Influence of cardiac resynchronisation therapy on different types of sleep disordered breathing

Abstract

Aims: This study investigates the influence of cardiac resynchronisation therapy (CRT) on sleep disordered breathing (SDB) in patients with severe heart failure (HF). Methods and results: Seventy-seven patients with HF (19 females; 62.6 ± 10 years) eligible for CRT were screened for presence, type, and severity of SDB before and after CRT initiation (5.3 ± 3 months) using cardiorespiratory polygraphy. NYHA class, frequency of nycturia, cardiopulmonary exercise, 6-minute walking test results, and echocardiography parameters were obtained at baseline and follow-up.Central sleep apnoea (CSA) was documented in 36 (47%), obstructive sleep apnoea (OSA) in 26 (34%), and no SDB in 15 (19%) patients. CRT improved clinical and haemodynamic parameters. SDB parameters improved in CSA patients only (apnoea hypopnoea index: 31.2 ±15.5 to 17.3 ± 13.7/h, p b 0.001; SaO 2 min: 81.8± 6.6 to 84.8± 3.3%, p = 0.02, desaturation: 6.5± 2.3 to 5.5 ± 0.8%, p = 0.004). Daytime capillary pCO 2 was significantly lower in CSA patients compared to those without SDB with a trend towards increase with CRT (35.5 ± 4.2 to 37.9 ± 5.7 mm Hg, ns). After classifying short term clinical and haemodynamic CRT effects, improved SDB parameters in CSA occurred in responders only. Conclusions: In patients with severe HF eligible for CRT, CSA is common and can be influenced by CRT, this improvement depends on good clinical and haemodynamic response to CRT.

Adaptive Servo Ventilation Improves Cardiac Dysfunction and Prognosis in Chronic Heart Failure Patients With Cheyne-Stokes Respiration

“…[30][31][32][33][34][35] The present study included 12 patients at least 12 months after CRT implantation, and CSR-CSA and depressed cardiac function still remained in spite of standard pharmacotherapy and CRT in these patients.…”

Overdrive Ventricular Pacing in Pacemaker Recipients with Permanent Atrial Fibrillation and Sleep Apnea

“…Gabor et al observed no change in blood O 2 saturation despite a clear alleviation of CSA by CRT, 10 while Oldenburg et al noted a mitigation of O 2 desaturation. 11 The duration of pulse oximeter O 2 saturation < 90% during BUV40 was significantly longer among our patients with history of HF decompensation than our patients without ( Table 3), suggesting that patients with previous cardiac decompensation were more hypoxic at baseline than patients who never previously suffered an episode of acute HF. This did not seem strictly related to SA, since AHI was not highest among patients with the longest duration of pulse oximeter O 2 saturation < 90%.…”

“…Measurements of BNP have not been included in the majority of studies of CRT and sleep disordered breathing. [9][10][11][12]14 Lüthje et al observed a decrease in BNP after 3 months of CRT, of similar amplitude in patients with versus without CSA. 13 In that study, BNP was unchanged by overnight overdrive atrial pacing.…”

“…Our observations are concordant with previous reports of a decrease in apneic events by cardiac pacing in patients with HF and predominant CSA. 1,[9][10][11][12]18,21 The impact of our experiment on apnea-related symptoms or on HF outcome has not been assessed. Patients with HF and CSA often have a paucity of symptoms related to central apnea.…”

“…In contrast, cardiac resynchronization therapy (CRT) does alleviate central SA/Cheyne-Stokes respiration (CSA), a breathing disorder present in > 30% of patients with stable HF and associated with a decreased survival rate. [3][4][5][6][7][8][9][10][11][12][13][14] The aim of this study was to compare the effects of overnight overdrive ventricular pacing (OVP) versus overnight ventricular pacing at a low backup rate on SA in recipients of permanent pacemakers suffering from permanent atrial fi brillation (AF). The comparison was also made in separating the patients depending on whether they suffered from HF or not.…”