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1.
Sleep Med ; 107: 157-163, 2023 07.
Article in English | MEDLINE | ID: mdl-37178547

ABSTRACT

STUDY OBJECTIVES: Cheyne - Stokes respiration (CSR) is prevalent in patients with chronic heart failure (CHF). Adaptive Servo Ventilation (ASV) alleviates CSR and improves objective sleep quality. We investigated the effects of ASV on neurocognitive function in the symptomatic phenotype of patients with CSR and CHF. METHODS: This case series included patients diagnosed with stable CHF (NYHA ≥ II) and CSR (N = 8). Sleep and neurocognitive function were assessed at baseline and after 1- and 6-months following initiation of ASV treatment. RESULTS: In CHF patients (n = 8, median age 78.0[64.5-80.8] years and BMI 30.0[27.0-31.5] kg/m2, median ejection fraction 30[24-45]%, Epworth Sleepiness Scale (ESS) score 11.5[9.0-15.0]), ASV markedly improved respiration during sleep (Apnea-Hypopnea Index (AHI) 44.1[39.0-51.5]n/h at baseline, 6.3[2.4-9.7]n/h at 6 months treatment, respectively, p < 0.01). The 6-min-walk test distance increased by treatment from (295.0[178.8-385.0] m to 356.0[203.8-495.0] m (p = 0.05)). Sleep structure was modified, and Stage 3 increased markedly from 6.4[1.7-20.1] % to 20.8[14.2-25.3] %, p < 0.02). Sleep latency in the Maintenance of Wakefulness Test increased from 12.0[6.0-30.0] min to 26.3[12.0-30.0] min, (p = 0.04). In the Attention Network Test, evaluating neurocognition, the number of lapses decreased from 6.0[1.0-44.0] to 2.0[0.3-8.0], (p = 0.05) and the overall number of responses to a preset stimulus increased after treatment (p = 0.04). CONCLUSIONS: ASV treatment in CHF patients with CSR may improve sleep quality, neurocognition and daytime performance.


Subject(s)
Cheyne-Stokes Respiration , Cognition , Continuous Positive Airway Pressure , Disorders of Excessive Somnolence , Heart Failure , Disorders of Excessive Somnolence/complications , Disorders of Excessive Somnolence/psychology , Disorders of Excessive Somnolence/therapy , Heart Failure/complications , Heart Failure/psychology , Heart Failure/therapy , Chronic Disease , Cheyne-Stokes Respiration/etiology , Cheyne-Stokes Respiration/psychology , Cheyne-Stokes Respiration/therapy , Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Continuous Positive Airway Pressure/instrumentation , Pilot Projects
2.
Paediatr Respir Rev ; 43: 78-84, 2022 Sep.
Article in English | MEDLINE | ID: mdl-35459626

ABSTRACT

Cheyne-Stokes respiration (CSA-CSR) is a form of central sleep apnea characterized by alternating periods of hyperventilation and central apneas or hypopneas. CSA-CSR develops following a cardiac insult resulting in a compensatory increase in sympathetic activity, which in susceptible patients causes hyperventilation and destabilizes respiratory control. The physiological changes that occur in CSA-CSR include hyperventilation, a reduced blood gas buffering capacity, and circulatory delay. In adults, 25% to 50% of patients with heart failure are reported to have CSA-CSR. The development of CSA-CSR in this group of patients is considered a poor prognostic sign. The prevalence, progression, and treatment outcomes of CSA-CSR in children remain unclear with only 11 children being described in the literature. The lack of data is possibly not due to the paucity of children with severe heart failure and CSA-CSR but because they may be under-recognized, compounded by the absence of routine polysomnographic assessment of children with moderate to severe heart failure. Building on much broader experience in the diagnosis and management of CSA-CSR in adult sleep medicine and our limited experience in a pediatric quaternary center, this paper will discuss the prevalence of CSA-CSR, its' treatment options, outcomes in children, and the potential future direction for research in this understudied area of pediatric sleep medicine.


