Sleep Apnea and Heart Failure

Bradley, T. Douglas; Floras, John S.

doi:10.1161/01.cir.0000061758.05044.64

Cited by 457 publications

(118 citation statements)

References 64 publications

(71 reference statements)

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“…Central sleep apnoea is a primary comorbidity in HF,1, 3, 5, 15, 16, 17, 18, 20, 23 increasing in prevalence with deteriorating cardiac function 21, 22, 48. Chronic HF is recognized as an independent risk factor for the development of CSA 1, 5.…”

Section: Prevalence Of Sleep‐disordered Breathing In Heart Failurementioning

confidence: 99%

“…The pre‐eminent disorders are obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and mixed sleep apnoea, which presents with components of both OSA and CSA. All three forms are characterized by episodes of hypopnoea and/or apnoea, with disease severity increasing with the number of events 1, 2, 3, 4, 5. In this context, hypopnoeas are defined as a reduction in nasal flow of ≥50% for ≥10 s combined with arousal or a decline in oxygen saturation ≥4 percentage points.…”

Section: Introductionmentioning

confidence: 99%

“…The patency of the respiratory tract is functional, but the ventilatory effort, the essential central trigger for breathing, is intermittently disrupted. This malfunction can originate from a variety of neurological diseases11, 12, 13, 14 or HF 1, 3, 5, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24. In HF, the accepted hypothesis is that pulmonary congestion, (which is further aggravated in a horizontal sleeping position) due to a higher left ventricular filling pressure, activates lung vagal irritant receptors causing hyperventilation and hypocapnia 3, 5, 19.…”

Section: Introductionmentioning

confidence: 99%

“…An increased heart rate, diminished heart rate variability, higher blood pressure, and increased cardiac oxygen demand ensue 3, 5, 24, 27, 28. Additionally, oxidative stress may be triggered as a result of the repeated hypoxemia and reoxygenation processes in sleep‐disordered breathing 29, 30, 31, 32.…”

Section: Introductionmentioning

confidence: 99%

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Sleep‐disordered breathing in heart failure: facts and numbers

Pietrock

Haehling

2017

ESC Heart Failure

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Sleep‐disordered breathing has a high prevalence in the general population, but is especially prominent in patients with heart failure (HF). HF and sleep‐disordered breathing share a bidirectional relationship, with sleep‐disordered breathing being both cause and effect of poor cardiac functioning. The high inter‐individual variability of symptom presentation can impede the clinical diagnostic process. Polysomnography is the gold‐standard method of diagnosing sleep‐disordered breathing. Therapy of sleep‐disordered breathing should always consist of optimizing the treatment of the underlying disorder of HF. Additional therapeutic measures include continuous positive airway pressure ventilation therapy. New therapeutic options using neurostimulation are yielding promising results; however, long‐term benefits still need to be confirmed.

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Section: Prevalence Of Sleep‐disordered Breathing In Heart Failurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Sleep‐disordered breathing in heart failure: facts and numbers

Pietrock

Haehling

2017

ESC Heart Failure

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“…It may also contribute to the development of hypertension, cardiac arrhythmia, and myocardial ischaemia via a complex interplay of neurohormonal and inflammatory mechanisms 11. CSA is generally thought to be a marker of increasing severity of CHF and may contribute to worsening symptoms of HF 12, 13.…”

Section: Introductionmentioning

confidence: 99%

Development and validation of a novel non‐contact monitor of nocturnal respiration for identifying sleep‐disordered breathing in patients with heart failure

et al. 2016

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AimsAt least 50% of patients with heart failure (HF) may have sleep‐disordered breathing (SDB). Overnight in‐hospital polysomnography (PSG) is considered the gold standard for diagnosis, but a lack of access to such testing contributes to under‐diagnosis of SDB. Therefore, there is a need for simple and reliable validated methods to aid diagnosis in patients with HF. The aim of this study was to investigate the accuracy of a non‐contact type IV screening device, SleepMinderTM (SM), compared with in‐hospital PSG for detecting SDB in patients with HF.Methods and resultsThe study included 75 adult patients with systolic HF and suspected SDB who underwent simultaneous PSG and SM recordings. An algorithm was developed from the SM signals, using digital signal processing and pattern recognition techniques to calculate the SM apnoea‐hypopnoea index (AHI). This was then compared with expert‐scored PSGAHI. The SM algorithm had 70% sensitivity and 89% specificity for identifying patients with clinically significant SDB (AHI ≥ 15/h). At this threshold, it had a positive likelihood ratio of 6.3 and a negative likelihood ratio of 0.16. The overall accuracy of the SMAHI algorithm was 85.8% as shown by the area under a receiver operator characteristic curve. The mean AHI with SM was 3.8/h (95% confidence interval 0.5–7.1) lower than that with PSG.ConclusionsThe accuracy of the non‐contact type IV screening device SM is good for clinically significant SDB in patients with systolic HF and could be considered as a simple first step in the diagnostic pathway.

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