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Baudrand R, Guarda FJ, Torrey J, Williams G, Vaidya A. Dietary Sodium Restriction Increases the Risk of Misinterpreting Mild Cases of Primary Aldosteronism. J Clin Endocrinol Metab 2016; 101:3989-3996. [PMID: 27428770 PMCID: PMC5095258 DOI: 10.1210/jc.2016-1963] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
CONTEXT The aldosterone to renin ratio (ARR) is recommended to screen for primary aldosteronism (PA). OBJECTIVE To evaluate whether dietary sodium restriction results in misinterpretation of PA screening. PARTICIPANTS Untreated hypertensives with ARR more than 20 on a high dietary sodium intake (HS) were also evaluated on a low dietary sodium intake (LS) (n = 241). Positive screening for PA was defined as: plasma renin activity (PRA) less than or equal to 1.0 ng/mL · h with serum aldosterone more than or equal to 6 ng/dL. PA was confirmed by a 24-hour urinary aldosterone excretion more than or equal to 12 mcg with urinary sodium more than 200 mmol. RESULTS Only 33% (79/241) of participants with an ARR more than 20 had a positive PA screen on HS. On LS, 56% (44/79) of these participants no longer met criteria for positive PA screening. When compared with participants with positive PA screening on both diets, participants with a positive screen on HS but negative on LS exhibited a significantly higher PRA on both diets. Remarkably, of the 48/79 participants who had PA confirmed, 52% had negative PA screening on LS. The distinguishing feature of these participants with "discordant" screening results was a larger rise in PRA on LS resulting in normalization of the ARR and higher Caucasian race prevalence. CONCLUSIONS Sodium restriction is recommended in hypertension; however, it can significantly raise PRA, normalize the ARR, and result in false interpretation of PA screening. Milder phenotypes of PA, where PRA is not as suppressed, are most susceptible to dietary sodium influences on renin and ARR. Optimal screening for PA should occur under conditions of HS.
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Affiliation(s)
- Rene Baudrand
- Program for Adrenal Disorders and Endocrine Hypertension (R.B., F.J.G.), Department of Endocrinology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 7550006, Chile; and Center for Adrenal Disorders (J.T., G.W., A.V.), Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Francisco J Guarda
- Program for Adrenal Disorders and Endocrine Hypertension (R.B., F.J.G.), Department of Endocrinology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 7550006, Chile; and Center for Adrenal Disorders (J.T., G.W., A.V.), Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Jasmine Torrey
- Program for Adrenal Disorders and Endocrine Hypertension (R.B., F.J.G.), Department of Endocrinology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 7550006, Chile; and Center for Adrenal Disorders (J.T., G.W., A.V.), Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Gordon Williams
- Program for Adrenal Disorders and Endocrine Hypertension (R.B., F.J.G.), Department of Endocrinology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 7550006, Chile; and Center for Adrenal Disorders (J.T., G.W., A.V.), Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Anand Vaidya
- Program for Adrenal Disorders and Endocrine Hypertension (R.B., F.J.G.), Department of Endocrinology, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago 7550006, Chile; and Center for Adrenal Disorders (J.T., G.W., A.V.), Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115
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Biffi E, Piazza C, Cavalleri M, Taddeo P, Carcano A, Morandi F, Reni G. An assistive device for congenital central hypoventilation syndrome outpatients during sleep. Ann Biomed Eng 2014; 42:2106-16. [PMID: 25069973 DOI: 10.1007/s10439-014-1068-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/11/2014] [Indexed: 11/26/2022]
Abstract
Congenital Central Hypoventilation Syndrome is a genetic disease characterized by alveolar hypoventilation and autonomic dysregulation. Patients have hypoventilations, especially during sleep, conditioning hypercapnia which can lead to neurological damage and death. They therefore need mechanical ventilators, that provide sufficient gas exchange, and pulse-oximeters that monitor oxy-hemoglobin blood concentration. Due to the restrictions regarding domiciliary assistive devices, the presence of a caregiver is required all night long. Currently, the only alarm systems available are the ones integrated in the ventilators and monitoring systems. During the night, multiple false alarms may occur, interrupting the sleep and causing anxiety. In this work we describe an assistive device that acquires real-time data from a pulse-oximeter, provides a multisensory stimulation if oxygen saturation falls under a certain threshold, and wakes up the patient if the hypoxia is severe. Tests on healthy subjects have shown that the device guarantees rapid awakenings, with a stimulator-dependent efficacy, and that it does not affect sleep efficiency. The purpose of the device is to determine a gentle awakening if mild hypoxia conditions persist, and to assure rapid awakening when a severe hypoxia occurs, reducing false alarms, improving the quality of sleep and increasing the self-sufficiency of the patients.
