by manual scoring during PSG (AHI-PSG) and that determined by the ASC device (AHI-ASC) during an overnight session. Results: Thirty patients with HF and SDB (age, 68.8 ± 15.4 years; two women; left ventricular ejection fraction, 53.8 ± 17.9%) were included. The median AHI in the diagnostic study was 28.4 events/h, including both obstructive and central respiratory events. During the titration, ASC markedly suppressed the respiratory events (AHI-PSG, 3.3 events/h), while the median AHI-ASC was 12.8 events/h. We identified a modest correlation between AHI-PSG and AHI-ASC (r = 0.36, p = 0.048). The Brand-Altman plot indicated that the ASC device overestimated the AHI, and a moderate agreement was observed with PSG. Conclusions: There was only a modest correlation between AHI-PSG and AHI-ASC. The discrepancy may be explained by either the central respiratory events that occur during wakefulness or the other differences between PSG and ASC in the detected respiratory events. Therefore, clinicians should consider this divergence when assessing residual respiratory events using ASC.
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Affiliation(s)
- Satomi Imanari
- Sleep Center, Toranomon Hospital, Tokyo, Japan.,Clinical Physiology, Toranomon Hospital, Tokyo, Japan
| | - Yasuhiro Tomita
- Sleep Center, Toranomon Hospital, Tokyo, Japan.,Cardiovascular Center, Toranomon Hospital, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Satoshi Kasagi
- Sleep Center, Toranomon Hospital, Tokyo, Japan.,Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | | | - Yuka Kimura
- Sleep Center, Toranomon Hospital, Tokyo, Japan.,Clinical Physiology, Toranomon Hospital, Tokyo, Japan
| | - Sugao Ishiwata
- Clinical Physiology, Toranomon Hospital, Tokyo, Japan.,Cardiovascular Center, Toranomon Hospital, Tokyo, Japan
| | - Koji Narui
- Sleep Center, Toranomon Hospital, Tokyo, Japan
| | - Takatoshi Kasai
- Sleep Center, Toranomon Hospital, Tokyo, Japan.,Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Phrenic Nerve Stimulation Improves Physical Performance and Hypoxemia in Heart Failure Patients with Central Sleep Apnea. J Clin Med 2021; 10:jcm10020202. [PMID: 33429858 PMCID: PMC7826567 DOI: 10.3390/jcm10020202] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Central sleep apnea (CSA) is a common comorbidity in patients with heart failure (HF) and has been linked to increased morbidity and mortality risk. In addition, CSA is associated with impaired quality of life, reduced physical performance capacity, and hypoxemia. Phrenic nerve stimulation (PNS) is a novel approach to the treatment of CSA and has been shown to be safe and effective in this indication. However, there are currently no data on the effects of PNS on physical performance and hypoxia in CSA HF patients, both of which have been shown to be linked to mortality in HF. Methods: This prospective study enrolled patients with HF and CSA diagnosed using polysomnography. All were implanted with a PNS system (remedē® system, Respicardia Inc., Minnetonka, MN, USA) for the treatment of CSA. Examinations included polysomnography (to determine hypoxemic burden), echocardiography and a standardized 6-min walk test prior to device implantation (baseline) and after 6 months of follow-up. Results: A total of 24 patients were enrolled (mean age 67.1 ± 11.2 years, 88% male). The 6-min walk distance was 369.5 ± 163.5 m at baseline and significantly improved during follow-up (to 410 ± 169.7 m; p = 0.035). Hypoxemic burden, determined based on time with oxygen saturation < 90% improved from 81 ± 55.8 min at baseline to 27.9 ± 42.8 min during PNS therapy (p < 0.01). Conclusion: In addition to safely and effectively treating CSA, PNS is also associated with improved physical performance capacity and reduced hypoxemic burden in patients with HF.
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Celik Y, Thunström E, Strollo PJ, Peker Y. Continuous positive airway pressure treatment and anxiety in adults with coronary artery disease and nonsleepy obstructive sleep apnea in the RICCADSA trial. Sleep Med 2020; 77:96-103. [PMID: 33341644 DOI: 10.1016/j.sleep.2020.11.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 11/29/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anxiety and obstructive sleep apnea (OSA) coexist among adults with coronary artery disease (CAD) following revascularization. Continuous positive airway pressure (CPAP) is the first line treatment of OSA patients with daytime sleepiness. The current study evaluated the effect of CPAP on anxiety in CAD patients with nonsleepy OSA. METHODS Two hundred forty-four revascularized CAD patients with nonsleepy OSA (apnea-hypopnea index ≥15/h, Epworth Sleepiness Scale score <10) were randomly assigned to CPAP or no-CPAP between 2005 and 2010. Zung Self-rating Anxiety Scale (SAS) was administered at baseline and after 3 and 12 months with higher scores suggesting more anxiety. RESULTS A total of 208 patients with complete SAS scores at baseline and 12-month follow-up were included (CPAP, n = 103; no-CPAP, n = 105). In the intention-to-treat analysis, CPAP had no significant effect on the SAS scores. On-treatment analysis revealed a significant increase in the median of delta SAS score (+3.75) after three months among the participants using the device 2.8 h/day or more while there was a decline in the median of delta SAS score (-1.25) in the non-adherent or no-CPAP group (p = 0.031). The increase in the SAS score (+1.25) in the adherent group, and the decline (-1.25 points) in the non-adherent/no-CPAP group remained significant after one year (p = 0.011). Baseline SAS score predicted non-adherence [adjusted odds ratio 1.11; 95% confidence interval (CI) 1.04-1.18; p = 0.003], and there was an association between the increase in the SAS scores and accumulated CPAP hours/day [standardized β = 0.144 (95% CI 0.005-0.695), p = 0.047]. CONCLUSION Our results suggest that anxiety should be considered in the management of CAD patients with nonsleepy OSA following revascularization. CLINICAL TRIAL REGISTRATION NCT00519597.
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Affiliation(s)
- Yeliz Celik
- Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey
| | - Erik Thunström
- Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Patrick J Strollo
- Dept of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden
| | - Yüksel Peker
- Koc University Research Center for Translational Medicine (KUTTAM), Istanbul, Turkey; Dept. of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Dept of Clinical Sciences, Respiratory Medicine and Allergology, Faculty of Medicine, Lund University, Lund, Sweden; Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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