Subject(s)
Heart Failure , Sleep Apnea, Central , Adult , Humans , Child , Cheyne-Stokes Respiration/therapy , Cheyne-Stokes Respiration/diagnosis , Cheyne-Stokes Respiration/etiology , Hyperventilation/complications , Sleep Apnea, Central/complications , Sleep Apnea, Central/therapy , Heart Failure/complications , Heart Failure/therapy , Sleep
3.
Respirology ; 27(2): 161-169, 2022 02.
Article in English | MEDLINE | ID: mdl-34873795

ABSTRACT

BACKGROUND AND OBJECTIVE: Case reports have suggested that continuous positive airway pressure (CPAP) telemonitoring can detect the onset of acute cardiac events such as decompensated heart failure (HF) or atrial fibrillation through an increase in the apnoea-hypopnoea index (AHI) and onset of Cheyne-Stokes Respiration (CSR). This study addressed whether long-term remote CPAP treatment telemonitoring revealing CSR can help detect serious cardiac events (SCEs) in obstructive sleep apnoea (OSA) patients. METHODS: This monocentric prospective cohort study included adults receiving CPAP therapy for OSA with daily telemonitoring. Any sudden increase in AHI generated an alert for the home healthcare provider to download CPAP data to identify CSR. A medical consultation was scheduled if CSR was detected. RESULTS: We included 555 adults (412 men; 57% with known cardiovascular comorbidities). During the 1-year follow-up, 78 CSR episodes were detected in 74 patients (CSR+). The main conditions associated with incident CSR were HF (24 patients [30.8%]), ventilatory instability (21, 26.9%), leaks (13, 16.7%), medications inducing central apnoeas (baclofen, ticagrelor, opioids) (7, 9.0%), arrhythmias (6, 7.7%) and renal failure (2, 2.6%). Fifteen (20.3%) CSR+ patients had a confirmed SCE. In univariable analysis, a CSR episode increased the risk of an SCE by 13.8-fold (5.7-35.6) (p < 0.0001), with an adjusted OR of 5.7 (2.0-16.8) in multivariable analysis. CONCLUSION: Long-term telemonitoring of patients on CPAP treatment can alert CSR episodes and allows early detection of SCEs in patients with or without known cardiac comorbidities.


Subject(s)
Heart Failure , Sleep Apnea, Central , Sleep Apnea, Obstructive , Adult , Cheyne-Stokes Respiration/complications , Cheyne-Stokes Respiration/etiology , Continuous Positive Airway Pressure , Female , Heart Failure/complications , Heart Failure/diagnosis , Humans , Male , Prospective Studies , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/diagnosis , Sleep Apnea, Obstructive/therapy
4.
Monaldi Arch Chest Dis ; 91(2)2021 Apr 01.
Article in English | MEDLINE | ID: mdl-33792229

ABSTRACT

We present a case report of a heart failure patient who underwent cardiopulmonary exercise testing and sleep screening 12 months before and after heart transplantation (HTx). Severe Cheyne-Stokes respiration (CSR) with central sleep apnoea (CSA) was identified either before and after HTx, while periodic breathing during exercise vanished. We suggest that optimization of hemodynamics and medical therapy (low dose of diuretic) did not withdraw the central mechanisms underlying the diathesis for CSR-CSA. While periodic breathing during exercise reversal may support a closer link with an exertional central hemodynamic. This observation indirectly neglects the possible unifying mechanistic background of CSR and periodic breathing, during exercise, in this setting.


Subject(s)
Heart Failure , Heart Transplantation , Sleep Apnea, Central , Cheyne-Stokes Respiration/etiology , Exercise Test , Heart Transplantation/adverse effects , Humans , Sleep Apnea, Central/diagnosis , Sleep Apnea, Central/etiology
5.
Monaldi Arch Chest Dis ; 90(1)2020 Mar 27.
Article in English | MEDLINE | ID: mdl-32225996

ABSTRACT

Exercise oscillatory ventilation (EOV) is an ominous sign in heart failure due to reduced left ventricular ejection fraction (HFrEF) whatever it is represented. But EOV is detected also in normal healthy individuals and in other cardiovascular disease (CVD) patients, however, its prevalence in these is not completed clear. The aim was to describe the occurrence of EOV in healthy subjects and the overall population all CVD patients who performing symptom limited cardiopulmonary exercise testing (CPET). Healthy subjects were divided in athletes and normal subjects, while, CVD patients were subdivided into: i) t hose with preserved left ventricular ejection fraction (LVEF); ii) those with mild to moderate impairment of LVEF (41-49%); iii) those with severe impairment of LVEF (≤40%); iv) HFrEF or with preserved LVEF (HFpEF); and iv) patients after heart transplantation (HXT). EOV was observed only in CVD patients and in those with depressed LVEF; the prevalence of EOV was observed 1.9% (3/55) those with mild to moderate impairment of LVEF (41-49%), 3.4% (56/1613) those with severe impairment of LVEF (≤40%), and 7.3% (214/2903) in HFrEF); no EOV was observed in CVD with preserved LVEF. Kremser's EOV was observed in patients, and, particularly, in those with systolic function impairment. Moreover, as EOV impacts prognosis in HFrEF, its occurrence can modify prognostic-decision models. Even though, EOV prevalence was derived from largest single center population, more studies are needed to tackle the EOV prevalence in different CVD conditions and in normal subjects.