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Affiliation(s)
- Emilia Biffi
- Bioengineering Lab, Scientific Institute, IRCCS E. Medea, Via don Luigi Monza 20, 23842, Bosisio Parini, LC, Italy,
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Xu Z, Jia X, Bai P, Shen K. [Non-invasive mechanical ventilation in a child with central hypoventilation syndrome: one year follow-up]. Zhonghua Er Ke Za Zhi 2014; 52:117-121. [PMID: 24739723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To investigate clinical features and therapeutic methods of late-onset central hypoventilation syndrome. METHOD A nine-year old boy was trachea-intubated and mechanically ventilated because of pneumonia, respiratory and heart failure and pulmonary hypertension. It was found that hard to extubate the patient as he was breathing normally while awake but had shallow breathing, oxygen desaturation and CO2 retention when falling asleep. Nocturnal polysomnography together with transcutaneous CO2 supported the diagnosis of central hypoventilation. The final diagnosis was late-onset congenital central hypoventilation syndrome as the patient gained weight rapidly since 3 years of age and the brain magnetic resonance imaging (MRI) and genetic screening were unremarkable. RESULT The patient was treated with bi-level positive air pressure ventilation via nasal mask which showed good oxygen saturation and CO2 dropped down. The follow up study done one year later showed normal brain MRI, relief of pulmonary hypertension and better CO2 level in both awaken and sleeping status. CONCLUSION The late-onset congenital central hypoventilation syndrome in this case had onset of symptoms at 2 years of age, he had normal breathing while he was awake but had oxygen desaturation and CO2 retention during sleep, therefore, respiratory support is required in severe cases. Mechanical ventilation via tracheotomy and non-invasive ventilation via mask are the major choice.
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Affiliation(s)
- Zhifei Xu
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Xinlei Jia
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Ping Bai
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
| | - Kunling Shen
- Department of Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China.
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Cavalleri M, Carcano A, Morandi F, Piazza C, Maggioni E, Reni G. A new device for the care of Congenital Central Hypoventilation Syndrome patients during sleep. Annu Int Conf IEEE Eng Med Biol Soc 2013; 2013:2445-2448. [PMID: 24110221 DOI: 10.1109/embc.2013.6610034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Congenital Central Hypoventilation Syndrome (CCHS) is a genetic disease that causes an autonomous nervous system dysregulation. Patients are unable to have a correct ventilation, especially during sleep, facing risk of death. Therefore, most of them are mechanically ventilated during night and their blood oxygenation is monitored, while a supervisor keeps watch over them. If low oxygen levels are detected by the pulse-oximeter, an alarm fires; the supervisor deals with the situation and, if there is neither a technical problem nor a false alarm, wakes the subject, as CCHS patients usually recover from hypoxia when roused from sleep. During a single night multiple alarms may occur, causing fractioned sleep for the subject and a lasting state of anxiety for supervisors.
