RESUMEN
La apnea central del sueño es causada por una falla temporal del centro ponto-medular que es el responsable de generar una respiración rítmica. Puede ser un hallazgo fisiológico durante la transición vigilia-sueño o estar presente por múltiples causas. La enfermedad cardiovascular o cerebro-vascular, el síndrome de apneas e hipopneas obstructivas durante el sueño, el uso de opioides y el tratamiento con CPAP son las más frecuentes en la práctica clínica, mientras que en sujetos sanos las apneas centrales se relacionan con la altura durante la exposición recreacional. Este trabajo revisa la fisiopatología de las apneas centrales, su clasificación, las normas para su identificación en los estudios de sueño y un enfoque práctico sobre las opciones terapéuticas disponibles.
Central sleep apnea is caused by a temporary failure of the ponto-medullary center that is responsible for generating rhythmic breathing. It can be a physiological finding during the sleep-wake transition or be present for multiple causes. Cardiovascular or cerebrovascular disease, obstructive sleep apnea/hypopnea syndrome, use of opioids and treatment with CPAP (Continuous Positive Airway Pressure) are the most frequent in clinical practice, while in healthy subjects central apneas are related to high altitude during recreational exposure. This study reviews the physiopathology of central apneas, their classification, the current rules for their identification in sleep studies and a practical approach to the therapeutic options available.
RESUMEN
Objective To evaluate the long-tem effect of adaptive servo ventilation (ASV) on patients with chronic heart failure (CHF) and sleep-disordered breathing (SDB). Methods The controlled clinical articles were searched included in PubMed, Cochrane, EMBASE and CBM, CJFD, WangFang Database from Jan. 1970 to Dec. 2015. Included standard: left ventricular ejection fraction (LVEF) ≤55%, apnea hypopnea index (AHI) ≥15/h, follow up period over 4 weeks. After quality assessment (modified Jadad score) and data extraction by two independent reviewers, mete analysis was performed with RevMan 5.3 software. Results Thirteen studies were recruited including 442 cases being followed over 4 weeks [ASV group 233 cases and control group 216 cases (corssover design 7)]. Compared to control group, LVEF increased [weighted mean difference (WMD)=3.72, 95%CI: 1.80-5.64, PP<0.01] and AHI decreased significantly (WMD=–18.63, 95%CI: –26.19-–11.08), the distance walked in 6 minutes increased (WMD=28.72, 95%CI: 2.26-55.18, P=0.03) and plasma N terminal brain natriuretic peptide precursor (NT-pro BNP) decreased significantly (WMD=–744.03, 95%CI: –1262.45-–225.62, P<0.05) in ASV group. Conclusion Over 4 weeks ASV may improve LVEF and AHI, increase 6-min walking distance and decrease NT-pro BNP in patients with CHF and SDB.