Subject(s)
Cardiovascular Diseases , Cheyne-Stokes Respiration/etiology , Heart Failure , Ventricular Dysfunction, Left , Athletes , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/physiopathology , Case-Control Studies , Decision Support Techniques , Exercise Test , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Oxygen Consumption , Prognosis , Stroke Volume , Ventricular Dysfunction, Left/complications , Ventricular Dysfunction, Left/diagnosis , Ventricular Function, Left
6.
PLoS One ; 15(3): e0221191, 2020.
Article in English | MEDLINE | ID: mdl-32163424

ABSTRACT

Cheyne-Stokes respiration (CSR) is a sleep-disordered breathing characterized by recurrent central apneas alternating with hyperventilation exhibiting a crescendo-decrescendo pattern of tidal volume. This respiration is reported in patients with heart failure, stroke or damage in respiratory centers. It increases mortality for patients with severe heart failure as it has adverse impacts on the cardiac function. Early stage of CSR, also called periodic breathing, is often undiagnosed as it only provokes hypopneas instead of apneas, which are much more difficult to detect. This paper demonstrates the proof of concept of a new method devoted to the early detection of CSR. The proposed approach relies on a signal demodulation technique applied to ventilation signals measured on 15 patients with chronic heart failure whose respiration goes from normal to severe CSR. Based on a modulation index and its instantaneous frequency, oscillation zones are detected and classified into three categories: CSR, periodic breathing and no abnormal pattern. The modulation index is used as an efficient indicator to quantify the degree of certainty of the pathology for each patient. Results show high correlation with experts' annotations with sensitivity and specificity values of 87.1% and 89.8% respectively. A final decision leads to a classification which is confirmed by the experts' conclusions.


Subject(s)
Algorithms , Cheyne-Stokes Respiration/diagnosis , Cheyne-Stokes Respiration/etiology , Heart Failure/complications , Patient-Specific Modeling , Aged , Cheyne-Stokes Respiration/physiopathology , Early Diagnosis , Humans , Male , Middle Aged , Polysomnography/methods , Respiration , Retrospective Studies , Sensitivity and Specificity , Sleep Apnea, Central/physiopathology , Tidal Volume
8.
Respirology ; 25(3): 305-311, 2020 03.
Article in English | MEDLINE | ID: mdl-31218793

ABSTRACT

BACKGROUND AND OBJECTIVE: Increases in Cheyne-Stokes respiration (CSR) cycle length (CL), lung-to-periphery circulation time (LPCT) and time to peak flow (TTPF) may reflect impaired cardiac function. This retrospective analysis used an automatic algorithm to evaluate baseline CSR-related features and then determined whether these could be used to identify patients with systolic heart failure (HF) who experienced serious adverse events in the Treatment of Sleep-Disordered Breathing with Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure (SERVE-HF) substudy. METHODS: A total of 280 patients had overnight diagnostic polysomnography data available; an automated algorithm was applied to quantify CSR-related features. RESULTS: Median baseline CL, LPCT and TTPF were similar in the control (n = 152) and adaptive servo-ventilation (ASV, n = 156) groups. In both groups, CSR-related features were significantly longer in patients who did (n = 129) versus did not (n = 140) experience a primary endpoint event (all-cause death, life-saving cardiovascular intervention or unplanned hospitalization for worsening HF): CL, 61.1 versus 55.1 s (P = 0.002); LPCT, 36.5 versus 31.5 s (P < 0.001); TTPF, 15.20 versus 13.35 s (P < 0.001), respectively. This finding was independent of treatment allocation. CONCLUSION: Patients with systolic HF and central sleep apnoea who experienced serious adverse events had longer CSR CL, LPCT and TTPF. Future studies should examine an independent role for CSR-related features to enable risk stratification in systolic HF.