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Calvin AD, Somers VK, van der Walt C, Scott CG, Olson LJ. Relation of natriuretic peptide concentrations to central sleep apnea in patients with heart failure. Chest 2011; 140:1517-1523. [PMID: 21636668 PMCID: PMC3231957 DOI: 10.1378/chest.10-2472] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2010] [Accepted: 05/06/2011] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Central sleep apnea (CSA) is frequent among patients with heart failure (HF) and associated with increased morbidity and mortality. Elevated cardiac filling pressures promote CSA and atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) secretion. We hypothesized that circulating natriuretic peptide concentrations predict CSA. METHODS Consecutive patients with HF (n = 44) with left ventricular ejection fraction (LVEF) ≤ 35% underwent polysomnography for detection of CSA. CSA was defined as an apnea-hypopnea index ≥ 15 with ≥ 50% central apneic events. The relation of natriuretic peptide concentrations to CSA was evaluated by estimation of ORs and receiver operator characteristics (ROCs). RESULTS Twenty-seven subjects (61%) had CSA, with men more frequently affected than women (73% vs 27%; OR, 7.1; P = .01); given that only three women had CSA, further analysis was restricted to men. Subjects with CSA had higher mean ANP (4,336 pg/mL vs 2,510 pg/mL, P = .03) and BNP concentrations (746 pg/mL vs 379 pg/mL, P = .05). ANP and BNP concentrations were significantly related to CSA (OR, 3.7 per 3,000 pg/mL, P = .03 and OR, 1.5 per 200 pg/mL, P = .04, respectively), whereas age, LVEF, and New York Heart Association functional class were not. Concentrations of ANP and BNP were predictive of CSA as ROC demonstrated areas under the curve of 0.75 and 0.73, respectively. CONCLUSIONS Risk of CSA is related to severity of HF. ANP and BNP concentrations performed similarly for detection of CSA; low concentrations appear associated with low risk for CSA in men.
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Affiliation(s)
- Andrew D Calvin
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | - Virend K Somers
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
| | | | - Christopher G Scott
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN; Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Lyle J Olson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
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Kashine S, Kishida K, Funahashi T, Nakagawa Y, Otuki M, Okita K, Iwahashi H, Kihara S, Nakamura T, Matsuzawa Y, Shimomura I. Characteristics of sleep-disordered breathing in Japanese patients with type 2 diabetes mellitus. Metabolism 2010; 59:690-6. [PMID: 19913847 DOI: 10.1016/j.metabol.2009.08.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 08/26/2009] [Indexed: 11/22/2022]
Abstract
Sleep-disordered breathing (SDB), especially sleep apnea-hypopnea syndrome, is often observed in patients with type 2 diabetes mellitus; but there are only a few studies on SDB in Japanese diabetic subjects. We investigated the prevalence of SDB in diabetic patients; associations between severity of sleep apnea (SA) and clinical factors, visceral fat, and adiponectin; and associations between type of SA and clinical factors. In the present study, 40 Japanese diabetic patients underwent overnight cardiorespiratory monitoring, and night and morning measurements of serum adiponectin concentrations. Sleep apnea was detected in Japanese diabetic patients at a high prevalence (77.5%). The following variables were associated with SDB: age, body mass index, estimated visceral fat area, and nocturnal reduction in serum adiponectin concentrations. The prevalence of central sleep apnea (CSA, >or=5/h) was 32.3% among diabetic SDB patients. Diabetic SDB patients with CSA had higher hemoglobin, increased intima-media thickness, and higher plasma brain natriuretic peptide levels than those without CSA (<5/h). In conclusion, our study demonstrated a high prevalence of SDB in Japanese diabetic patients, which correlated with visceral fat area and adiponectin. A high frequency of CSA was noted in diabetic SDB patients, together with high hemoglobin, high brain natriuretic peptide, and increased intima-media thickness. The present results of prevalence of SDB may be relevant to the higher incidence of cardiovascular disease in diabetic patients, which need to be clarified in future studies.
