Sleep disordered breathing in patients with heart failure

Krawczyk, Magdalena; Flinta, Irena; Garncarek, Magdalena; Jankowska, Ewa A.; Banasiak, Waldemar; Germany, Robin; Javaheri, Shahrokh; Ponikowski, Piotr

doi:10.5603/cj.2013.0092

Cited by 15 publications

(10 citation statements)

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“…Centralny bezdech senny stanowi mniej niż 10% wszystkich przypadków bezdechu. Mechanizmy przyczyniające się do powstania CSA u chorych z HF są złożone i stanowią przedmiot zainteresowania wielu grup badawczych [10]. Znacznie częstszy niż CSA jest obturacyjny bezdech senny, którego patogeneza pozostaje zupełnie inna [11].…”

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Stymulacja nerwu przeponowego w leczeniu centralnego bezdechu sennego u chorych z niewydolnością serca

2019

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Central sleep apnea (CSA) is characterised by a cessation of airflow in the respiratory airways during sleep due to fluctuations in respiratory drive accompanied by a cessation of respiratory muscle activity. Patients with CSA often have a Cheyne-Stokes respiration. CSA occurs in patients with various diseases including patients with heart failure (HF). It can lead to many unfavourable phenomena associated with sympathetic nervous system activation and increased mortality. Continuous positive airway pressure and other methods are used in the treatment of CSA. Recently, a new method has been developed that features stimulation of the phrenic nerve. This leads to contractions of the diaphragm and to regulation of the breathing pattern. The following paper presents the current state of knowledge on stimulation of the phrenic nerve, and its impact on respiratory parameters, physical performance and quality of life in patients with HF.

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Stymulacja nerwu przeponowego w leczeniu centralnego bezdechu sennego u chorych z niewydolnością serca

2019

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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%

“…This malfunction can originate from a variety of neurological diseases 11-14 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 The paCO 2 threshold to stimulate the central respiratory centre is not surpassed.…”

Section: Central Sleep Apnoeamentioning

confidence: 99%

“…21,22,47,48 In one study, patients with chronic HF (New York Heart Association ≥II or left-ventricular Editorial ejection fraction ≤40%) 40% were diagnosed with CSA and 35% with OSA. 21 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.…”

Section: Prevalence Of Sleep-disordered Breathing In Heart Failurementioning

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%

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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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Central Sleep Apnea with Cheyne-Stokes Breathing in Heart Failure – From Research to Clinical Practice and Beyond

Terziyski

Draganova

2018

Advances in Experimental Medicine and Biology

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Characterized by periodic crescendo-decrescendo pattern of breathing alternating with central apneas, Central sleep apnea (CSA) with Cheyne-Stokes Breathing represents a highly prevalent, yet underdiagnosed comorbidity in chronic heart failure (CHF). A diverse body of evidence demonstrates increased morbidity and mortality in the presence of CSB. CSB has been described in both CHF patients with preserved and reduced ejection fraction, regardless of drug treatment. Risk factors for CSB are older age, male gender, high BMI, atrial fibrillation and hypocapnia.The pathophysiology of CSB has been explained by the loop gain theory, where a controller (the respiratory center) and a plant (the lungs) are operating in a reciprocal relationship (negative feedback) to regulate a key parameter (partial pressure of carbon dioxide (pCO)). The temporal interaction between these elements is dependent on the circulatory delay. Increased chemosensitivity/chemoresponsiveness of the respiratory center and/or augmented ascending non- CO stimuli from the C-fibers in the lungs (interstitial pulmonary edema), overly efficient ventilation when breathing at low volumes and prolonged circulation time are involved. An alternative hypothesis of CSB being an adaptive response of the failing heart has its merits as well. The clinical manifestation of CSB is usually poor, lacking striking symptoms and complaints. Witnessed apneas and snoring are infrequently reported by the sleep partner. Sometimes patients may report poor sleep quality with frequent awakenings, paroxysmal nocturnal dyspnea and frequent urination at night. Standard instrumental and laboratory studies, performed in CHF patients, may present clues to the presence of CSB. Concentric remodeling of the left ventricle and dilated left atrium (echocardiography), high BNP and C-reactive protein levels, increased ventilation-carbon dioxide output (VEVCO) and lower end-tidal CO (cardiopulmonary exercise testing), reduced diffusion capacity (pulmonary function testing) and hypocapnia (blood-gas analysis) may indicate the presence of CSB.CSB and cardiovascular disease are probably linked through bidirectional causality. Cyclic variations in heart rate, blood pressure, respiratory volume, partial pressure of arterial oxygen (pO) and pCO lead to sympathetic-adrenal activation. The latter worsens ventricular energetism and survival of cardiomyocytes and exerts antiarhythmogenic effects. It causes cardiac remodeling, potentiating the progression and the lethal outcome in CHF patients. Several treatment modalities have been proposed in CSB. The most commonly used are continuous positive airway pressure (CPAP), adaptive servoventilation (ASV) and nocturnal home oxygen therapy (HOT). Novel therapies like nocturnal supplemental CO and phrenic nerve stimulation are being tested recently. The current treatment recommendations (by the American Academy of Sleep Medicine) are for CPAP and HOT as standard therapies, while ASV is an option only in patients with EF > 45%. BPAP (bilevel device) remains an ...

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Sleep disordered breathing in patients with heart failure

Abstract: Sleep disordered breathing (SDB) is a common co-morbidity in patients with heart failure (HF). (Cardiol J 2013; 20, 4: 345-355)

Cited by 15 publications

References 53 publications

Stymulacja nerwu przeponowego w leczeniu centralnego bezdechu sennego u chorych z niewydolnością serca

Stymulacja nerwu przeponowego w leczeniu centralnego bezdechu sennego u chorych z niewydolnością serca

Sleep‐disordered breathing in heart failure: facts and numbers

Central Sleep Apnea with Cheyne-Stokes Breathing in Heart Failure – From Research to Clinical Practice and Beyond

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