Subject(s)
Cheyne-Stokes Respiration/etiology , Heart Failure, Systolic/complications , Sleep Apnea, Central/complications , Aged , Algorithms , Cheyne-Stokes Respiration/physiopathology , Female , Heart Failure, Systolic/physiopathology , Hospitalization , Humans , Male , Middle Aged , Polysomnography , Positive-Pressure Respiration/adverse effects , Positive-Pressure Respiration/methods , Retrospective Studies , Sleep Apnea, Central/physiopathology , Sleep Apnea, Central/therapy , Survival Rate
9.
Clin Res Cardiol ; 109(7): 881-891, 2020 Jul.
Article in English | MEDLINE | ID: mdl-31784904

ABSTRACT

INTRODUCTION: The SERVE-HF trial included patients with heart failure and reduced ejection fraction (HFrEF) with sleep-disordered breathing, randomly assigned to treatment with Adaptive-Servo Ventilation (ASV) or control. The primary outcome was the first event of death from any cause, lifesaving cardiovascular intervention, or unplanned hospitalization for worsening heart failure. A subgroup analysis of the SERVE-HF trial suggested that patients with Cheyne-Stokes respiration (CSR) < 20% (low CSR) experienced a beneficial effect from ASV, whereas in patients with CSR ≥ 20% ASV might have been harmful. Identifying the proteomic signatures and the underlying mechanistic pathways expressed in patients with CSR could help generating hypothesis for future research. METHODS: Using a large set of circulating protein-biomarkers (n = 276, available in 749 patients; 57% of the SERVE-HF population) we sought to investigate the proteins associated with CSR and to study the underlying mechanisms that these circulating proteins might represent. RESULTS: The mean age was 69 ± 10 years and > 90% were male. Patients with CSR < 20% (n = 139) had less apnoea-hypopnea index (AHI) events per hour and less oxygen desaturation. Patients with CSR < 20% might have experienced a beneficial effect of ASV treatment (primary outcome HR [95% CI] = 0.55 [0.34-0.88]; p = 0.012), whereas those with CSR ≥ 20% might have experienced a detrimental effect of ASV treatment (primary outcome HR [95% CI] = 1.39 [1.09-1.76]; p = 0.008); p for interaction = 0.001. Of the 276 studied biomarkers, 8 were associated with CSR (after adjustment and with a FDR1%-corrected p value). For example, higher PAR-1 and ITGB2 levels were associated with higher odds of having CSR < 20%, whereas higher LOX-1 levels were associated with higher odds of CSR ≥ 20%. Signalling, metabolic, haemostatic and immunologic pathways underlie the expression of these biomarkers. CONCLUSION: We identified proteomic signatures that may represent underlying mechanistic pathways associated with patterns of CSR in HFrEF. These hypothesis-generating findings require further investigation towards better understanding of CSR in HFrEF. SUMMARY OF THE FINDINGS: PAR-1 proteinase-activated receptor 1, ADM adrenomedullin, HSP-27 heat shock protein-27, ITGB2 integrin beta 2, GLO1 glyoxalase 1, ENRAGE/S100A12 S100 calcium-binding protein A12, LOX-1 lectin-like LDL receptor 1, ADAM-TS13 disintegrin and metalloproteinase with a thrombospondin type 1 motif, member13 also known as von Willebrand factor-cleaving protease.


Subject(s)
Cheyne-Stokes Respiration/etiology , Cheyne-Stokes Respiration/metabolism , Heart Failure/complications , Ventricular Dysfunction, Left/complications , Aged , Biomarkers/metabolism , Cheyne-Stokes Respiration/therapy , Female , Heart Failure/metabolism , Heart Failure/therapy , Humans , Male , Middle Aged , Proteomics , Respiration, Artificial , Treatment Outcome , Ventricular Dysfunction, Left/metabolism , Ventricular Dysfunction, Left/therapy
10.
Clin Chest Med ; 40(2): 449-457, 2019 06.
Article in English | MEDLINE | ID: mdl-31078221

ABSTRACT

Periodic breathing (PB) during exercise is a slow, prominent, consistent fluctuation in ventilation and derived parameters that may be persistent for the entire exercise or present only in the early phases of exercise. It is associated with a negative prognosis, particularly if concomitant with PB during sleep. Little is known about exercise-induced PB physiology, but hyperventilation is likely due to an increased sympathetic activity combined with an enhanced stimulation of intrapulmonary, chemoreceptors and metaboreceptors, low cardiac output leading to increased circulatory delay, and cerebrovascular reactivity to CO2, all with have a definite role.


