Management of Sleep Disordered Breathing in Patients with Heart Failure

Oates, Connor P.; Ananthram, Manjula; Gottlieb, Stephen S.

doi:10.1007/s11897-018-0387-7

Cited by 11 publications

(8 citation statements)

References 67 publications

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“…Patients who in a second step should have their breathing objectively screened by polygraphy are those who report snoring, have witnessed apnoeas, and who experience excessive daytime sleepiness and poor sleep quality. Patients with nocturnal angina, recurrent arrhythmias, refractory heart failure symptoms, other types of witnessed abnormal breathing pattern or repetitive desaturations could also be screened .…”

Section: Discussionmentioning

confidence: 99%

“…Today, there is no clear consensus regarding how SDB should be treated in patients with chronic heart failure . However, SDB is important to recognise because it is associated with impairment of the already failing heart, and because it affects sleep, with negative implications for daily life.…”

Section: Discussionmentioning

confidence: 99%

“…In the knowledge gap after the SERVE‐HF study, there has been insecurity both in the cardiovascular and sleep community regarding how to approach patients with chronic heart failure and SDB, with special emphasis on patients with central sleep apnoea . Nonetheless, the commonness of SDB in chronic heart failure and the impact it has on the individual calls for continued awareness.…”

Section: Introductionmentioning

confidence: 99%

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Sleepless nights and sleepy days: a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep‐disordered breathing

Gullvåg

Gjeilo

Fålun

et al. 2019

Scandinavian Caring Sciences

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Background Sleep‐disordered breathing, including obstructive sleep apnoea and central sleep apnoea, is a common disorder among patients with chronic heart failure. Obstructive sleep apnoea is often treated with continuous positive airway pressure, but central sleep apnoea lacks a clear treatment option. Knowledge of how sleep‐disordered breathing is experienced (e.g. difficulties and care needs) and handled (e.g. self‐care actions) by the patients is limited, but needed, to provide patient‐centred care. Aim To explore how newly verified sleep‐disordered breathing is experienced by patients with chronic heart failure. Methods Data were collected through semi‐structured interviews and analysed with qualitative content analysis. Seventeen participants (14 men, three women), mean age 60 years (range 41–80) diagnosed with chronic heart failure and objectively verified sleep‐disordered breathing (nine obstructive, seven central and one mixed) were strategically selected from heart failure outpatient clinics at two Norwegian university hospitals. Results Patients with chronic heart failure and newly verified sleep‐disordered breathing (SDB) described experiences of poor sleep that had consequences for their daily life and their partners. Different self‐care strategies were revealed, but they were based on ‘common sense’ and were not evidence‐based. The awareness of having SDB was varied; for some, it gave an explanation to their trouble while others were surprised by the finding. Conclusion Patients with chronic heart failure and sleep‐disordered breathing experienced reduced sleep quality, influencing their daily life. Possible underlying causes of disrupted sleep, such as sleep‐disordered breathing, should be identified to establish proper patient‐centred treatment strategies. There is a need for new strategies to approach patients with chronic heart failure (i.e. those with central sleep apnoea) who are not subject to continuous positive airway pressure treatment for their sleep‐disordered breathing.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sleepless nights and sleepy days: a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep‐disordered breathing

Gullvåg

Gjeilo

Fålun

et al. 2019

Scandinavian Caring Sciences

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“…As the severity of the heart failure increases, and especially in the presence of an impaired ejection fraction, the proportion of central apneas associated to impaired respiratory regulation (Cheyne-Stokes respiration) increases, so that the most common cause of central sleep apnea is more severe heart failure. In contrast, OSA is mostly observed in patients with heart failure with preserved ejection fraction 44 .…”

