Evaluation and Treatment of Central Sleep Apnea in Patients with Heart Failure

Fudim, Marat; Shahid, Izza; Emani, Sitaramesh; Klein, Liviu; Dupuy-McCauley, Kara; Zieroth, Shelley; Mentz, Robert J

doi:10.1016/j.cpcardiol.2022.101364

Cited by 16 publications

(8 citation statements)

References 75 publications

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“…Studies have shown that CSA mostly occurs in patients with chronic heart failure. 10 Although adverse effects of trazodone, such as CSA, have not been reported, the outpatient physician made the decision to perform trazodone withdrawal to rule out the drug’s effects in our patient. PAP improves the symptoms of OSA, such as drowsiness and insomnia.…”

Section: Discussionmentioning

confidence: 95%

Successful treatment of auto-trilevel positive airway pressure plus trazodone for obstructive sleep apnea complicated by anxiety disorder: a case report

He,

Lang,

Pei

et al. 2023

J Int Med Res

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Obstructive sleep apnea (OSA) is a highly prevalent type of sleep-disordered breathing, which is often comorbid with affective disorders such as anxiety. A 61-year-old woman who was diagnosed with OSA affected by anxiety disorder complained of poor sleep quality at night and anxiety symptoms, and showed chest tightness, dyspnea, snoring, and apnea events during sleep. The patient initially received treatment with positive airway pressure (PAP) combined with trazodone, and subsequently switched to auto-trilevel PAP (AtPAP) combined with trazodone therapy. The initial attempt to treat the patient’s disease by auto-adjusting PAP combined with trazodone failed because of central sleep apnea (CSA), which frequently occurred at night. After switching to AtPAP combined with trazodone therapy, CSA was effectively eliminated. In addition, sleep quality, hypoxia, and anxiety disorders were improved. The first report of successful therapy of AtPAP combined with trazodone for OSA complicated by anxiety disorder provides a new therapeutic strategy for this patient population.

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Section: Discussionmentioning

confidence: 95%

Successful treatment of auto-trilevel positive airway pressure plus trazodone for obstructive sleep apnea complicated by anxiety disorder: a case report

He,

Lang,

Pei

et al. 2023

J Int Med Res

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“…It occurs between 0,6% and 20,3% in patients who have difficulty breathing during sleep [19]. Risk factors for CSA include: male gender, low body mass index (BMI), drugs -mainly opiates, heart diseases such as atrial fibrillation, coronary artery disease and stroke [19,20,21].…”

Section: Central Sleep Apneamentioning

confidence: 99%

“…If the cause of CSA is not established, the disease is defined as idiopathic [18]. In patients with CSA with cardiovascular diseases, the main cause of the disease is low cardiac output, which subsequently leads to hypoxemia, which results in activation of the sympathetic system and results in hyperventilation [20,21]. During sleep apneic threshold decreases which results in hyperventilation resulting in hypocapnia which leads to apnea which results in hypercapnia and the cycle repeats [20,21].…”

Section: Central Sleep Apneamentioning

confidence: 99%

“…In patients with CSA with cardiovascular diseases, the main cause of the disease is low cardiac output, which subsequently leads to hypoxemia, which results in activation of the sympathetic system and results in hyperventilation [20,21]. During sleep apneic threshold decreases which results in hyperventilation resulting in hypocapnia which leads to apnea which results in hypercapnia and the cycle repeats [20,21]. In CSA with heart failure, Cheyne-Stokes respiration often occurs, which is characterized by sequential waxing and waning changes in tidal volume all while prolonging apnea and cycle time (from 45 to 75 seconds) [21].…”

Section: Central Sleep Apneamentioning

confidence: 99%

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Diagnostic and therapeutic process of respiratory disorders during sleep