Subject(s)
Cheyne-Stokes Respiration/etiology , Exercise Test/methods , Heart Failure/complications , Female , Humans , Male , Prognosis
11.
Int J Cardiol ; 289: 76-82, 2019 08 15.
Article in English | MEDLINE | ID: mdl-30917898

ABSTRACT

BACKGROUND: Although Cheyne-Stokes respiration (CSR) is an oscillatory phenomenon, the direct effects of cyclical hyperventilation and apnea on cardiopulmonary hemodynamics have been poorly investigated. The aim of the study was to examine the echocardiographic changes associated with CSR phases in a group of patients with systolic heart failure (HF) and daytime CSR. METHODS: 14 HF patients (age 70 ±â€¯9 years, LVEF 24 ±â€¯5) underwent a thorough clinical evaluation, 24-h respiratory polygraphy, chemoreflex evaluation by rebreathing technique and neuro-hormonal assessment. Furthermore, they received a simultaneous echocardiographic and respiratory monitoring embedding the respiratory signal in the echocardiographic machine. RESULTS: All patients had daytime CSR (diurnal apnea-hypopnea index, AHI: 18.5, interquartile range: 15.3-39.5 events/h). Systolic pulmonary artery pressure and pulmonary vascular resistances (PVR) increased from hyperventilation to apnea (H 45.3 ±â€¯11.4 vs A 52.4 ±â€¯13.8 mmHg, p = 0.004, and H 3.3 ±â€¯2.5 vs A 5.1 ±â€¯3.2 Wood units, p = 0.0003, respectively), while acceleration time of the pulmonary artery decreased (H 110.1 ±â€¯19.8 vs A 92.0 ±â€¯19.9 ms, p = 0.001). During apnea a reduction of right and left ventricular outflow tract VTI (H 12.8 ±â€¯4.9 versus A 9.9 ±â€¯3.1, p = 0.002 and H 26.9 ±â€¯8.8 versus A 22.8 ±â€¯7.9 mm, p = 0.006, respectively), and a reduction in tricuspid annular plane systolic excursion (H 15.9 ±â€¯4.4 versus A 14.4 ±â€¯4.1 mm, p = 0.005) were also observed. Notably, PVR variation strongly correlated with chemosensitivity to hypercapnia (R = 0.89, p = 0.0004) and plasma norepinephrine level (R = 0.78, p = 0.003). CONCLUSIONS: In HF patients with CSR, an increase in pulmonary pressure and pulmonary vascular resistances was observed during apnea. Pulmonary vasoconstriction strongly correlated with chemosensitivity to hypercapnia and indexes of adrenergic activation.


Subject(s)
Cheyne-Stokes Respiration/etiology , Heart Failure/complications , Hemodynamics/physiology , Lung/physiopathology , Aged , Cheyne-Stokes Respiration/physiopathology , Echocardiography , Female , Follow-Up Studies , Heart Failure/diagnosis , Heart Failure/physiopathology , Humans , Male , Polysomnography , Prospective Studies
13.
Heart Lung ; 48(2): 114-120, 2019.
Article in English | MEDLINE | ID: mdl-30340809

ABSTRACT

BACKGROUND: Cheyne-Stokes respiration and periodic breathing (CSRPB) have not been studied sufficiently in the intensive care unit setting (ICU). OBJECTIVES: To determine whether CSRPB is associated with adverse outcomes in ICU patients. METHODS: The ICU group was divided into quartiles by CSRPB (86 patients in quartile 1 had the least CSRPB and 85 patients in quartile 4 had the most CSRPB). Adverse outcomes (emergent intubation, cardiorespiratory arrest, inpatient mortality and the composite of all) were compared between patients with most CSRPB (quartile 4) and those with least CSRPB (quartile 1). RESULTS: ICU patients in quartile 4 had a higher proportion of cardiorespiratory arrests (5% versus 0%, (p=.042), and more adverse events over all (19% versus 8%, p=.041) as compared to patients in quartile 1. CONCLUSIONS: CSRPB can be measured in the ICU and it's severity is associated with adverse outcomes in critically ill patients.