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MESH Headings
- Adiponectin/blood
- Adipose Tissue/physiopathology
- Adult
- Aged
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/diagnostic imaging
- Diabetes Mellitus, Type 2/physiopathology
- Female
- Glycated Hemoglobin/metabolism
- Humans
- Japan
- Male
- Middle Aged
- Natriuretic Peptide, Brain/metabolism
- Prevalence
- Sleep Apnea, Central/blood
- Sleep Apnea, Central/complications
- Sleep Apnea, Central/diagnostic imaging
- Sleep Apnea, Central/physiopathology
- Statistics, Nonparametric
- Tunica Intima/diagnostic imaging
- Ultrasonography
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Affiliation(s)
- Susumu Kashine
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Abstract
Congenital central hypoventilation syndrome (CCHS) patients show reduced breathing drive during sleep, decreased hypoxic and hypercapnic ventilatory responses, and autonomic and affective deficits, suggesting both brainstem and forebrain injuries. Forebrain damage was previously described in CCHS, but methodological limitations precluded detection of brainstem injury, a concern because genetic mutations in CCHS target brainstem autonomic nuclei. To assess brainstem and cerebellar areas, we used diffusion tensor imaging-based measures, namely axial diffusivity, reflecting water diffusion parallel to fibers, and sensitive to axonal injury, and radial diffusivity, measuring diffusion perpendicular to fibers, and indicative of myelin injury. Diffusion tensor imaging was performed in 12 CCHS and 26 controls, and axial and radial diffusivity maps were compared between groups using analysis of covariance (covariates; age and gender). Increased axial diffusivity in CCHS appeared within the lateral medulla and clusters with injury extended from the dorsal midbrain through the periaqueductal gray, raphé, and superior cerebellar decussation, ventrally to the basal-pons. Cerebellar cortex and deep nuclei, and the superior and inferior cerebellar peduncles showed increased radial diffusivity. Midbrain, pontine, and lateral medullary structures, and the cerebellum and its fiber systems are injured in CCHS, likely contributing to the characteristics found in the syndrome.
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Affiliation(s)
- Rajesh Kumar
- Department of Neurobiology, University of California at Los Angeles, Los Angeles, California 90095-1763, USA
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Tada T, Kusano KF, Ogawa A, Iwasaki J, Sakuragi S, Kusano I, Takatsu S, Miyazaki M, Ohe T. The predictors of central and obstructive sleep apnoea in haemodialysis patients. Nephrol Dial Transplant 2007; 22:1190-7. [PMID: 17277346 DOI: 10.1093/ndt/gfl748] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sleep apnoea (SA) is often observed in haemodialysis patients, but there have been few studies on types of SA and their predictors. We therefore investigated the prevalence and types of SA and the associations between types of SA and clinical factors in haemodialysis patients. METHODS We initially examined nocturnal oxygen desaturation index (ODI) (desaturation of >4%/events per hour) in 119 haemodialysis patients (68 males, mean age of 61.4 years). Patients with ODI of more than five were diagnosed as having SA. Then, 30 patients underwent polysomnography and we measured Apnoea-hypopnoea index (AHI), which was calculated as the number of apnoeas plus hypopnoeas per hour of sleep. Clinical characteristics were examined in all patients. RESULTS Forty-one (34.5%) of the 119 patients had SA. Twenty-seven (22.7%) of the 119 patients had SA with subjective symptoms such as daytime somnolence and snoring. There was a significant difference between body mass index (BMI) in patients with SA and that in patients without SA (22.5 vs 19.8 kg/m2, P<0.001). There were significantly higher prevalences of hypertension (85.4 vs 66.7%, P<0.05) and diabetes mellitus (36.6 vs 10.3%, P<0.01) in patients with SA than those in patients without SA. Multivariable analysis showed that BMI was independently associated with the occurrence of SA (OR 1.20, 95% CI 1.05-1.38). Mean AHI of 30 patients who underwent polysomnography was 53.2+/-28.9 [central apnoea, 4.1+/-5.6 (8%); obstructive apnoea, 21.7+/-21.5 (42%); mixed apnoea, 4.9+/-8.0 (9%); hypopnoea, 21.4+/-15.5 (41%)]. The number of obstructive apnoea events per hour was significantly correlated with BUN (r=0.490, P<0.01), Cr (r=0.418, P<0.05) and BMI (r=0.489, P<0.01) and was inversely correlated with serum bicarbonate (r=-0.646, P<0.01) and brain natriuretic peptide (BNP) (r=-0.481, P<0.01). The number of central apnoea events per hour was correlated inversely with PaO2 (r=-0.393, P<0.05) and PaCO2 (r=-0.388, P<0.05) and tended to be correlated with cardiothoracic ratio (CTR) (r=0.347, P=0.060). CONCLUSIONS There is a high prevalence of SA in haemodialysis patients. The dominant type of SA in haemodialysis patients is obstructive sleep apnoea (OSA). Uraemia (BUN, Cr), metabolic acidosis (serum bicarbonate) and BMI are good predictors of OSA. PaO2, PaCO2 and CTR are good predictors of central sleep apnoea (CSA). Good management of these factors might improve SA in haemodialysis patients.