Section: Obstructive Sleep Apnea and Cardiovascular Diseasesmentioning

confidence: 98%

Obstruktive Schlafapnoe – Einfluss auf kardiovaskuläres System und Kognition

Schneider¹

2023

Laryngorhinootologie

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ZusammenfassungKardiovaskuläre und kognitive Erkrankungen sind ebenso wie die obstruktive Schlafapnoe sehr häufige Krankheiten mit einer erheblichen Beeinträchtigung der Lebensqualität und einer deutlichen sozioökonomischen Bedeutung. Die Auswirkungen einer unbehandelten obstruktiven Schlafapnoe (OSA) auf das kardiovaskuläre und kognitive Erkrankungsrisiko und die Therapieeffekte einer OSA sind für die meisten kardiovaskulären und kognitiven Folgeerkrankungen wissenschaftlich nachgewiesen. Für die klinische Praxis besteht ein deutlicher Bedarf nach mehr Interdisziplinarität. Aus schlafmedizinischer Sicht müssen bei der Therapieindikation das individuelle kardiovaskuläre und kognitive Risiko berücksichtigt und kognitive Erkrankungen bei der Beurteilung der Therapieintoleranz und residuellen Symptomatik beachtet werden. Aus internistischer Sicht sollte bei Patienten mit schlecht einstellbarem Hypertonus, Vorhofflimmern, koronarer Herzkrankheit und Schlaganfall die Abklärung einer OSA in die Diagnostik integriert werden. Bei Patienten mit milder kognitiver Beeinträchtigung, Alzheimer-Krankheit und Depression können sich die typischen Symptome wie Fatigue, Tagesmüdigkeit und Reduktion der kognitiven Leistungen mit OSA-Symptomen überschneiden. Die Diagnostik einer OSA sollte in die Abklärung dieser Krankheitsbilder integriert werden, da eine Therapie der OSA die kognitiven Beeinträchtigungen reduzieren und die Lebensqualität verbessern kann.

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“…Therefore, SA is thought to be a potential target for therapeutic approaches which can improve the health status of HF patients (15). Whilst current evidence indicates that OSA treatment with continuous positive airway pressure (CPAP) decreases all-cause mortality in HF patients (16)(17)(18), the benefits of non-invasive ventilation (NIV) for CSA therapy are still debated (19)(20)(21), as suggested by the results of both SERVE-HF (22) and ADVENT-HF (23) randomized clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Effects of sacubitril-valsartan on clinical, echocardiographic and polygraphic parameters in patients affected by heart failure with reduced ejection fraction and sleep apnea

Armentaro

Pelaia

Volpentesta

et al. 2022

European Heart Journal

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Background Heart failure with reduced ejection fraction (HFrEF) is a clinical condition frequently diagnosed in clinical practice. In patients affected by HFrEF, sleep apnea (SA) can be detected among the most frequent comorbidities. Sacubitril–valsartan (sac/val) association has been proven to be effective in reducing disease progression and all-cause mortality in HFrEF patients. Sac/val treatment can potentially attenuate SA development via several pathophysiologic mechanisms, including improvement of global hemodynamics, reduction of extracellular fluid overload, and decrease of sympathetic neural activity. Purpose The aim of this work is to evaluate the effects of a 6-month therapy with sac/val on hemodynamic and metabolic parameters, as well as on the occurrence of apnea/hypopnea and oxygen saturation in patients with HFrEF and SA, already treated with CPAP. Methods We recruited 132 patients affected by HFrEF and SA, already under treatment with continuous positive airway pressure (CPAP), which was discontinued 24 hours before the scheduled study timepoints. Physical examination, echocardiography, nocturnal cardio-respiratory monitoring, and laboratory tests were performed in each patient at baseline and after a 6-month treatment with sac/val. Results After 6 months, sac/val induced statistically significant changes in clinical, hemodynamic, biohumoral (NT-proBNP, serum electrolytes, creatinine and uric acid), and echocardiographic parameters. In particular, cardiac index (CI), both atrial and ventricular volumes and global longitudinal strain (GLS) improved. Moreover, polysomnography, carried out during a temporary CPAP interruption, revealed a significant reduction in global apnea-hypopnea index (AHI) value (p<0.0001), central AHI (p<0.0001), obstructive AHI (p<0.0001), oxygen desaturation index (ODI) (p<0.0001), and percentage time of saturation below 90% (TC90) (p<0.0001). The changes of CI, estimated glomerular filtration rate (eGFR), NT-proBNP and tricuspid annular plane excursion (TAPSE) contributed to 23.6%, 7.6%, 7.3% and 4.8% of AHI variability, respectively, and the whole model accounted for a 43.3% of AHI variation. Conclusions Our results suggest that treatment with sac/val is able to significantly improve the cardiorespiratory performance of patients with HFrEF and SA, integrating the positive impact of CPAP. Thus, both CPAP and sac/val therapy may synergistically contribute to lower the risks of both cardiac and pulmonary complications in HFrEF patients with SA. Funding Acknowledgement Type of funding sources: None.

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Management of Sleep Disordered Breathing in Patients with Heart Failure

Cited by 11 publications

References 67 publications

Sleepless nights and sleepy days: a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep‐disordered breathing

Sleepless nights and sleepy days: a qualitative study exploring the experiences of patients with chronic heart failure and newly verified sleep‐disordered breathing

Obstruktive Schlafapnoe – Einfluss auf kardiovaskuläres System und Kognition

Effects of sacubitril-valsartan on clinical, echocardiographic and polygraphic parameters in patients affected by heart failure with reduced ejection fraction and sleep apnea

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