Sleep and heart failure

Central sleep apnoea syndrome with upper airway collapse

“…There was no clinical, radiological or echographic evidence of left ventricular failure, despite the patient's age and pacemaker requirement. Cardiac failure [5,6] is thought to cause CSA by means of an increased circulation time between peripheral chemoreceptors and the respiratory centres, thereby leading to a delay in respiratory response to C0 2 • Although we lack direct evidence, we hypothesize a role for local factors in the genesis of CSA in this case. As postulated by BRADLEY et al [16), partial or complete collapse of the pharynx, facilitated by increased pharyngeal compliance, may stimulate mechanoreceptors in the airway and reflexly inhibit central respiratory drive.…”

“…The effectiveness of nCP AP supports the suggestion of a role for local upper airway factors in the genesis of CSA in this case. Reflex central stimulation of breathing in response to local pressure has not been demonstrated [6]. The effects of nCPAP on respiratory instability related to hypocapnia remain unknown.…”

“…CSA may have a variety of causes, such as a failure of central respiratory generation with lesions of the central nervous system (CNS) [1]. Alternatively, there may be reflex inhibition of ventilation through activation of upper airway receptors (2], or CSA may occur in response to instability of respiratory control, as occurs at altitude [3], with metabolic disorders [4], and with heart failure [5,6].…”