Sleep disordered breathing in patients with acutely decompensated heart failure

Cheyne-Stokes respiration (CSR) is characterized by a pattern of cyclic oscillations of tidal volume and respiratory rate with periods of hyperpnea alternating with hypopnea or apnea in patients with heart failure. CSR harms the failing heart through intermittent hypoxia brought about by apnea and hypopnea and recurrent sympathetic surges. CSR impairs the quality of life and increases cardiac mortality in patients with heart failure. Thus, CSR should actively be pursued in patients with severe heart failure. When CSR persists despite optimal therapy of heart failure, noninvasive adaptive servoventilation is currently the most promising treatment.

show abstract

“…The highest prevalence of CSR occurred in hospitalized patients with severe CHF and/or stroke [2,5,26,27] (fig. 2).…”

Section: Prevalence and Importance Of Chf And Csrmentioning

confidence: 99%

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Brack¹,

Randerath

Bloch

2011

Respiration

View full text Add to dashboard Cite

show abstract

“…Up to 40% of patients with CHF have CSA and 11% have OSA [33]. SDB is common in both stable CHF and acute decompensated heart failure [38]. In 28 of 29 patients admitted with acute heart failure, SDB was demonstrated by polysomnography.…”

Section: Sleep-disordered Breathingmentioning

confidence: 99%

Management of Noncardiac Comorbidities in Chronic Heart Failure

Chong

Singh

Parry

et al. 2015

Cardiovascular Therapeutics

Self Cite

View full text Add to dashboard Cite

SummaryPrevalence of heart failure is increasing, especially in the elderly population. Noncardiac comorbidities complicate heart failure care and are increasingly common in elderly patients with reduced or preserved ejection fraction heart failure, owing to prolongation of patient's lives by advances in chronic heart failure (CHF) management. Common comorbidities include respiratory disease, renal dysfunction, anemia, arthritis, obesity, diabetes mellitus, cognitive dysfunction, and depression. These conditions contribute to the progression of the disease and may alter the response to treatment, partly as polypharmacy is inevitable in these patients. Cardiologists and other physicians caring for patients with CHF need to be vigilant to comorbid conditions that complicate the care of these patients. There is now more guidance on management of noncardiac comorbidities in heart failure, and this article contains a comprehensive review of the most recent updates on management of noncardiac comorbidities in CHF.

show abstract

“…[20][21][22] One of the interesting features of SDB in patients with HF compared with general SDB patients is a relative lack of symptoms, especially of daytime somnolence, [23][24][25][26] which could contribute to the lack of recognition and detection of SDB in HF patients. 27 One possible explanation for a lack of daytime sleepiness in HF patients with SDB is the increased sympathetic nervous system activity in HF patients compared with healthy subjects, 28,29 which is increased even further in the presence of OSA.…”

Section: 10mentioning

confidence: 99%

“…At 44-97 %, the prevalence of CSA in patients with acute decompensated HF is even greater than that in those with stable HF. [20][21][22] In addition, when present, CSA in acute decompensated HF patients is usually severe (AHI >30/h), 21 and has been shown to be a predictor of readmission and mortality. 47 It is interesting to note that optimal medical management, resolution of acute decompensation and return to baseline cardiopulmonary status are often not associated with a significant change in the severity of CSA.…”

mentioning

confidence: 99%

“…47 It is interesting to note that optimal medical management, resolution of acute decompensation and return to baseline cardiopulmonary status are often not associated with a significant change in the severity of CSA. 21,43,48,49 Insertion of a left ventricular assist device (LVAD) has been associated with improvements in SDB in refractory patients. 50,51 These findings could indicate that severe CSA was present prior to the acute decompensation episode, and that more severe HF drives the higher prevalence and greater severity of CSA in these patients.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Sleep-disordered Breathing in Heart Failure – Current State of the Art

Cowie

Woehrle

Oldenburg

et al. 2015

Cardiac Failure Review

View full text Add to dashboard Cite

In developed countries, approximately 1-2 % of the adult population has heart failure (HF), and the prevalence of this cardiovascular disease increases with age.1,2 HF can occur in the presence or absence of reduced left ventricular ejection fraction (LVEF), known as HF with reduced ejection fraction (HF-rEF) and HF with preserved ejection fraction (HF-pEF), respectively. The most widely studied of these is HF-rEF, which is particularly prevalent in men with ischaemic heart disease.3 HF-pEF is present in 40-50 % of HF patients. 4,5 It is more prevalent in women and the underlying aetiology is more often non-ischaemic. 3,6 Despite these differences, the negative prognostic impact of both HF-rEF and HF-pEF appears to be similar. 6 The prevalence of renal disease and sleep-disordered breathing (SDB) is similar in patients with HF-rEF or HF-pEF, but the profile of other co-morbidities differs, with pulmonary disease, anaemia and obesity tending to be more prevalent in HF-pEF patients. 7 Even with the wide range of therapeutic options available for patients with HF-rEF and treatment being optimised according to current guideline recommendations, most HF-rEF patients will eventually die from progressive disease; for HF-pEF there are still no evidence-based treatments available, so the focus is mainly on treatment of co-morbidities and optimising risk factors. and often a combination of the two, is highly prevalent in patients with heart failure (HF), is associated with reduced functional capacity and quality of life, and has a negative prognostic impact. European HF guidelines identify that sleep apnoea is of concern in patients with HF. Continuous positive airway pressure is the treatment of choice for OSA, and adaptive servoventilation (ASV) appears to be the most consistently effective therapy for CSA/CSR while also being able to treat concomitant obstructive events. There is a growing body of evidence that treating SDB in patients with HF, particularly using ASV for CSA/CSR, improves functional outcomes such as HF symptoms, cardiac function, cardiac disease markers, exercise tolerance and quality of life. However, conflicting results have been reported on 'hard' outcomes such as mortality and healthcare utilisation, and the influence of effectively treating SDB, including CSA/CSR, remains to be determined in randomised clinical trials. Two such trials (SERVE-HF and ADVENT-HF) in chronic stable HF and another in post-acute decompensated HF (CAT-HF) are currently underway. KeywordsObstructive sleep apnoea, central sleep apnoea, heart failure, adaptive servoventilation, continuous positive airway pressure Disclosure: Professor Cowie is co-principal investigator of the SERVE-HF study, and receives research and consultancy fees from ResMed. Acknowledgement: Medical writing support was provided by Nicola Ryan, independent medical writer, funded by ResMed. Sleep-disordered Breathing in Heart Failure -Current State of the Art Received 17SDB is characterised by intermittent hypoxia, reoxygenation, hypercapnia, arousals a...

show abstract

Sleep disordered breathing in patients with acutely decompensated heart failure

Cited by 60 publications

References 29 publications

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Cheyne-Stokes Respiration in Patients with Heart Failure: Prevalence, Causes, Consequences and Treatments

Management of Noncardiac Comorbidities in Chronic Heart Failure

Sleep-disordered Breathing in Heart Failure – Current State of the Art

Contact Info

Product

Resources

About