Maliszewska,

Oleksak,

Welian-Polus

et al. 2024

J Educ Health Sport

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Introduction and purpose Sleep apnea is a disturbance of sleep that affects about 10% of adult population and is not easily detected due to unspecific symptoms. The aim of this literature review is to present, respectively, obstructive sleep apnea and central sleep apnea symptoms and integrate the available data in the literature regarding the pathogenesis and treatment methods. Materials and methods A review of literature was performed using PubMed and Google Scholar database. The search criteria included keywords such as sleep apnea, obstructive sleep apnea treatment, central sleep apnea treatment. State of knowledge Sleep disturbances that involve breathing can be categorized as obstructive sleep apnea (OSA) and central sleep apnea. First one is associated with the obstruction of the upper airways and the second one – with malfunctioning breathing generator in the pontomedullary breathing pacemaker. Symptoms are unspecific which makes diagnostic process difficult. However, the right diagnosis and treatment may prevent patients from developing many cardiovascular diseases. Treatment options for OSA include: CPAP, reducing body weight, changing sleep position, braces and surgeries; for CSA: CPAP and acetazolamide. Conclusions OSA and CSA need to be further investigated in order to find more precise ways of diagnosis and treatment, as these diseases remain underreported. It is worth noting, that these conditions predispose to serious diseases, e.g. stroke. Therefore, developing new treatment techniques would beneficial for the health of population.

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“…Obstructive sleep apneas (OSAs) and central sleep apneas (CSAs) are among the most common comorbidities that are strongly associated with all-cause mortality in more than 50% of patients with HF [4,5]. Several therapeutic approaches have been applied to address CSA and OSA, but none of these pharmacologic interventions have been shown to significantly improve patients' prognoses for HF [6][7][8][9]. Due to its correlation with poorer left ventricular function and an advanced New York Heart Association (NYHA) class [10], CSA seems to be a significant indication of HF severity, despite OSA being considered an independent risk factor augmenting HF morbidity and death [11][12][13][14][15][16][17], while the benefits of non-invasive ventilation (NIV) for CSA therapy in HF are still debatable [18][19][20], as suggested by the findings of both SERVE-HF [21] and ADVENT-HF [22] randomized clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Effect of SGLT2-Inhibitors on Polygraphic Parameters in Elderly Patients Affected by Heart Failure, Type 2 Diabetes Mellitus, and Sleep Apnea

Armentaro,

Pelaia,

Condoleo

et al. 2024

Biomedicines

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Obstructive sleep apneas (OSAs) and central sleep apneas (CSAs) are the most common comorbidities in Heart Failure (HF) that are strongly associated with all-cause mortality. Several therapeutic approaches have been used to treat CSA and OSA, but none have been shown to significantly improve HF prognosis. Our study evaluated the effects of a 3-months treatment with sodium-glucose cotransporter type 2 inhibitor (SGLT2i) on polygraphic parameters in patients with sleep apnea (SA) and HF, across the spectrum of ejection fraction, not treated with continuous positive air pressure (CPAP). A group of 514 consecutive elderly outpatients with HF, type 2 diabetes mellitus (T2DM) and SA, eligible for treatment with SGLT2i, were included in the investigation before starting any CPAP therapy. The two groups were compared with the t-test and Mann–Whitney test for unpaired data when appropriate. Then, a simple logistic regression model was built using 50% reduction in AHI as the dependent variable and other variables as covariates. A multivariate stepwise logistic regression model was constructed using the variables that linked with the dependent variable to calculate the odds ratio (OR) for the independent predictors associated with the reduction of 50% in AHI. The treated group experienced significant improvements in polygraphic parameters between baseline values and follow-up with reduction in AHI (28.4 ± 12.9 e/h vs. 15.2 ± 6.5 e/h; p < 0.0001), ODI (15.4 ± 3.3 e/h vs. 11.1 ± 2.6 e/h; p < 0.0001), and TC90 (14.1 ± 4.2% vs. 8.2 ± 2.0%; p < 0.0001), while mean SpO2 improved (91. 3 ± 2.3 vs. 93.8 ± 2.5); p < 0.0001. These benefits were not seen in the untreated population. The use of SGLT2i in patients suffering from HF and mixed-type SA not on CPAP therapy significantly contributes to improving polygraphic parameters.

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Evaluation and Treatment of Central Sleep Apnea in Patients with Heart Failure

Cited by 16 publications

References 75 publications

Successful treatment of auto-trilevel positive airway pressure plus trazodone for obstructive sleep apnea complicated by anxiety disorder: a case report

Successful treatment of auto-trilevel positive airway pressure plus trazodone for obstructive sleep apnea complicated by anxiety disorder: a case report

Diagnostic and therapeutic process of respiratory disorders during sleep

Effect of SGLT2-Inhibitors on Polygraphic Parameters in Elderly Patients Affected by Heart Failure, Type 2 Diabetes Mellitus, and Sleep Apnea

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