Subject(s)
Cheyne-Stokes Respiration/diagnosis , Electrocardiography , Heart Arrest/complications , Intensive Care Units , Respiration , Adult , Cheyne-Stokes Respiration/etiology , Cheyne-Stokes Respiration/physiopathology , Female , Heart Arrest/diagnosis , Heart Arrest/physiopathology , Humans , Male , Middle Aged
14.
Sleep Med Clin ; 12(4): 565-572, 2017 Dec.
Article in English | MEDLINE | ID: mdl-29108611

ABSTRACT

Central sleep apnea (CSA) and Hunter-Cheyne-Stokes breathing (HCSB) are caused by failure of the pontomedullary pacemaker generating breathing rhythm. CSA/HCSB may complicate several disorders causing recurrent arousals and desaturations. Common causes of CSA in adults are congestive heart failure, stroke, and chronic use of opioids; opioids have hypoventilatory effects. Diagnosis and treatment of hyperventilatory CSA may improve quality of life, and, when associated with heart failure or cerebrovascular disease, reduce morbidity and perhaps mortality.


Subject(s)
Altitude , Cerebrovascular Disorders/complications , Cheyne-Stokes Respiration , Continuous Positive Airway Pressure/methods , Heart Failure/complications , Sleep Apnea, Central , Cheyne-Stokes Respiration/diagnosis , Cheyne-Stokes Respiration/etiology , Cheyne-Stokes Respiration/therapy , Humans , Sleep Apnea, Central/diagnosis , Sleep Apnea, Central/etiology , Sleep Apnea, Central/therapy
15.
Heart Vessels ; 32(8): 909-915, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28188451

ABSTRACT

The recent SERVE HF study concluded that patients with chronic heart failure (CHF) and Cheyne-Stokes respiration (CSR) have increased mortality when treated with adaptive servo-ventilation (ASV). We, therefore, wanted to explore if these patients tolerated discontinuation of ASV treatment. The study was a prospective post-ASV treatment observational design with a 3-month follow-up period. 14 patients from our outpatient clinic, all male, were originally diagnosed with CHF and Cheyne-Stokes respiration, which is a clinical form of central sleep apnea. Left ventricular ejection fraction (LVEF) was ≤45% when ASV treatment was initiated. Median machine use was 68 (42-78) months when the patients were instructed to terminate ASV treatment. The patients were then followed during conventional CHF treatment for 3 months. Study baseline was set the last ASV treatment day. Sleep data were collected from the machine the last day of use. Apnea-hypopnea index (AHI), LVEF, 6-min walk test and 24-h ambulatory electrocardiogram recordings were performed at baseline and at study end. Life quality data were obtained using The Minnesota Living with Heart Failure Questionaire (MLHFQ). New York Heart Association Functional Classification (NYHA) was registered. An ambulatory sleep screening was performed at study end. AHI increased significantly after 3 months without ASV treatment [from 1.6 (0.8-3.2) to 39.2 (24.3-44.1, p = 0.001)]. Quality of life (QOL) decreased significantly: 30 (13-54) at discontinuation of ASV vs. 46 (24-67) (MLHFQ) at study end, p = 0.04. Though there was no significant change in NYHA functional class, patients especially reported increased shortness of breath, reduced concentration and reduced memory after discontinuation of ASV treatment. There were no significant differences in LVEF, heart rhythm data and physical capacity. Left ventricular function was preserved indicating that discontinuation of ASV in heart failure patients does not affect cardiac capacity. There was a significant decrement in QOL that must be considered in further treatment of these patients.


Subject(s)
Cheyne-Stokes Respiration/therapy , Heart Failure/therapy , Cheyne-Stokes Respiration/etiology , Cheyne-Stokes Respiration/mortality , Continuous Positive Airway Pressure , Female , Follow-Up Studies , Heart Failure/complications , Heart Failure/physiopathology , Humans , Male , Norway/epidemiology , Prospective Studies , Quality of Life , Stroke Volume , Survival Rate/trends , Time Factors , Treatment Outcome , Ventricular Function, Left/physiology , Withholding Treatment
16.
Am J Respir Crit Care Med ; 195(2): 237-246, 2017 01 15.
Article in English | MEDLINE | ID: mdl-27559818