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Affiliation(s)
- Takeshi Tada
- Department of Cardiology, Okayama University Graduate School of Medicine, and Fukushima Naika Clinic, Saiwaicho Memorial Hospital, Okayama, Japan.
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Foo JYA, Bradley AP, Wilson SJ, Williams GR, Dakin C, Cooper DM. Screening of obstructive and central apnoea/hypopnoea in children using variability: a preliminary study. Acta Paediatr 2006; 95:561-4. [PMID: 16825136 DOI: 10.1080/08035250500477552] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AIM Polysomnography (PSG) is the current standard protocol for sleep disordered breathing (SDB) investigation in children. Presently, there are limited reliable screening tests for both central (CE) and obstructive (OE) respiratory events. This study compared three indices, derived from pulse oximetry and electrocardiogram (ECG), with the PSG gold standard. These indices were heart rate (HR) variability, arterial blood oxygen de-saturation (SaO2) and pulse transit time (PTT). METHODS 15 children (12 male) from routine PSG studies were recruited (aged 3-14 years). The characteristics of the three indices were based on known criteria for respiratory events (RPE). Their estimation singly and in combination was evaluated with simultaneous scored PSG recordings. RESULTS 215 RPE and 215 tidal breathing events were analysed. For OE, the obtained sensitivity was HR (0.703), SaO2 (0.047), PTT (0.750), considering all three indices (0) and either of the indices (0.828) while specificity was (0.891), (0.938), (0.922), (0.953) and (0.859) respectively. For CE, the sensitivity was HR (0.715), SaO2 (0.278), PTT (0.662), considering all indices (0.040) and either of the indices (0.868) while specificity was (0.815), (0.954), (0.901), (0.960) and (0.762) accordingly. CONCLUSIONS Preliminary findings herein suggest that the later combination of these non-invasive indices to be a promising screening method of SDB in children.
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Affiliation(s)
- Jong Yong A Foo
- Biomedical Engineering Research Centre, Nanyang Technological University, 50 Nanyang Drive, Singapore, 637553.
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Kasai T, Narui K, Dohi T, Ishiwata S, Yoshimura K, Nishiyama SI, Yamaguchi T, Momomura SI. Efficacy of nasal bi-level positive airway pressure in congestive heart failure patients with cheyne-stokes respiration and central sleep apnea. Circ J 2005; 69:913-21. [PMID: 16041159 DOI: 10.1253/circj.69.913] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cheyne - Stokes respiration with central sleep apnea (CSR-CSA) contributes to the poor prognosis in patients with congestive heart failure (CHF). Bi-level positive airway pressure (bi-level PAP) may be an effective alternative for treating CSR-CSA and CHF. METHODS AND RESULTS Fourteen patients with CSR-CSA were divided into 2 groups, a control group that included 7 patients who decided to receive only conventional medications and a group of 7 patients that received bi-level PAP. Left ventricular ejection fraction (LVEF), mitral regurgitation (MR) area, plasma brain natriuretic peptide (BNP) concentration and the New York Heart Association (NYHA) functional class were evaluated initially (baseline) and 3 months later. In the control group, there were no significant changes in cardiac function during the study period. In contrast, in the group that received bi-level PAP, there were significant improvements in LVEF (from 36.3+/-2.9% to 46.0+/-4.0%, p = 0.02), MR area (from 30.4+/-7.6% to 20.0+/-5.1%, p = 0.02), BNP (from 993.6+/-332.0 pg/ml to 474.0+/-257.6 pg/ml, p = 0.02) and NYHA functional class (from 3.1+/-0.1 to 2.1+/-0.1, p = 0.03). CONCLUSION Treatment with bi-level PAP improved cardiac functions in CHF patients with CSR-CSA.
