Differential Timing of Arousals in Obstructive and Central Sleep Apnea in Patients with Heart Failure

Simms, Taryn; Brijbassi, Melissa; Taranto‐Montemurro, Luigi; Bradley, T. Douglas

doi:10.5664/jcsm.2918

Cited by 21 publications

(6 citation statements)

References 39 publications

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“…Previous studies reported that the timing of arousal following termination of central apneas is later than observed with obstructive respiratory events (8 seconds versus 1 second, particularly in heart disease patients) [34, 35]. Thus, it would be anticipated that RRLM would also appear at 8 seconds following respiratory event termination.…”

Section: Discussionmentioning

confidence: 97%

Prevalence and associations of respiratory-related leg movements: the MrOS sleep study

Aritake¹,

Blackwell²,

Peters³

et al. 2015

Sleep Medicine

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Objectives Obstructive respiratory events often terminate with an associated respiratory-related leg movement (RRLM). Such leg movements are not scored as periodic leg movements (PLMS), though the criteria for distinguishing RRLM from PLMS differ between American Academy of Sleep Medicine (AASM) and World Association of Sleep Medicine (WASM)/ International Restless Legs Syndrome Study Group (IRLSSG) scoring manuals. Such LMs may have clinical significance in patients with obstructive sleep apnea (OSA). We examined the prevalence and correlates of RRLM in men with OSA. Methods A case control sample of 575 men was selected from all men with an apnea-hypopnea index (AHI, ≥3% desaturation criteria) ≥ 10 and good data from piezoelectric leg movement sensors at the first home sleep study in the MrOS cohort (mean age=76.8 years). Sleep studies were rescored for RRLMs using five different RRLM definitions varying both latency of leg movement onset from respiratory event termination and duration of the leg movement. Quartile of RRLM% (the number of RRLM/the number of hypopneas+apneas) was derived. Results Nonparametric densities of RRLM% were most influenced by alterations in the latency rather than the duration of the LM. The most liberal RRLM definition (latency 0–5 sec, duration 0.5–10 sec) led to a median RRLM% of 23.4 (IQ range 12.41, 37.12) in this sample. The average AHI and arousal index increased as quartile of RRLM% increased, as well as prevalence of COPD. The prevalence of those with a history of hypertension decreased as RRLM% increased. Non-caucasian race was associated with lower RRLM%. Conclusion Within an elderly sample with moderate to severe OSA, piezoelectric-defined RRLM% is associated with a number of sleep-related and demographic factors. Further study of the optimal definition, predictors and consequences of RRLM is warranted.

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Section: Discussionmentioning

confidence: 97%

Prevalence and associations of respiratory-related leg movements: the MrOS sleep study

Aritake¹,

Blackwell²,

Peters³

et al. 2015

Sleep Medicine

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“…It is already shown that the integrated analysis of PSG features can improve the identification of central hypopneas [ 22 ]. Predominance during NREM rather than rapid eye movement (REM) sleep, lack of inspiratory airflow curve flattening or thoracoabdominal paradoxical breathing (chest wall moving inward with inspiration) during hypopnea, arousals in the middle of the recovery breath sequence [ 23 ], and gradual flow restoration pattern at hypopnea termination can help classify hypopneas as central. Automation of hypopnea phenotyping (obstructive vs. central) is possible [ 24 ], but the accuracy in comparison to electromyography is limited (69%).…”

Section: Discussionmentioning

confidence: 99%

Algorithm for automatic detection of self-similarity and prediction of residual central respiratory events during continuous positive airway pressure