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Abstract
During sleep, maintenance of rhythmic breathing is critically dependent on the level of PCO(2), such that if the prevailing spontaneous PCO(2) decreases below the apneic threshold, central sleep apnea (CSA) occurs. Several studies have shown that in patients with systolic heart failure (SHF), presence of a low, awake arterial PCO(2) (Pa(CO(2))) increases the likelihood of developing CSA during sleep. We therefore sought to determine if a low Pa(CO(2)) is a predictor of CSA in patients with cirrhosis of the liver and with normal left ventricular systolic function. In 13 hypocapnic (Pa(CO(2)) < 36 mm Hg, mean = 33 mm Hg) patients with SHF and a mean left ventricular ejection fraction of 23%, the mean apnea-hypopnea index, was 28/hour. CSA accounted for most of the breathing disorders. In 10 hypocapnic (Pa(CO(2)) < 36 mm Hg, mean = 32 mm Hg) patients with cirrhosis and a normal left ventricular ejection fraction (60%), the mean apnea-hypopnea index was 2/hour. The maximum central apnea index was 0.2/hour. There were no significant differences in age, demographics, pulmonary function tests, Pa(O(2)), Pa(CO(2)), minute and alveolar ventilation, and ventilatory responses to CO(2) between the two groups. We conclude that, in contrast to SHF, presence of hypocapnia does not predict CSA in cirrhosis.
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Affiliation(s)
- Shahrokh Javaheri
- Emeritus Professor of Medicine, Pulmonary Section (111F), VA Medical Center, 3200 Vine Street, Cincinnati, OH 45220, USA.
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Abstract
Two patients with idiopathic central sleep apnea (ICSA), which is an uncommon condition, were recently encountered. This study examines the polysomnographic features of ICSA. The characteristic findings of ICSA are summarized as follows: (i) central apneas and hypopneas are progressively less frequent as sleep state deepens from stage 1 to stage 2 to stage 3 + 4 to stage REM (rapid eye movement); (ii) desaturation related to apneas and hypopneas is mild; and (iii) periodic breathing is commonly observed. However, the two patients demonstrated apparently different findings. It is suggested that the mechanisms underlying apnea and hypopnea in ICSA are heterogeneous.
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Affiliation(s)
- Masakazu Wakai
- Department of Neurology, Kakegawa City General Hospital, Shizuoka, Japan
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Kawamae K, Murakawa M, Otsuki M, Matsumoto Y, Tase C. Precordial compression without airway management induces lung injury in the rodent cardiac arrest model with central apnea. Resuscitation 2001; 51:165-71. [PMID: 11718972 DOI: 10.1016/s0300-9572(01)00405-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
To investigate whether the lung injury induced by precordial compression without ventilation or not, in the cardiac-arrest animal model with central apnea. Thirty male Sprague-Dawley rats were anesthetized with halothane. The cardiac arrest was induced by 100 mg/kg ketamine (IV) and accompanied with central apnea. They were allocated to four groups by means of resuscitation. Group A was treated with only precordial compression without the other treatments. In group B with tracheotomy and precordial compression. In group C was performed tracheotomy, oxygenation, and precordial compression. The animals in group D were treated with tracheotomy, oxygen administration, artificial ventilation, and precordial compression. Four minutes after cardiac arrest, the resuscitation was started and continued for 20 min. PaCO(2) in the group without mechanical ventilation increased significantly after the start of the resuscitation. All animals were sacrificed after resuscitation procedure. The wet/dry weight ratio of lung in group A (6.9+/-0.8) was significantly higher than that of the other groups B, C and D (5.9+/-0.6, 5.7+/-0.4 and 5.6+/-0.4, P<0.05 in each). The pathological findings also demonstrated the lung injuries, such as edema, migration, and destruction of structure in group A. The precordial compression alone did not improve CO(2) elimination in the gasping-less cardiac arrest model, as well as maybe inducing more severe lung injury than that with the protective management. This experimental model raises the possibility that chest compressions without airway management might result in lung injury.
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Affiliation(s)
- K Kawamae
- Department of Emergency Medicine and Anesthesiology, Fukushima Medical University School of Medicine, 1 Hikarigaoka, Fukushima, Fukushima plefecture 960-1247, Japan.
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