Oppersma

Ganglberger

Sun

et al. 2020

Sleep

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Study objectives Sleep disordered breathing is a significant risk factor for cardiometabolic and neurodegenerative diseases. High loop gain is a driving mechanism of central sleep apnea or periodic breathing. This study presents a computational approach that identifies “expressed/manifest” high loop gain via a cyclical self-similarity feature in effort-based respiration signals. Methods Working under the assumption that high loop gain increases the risk of residual central respiratory events during continuous positive airway pressure (CPAP), the full night similarity, computed during diagnostic non-CPAP polysomnography (PSG), was used to predict residual central events during CPAP (REC), which we defined as central apnea index (CAI)>10. Central apnea labels are obtained both from manual scoring by sleep technologists, and from an automated algorithm developed for this study. The Massachusetts General Hospital (MGH) sleep database was used, including 2466 PSG pairs of diagnostic and CPAP titration PSG recordings. Results Diagnostic CAI based on technologist labels predicted REC with an AUC of 0.82 ±0.03. Based on automatically generated labels, the combination of full night similarity and automatically generated CAI resulted in an AUC of 0.85 ±0.02. A subanalysis was performed on a population with technologist labeled diagnostic CAI>5. Full night similarity predicted REC with an AUC of 0.57 ±0.07 for manual and 0.65 ±0.06 for automated labels. Conclusions The proposed self-similarity feature, as a surrogate estimate of expressed respiratory high loop gain and computed from easily accessible effort signals, can detect periodic breathing regardless of admixed obstructive features such as flow-limitation, and can aid prediction of REC.

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“…Zwischen Patienten mit OSA und mit ZSA konnten Unterschiede im Zeitpunkt der Aufwachreaktionen nach Beendigung von Apnoen und Hypopnoen festgestellt werden. Aufwachreaktionen beenden bei OSA Patienten die Apnoe im Mittel nach 0,9 s. Bei Patienten mit ZSA hingegen finden Aufwachreaktionen im Mittel 8,0 s nach der Apnoe statt [30].…”

Section: Aufwachreaktionenunclassified

Ventrikuläre Arrhythmien bei obstruktiver und zentraler Schlafapnoe

2021

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Zusammenfassung Hintergrund Ventrikuläre Arrhythmien treten mit einer hohen Prävalenz auf und sind mit einer hohen Morbidität und Mortalität assoziiert. Sowohl die obstruktive (OSA) als auch die zentrale (ZSA) Schlafapnoe können auf Grund ihrer Pathophysiologie zu vermehrten ventrikulären Arrhythmien beitragen. Ziel Dieser Artikel soll die komplexen Zusammenhänge und Erkenntnisse jüngster Forschungen bezüglich schlafbezogenen Atmungsstörungen (SBAS) und ventrikulärer Arrhythmien und deren Therapiemöglichkeiten beleuchten. Material und Methoden Es erfolgte eine Literaturrecherche basierend auf prospektiven, retrospektiven, klinischen und experimentellen Studien sowie Reviews, Metaanalysen und aktuellen Leitlinien, die seit 2014 in der Medline-Datenbank gelistet wurden. Ergebnisse Es besteht ein bidirektionaler Zusammenhang zwischen der SBAS und ventrikulären Arrhythmien. Intermittierende Hypoxie, oxidativer Stress, wiederkehrende Arousals, intrathorakale Druckschwankungen und kardiales Remodeling tragen im Rahmen der SBAS zu einer erhöhten ventrikulären Arrhythmieneigung bei. Der Schweregrad der OSA, gemessen mittels Apnoe-Hypopnoe-Index, ist mit der Prävalenz ventrikulärer Arrhythmien assoziiert. Ähnliche Ergebnisse liegen für Patienten mit ZSA und Herzinsuffizienz vor. Studien zu ventrikulären Arrhythmien bei ZSA-Patienten ohne Herzinsuffizienz fehlen. Eine Positivdrucktherapie (PAP) bei OSA- oder ZSA-Patienten führte in verschiedenen Studien zu einer reduzierten Anzahl an ventrikulären Arrhythmien. Dieser Zusammenhang konnte jedoch nicht in allen Studien bestätigt werden. Ventrikuläre Arrhythmien treten bei der OSA gehäuft nachts auf, bei der ZSA gleichmäßig über den Tag verteilt. Diskussion Bisherige Studien weisen einen Zusammenhang zwischen der OSA bzw. der ZSA und ventrikulären Arrhythmien trotz unterschiedlicher Pathophysiologie nach. Hinsichtlich des Effektes der PAP auf ventrikuläre Arrhythmien bei Patienten mit OSA und ZSA sind weitere Studien erforderlich.

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Differential Timing of Arousals in Obstructive and Central Sleep Apnea in Patients with Heart Failure

Cited by 21 publications

References 39 publications

Prevalence and associations of respiratory-related leg movements: the MrOS sleep study

Prevalence and associations of respiratory-related leg movements: the MrOS sleep study

Algorithm for automatic detection of self-similarity and prediction of residual central respiratory events during continuous positive airway pressure

Ventrikuläre Arrhythmien bei obstruktiver und zentraler Schlafapnoe

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