ABSTRACT

RATIONALE: In patients with chronic heart failure, daytime oscillatory breathing at rest is associated with a high risk of mortality. Experimental evidence, including exaggerated ventilatory responses to CO2 and prolonged circulation time, implicates the ventilatory control system and suggests feedback instability (loop gain > 1) is responsible. However, daytime oscillatory patterns often appear remarkably irregular versus classic instability (Cheyne-Stokes respiration), suggesting our mechanistic understanding is limited. OBJECTIVES: We propose that daytime ventilatory oscillations generally result from a chemoreflex resonance, in which spontaneous biological variations in ventilatory drive repeatedly induce temporary and irregular ringing effects. Importantly, the ease with which spontaneous biological variations induce irregular oscillations (resonance "strength") rises profoundly as loop gain rises toward 1. We tested this hypothesis through a comparison of mathematical predictions against actual measurements in patients with heart failure and healthy control subjects. METHODS: In 25 patients with chronic heart failure and 25 control subjects, we examined spontaneous oscillations in ventilation and separately quantified loop gain using dynamic inspired CO2 stimulation. MEASUREMENTS AND MAIN RESULTS: Resonance was detected in 24 of 25 patients with heart failure and 18 of 25 control subjects. With increased loop gain-consequent to increased chemosensitivity and delay-the strength of spontaneous oscillations increased precipitously as predicted (r = 0.88), yielding larger (r = 0.78) and more regular (interpeak interval SD, r = -0.68) oscillations (P < 0.001 for all, both groups combined). CONCLUSIONS: Our study elucidates the mechanism underlying daytime ventilatory oscillations in heart failure and provides a means to measure and interpret these oscillations to reveal the underlying chemoreflex hypersensitivity and reduced stability that foretells mortality in this population.


Subject(s)
Circadian Rhythm/physiology , Heart Failure/physiopathology , Respiratory Rate/physiology , Carbon Dioxide/metabolism , Case-Control Studies , Cheyne-Stokes Respiration/etiology , Cheyne-Stokes Respiration/physiopathology , Female , Humans , Male , Middle Aged
17.
Med Biol Eng Comput ; 55(8): 1189-1198, 2017 Aug.
Article in English | MEDLINE | ID: mdl-27744563

ABSTRACT

Exercise periodic breathing (EPB) is associated with exercise intolerance and poor prognosis in patients with heart failure (HF). However, EPB detection during cardiopulmonary exercise test (CPET) is difficult. The present study investigated the use of a wireless monitoring device to record the EPB during CPET and proposed quantization parameter estimates for the EPB. A total of 445 patients with HF were enrolled and underwent exercise tests. The ventilation data from the wearable device were compared with the data obtained during the CPET and were analyzed based on professional opinion and on 2 automated programs (decision tree [DT] and oscillatory pattern methods). The measurement accuracy was greater with the DT method (89 %) than with the oscillatory pattern method (75 %). The cutoffs for EPB recognition using the DT method were (1) an intercept of the regression line passing through the minute ventilation rate vs. the time curve during the recovery phase ≥64.63, and (2) an oscillatory phase duration to total exercise time ratio ≥0.5828. The wearable device was suitable for the assessment of EPB in patients with HF, and our new automated analysis system using the DT method effectively identified the EPB pattern.


Subject(s)
Breath Tests/instrumentation , Cheyne-Stokes Respiration/diagnosis , Cheyne-Stokes Respiration/physiopathology , Exercise Test/instrumentation , Heart Failure/diagnosis , Heart Failure/physiopathology , Thermography/instrumentation , Cheyne-Stokes Respiration/etiology , Diagnosis, Computer-Assisted/methods , Equipment Design , Equipment Failure Analysis , Female , Heart Failure/complications , Humans , Male , Middle Aged , Oscillometry/instrumentation , Reproducibility of Results , Respiratory Mechanics , Rheology/instrumentation , Sensitivity and Specificity
18.
Lancet Respir Med ; 4(11): 873-881, 2016 11.
Article in English | MEDLINE | ID: mdl-27592224

ABSTRACT

BACKGROUND: A large randomised treatment trial (SERVE-HF) showed that treatment of central sleep apnoea with adaptive servoventilation in patients with heart failure and reduced ejection fraction (HFREF) increased mortality, although the analysis of the composite primary endpoint (time to first event of death from any cause, life-saving cardiovascular intervention, or unplanned hospital admission for worsening heart failure) was neutral. This secondary multistate modelling analysis of SERVE-HF data investigated associations between adaptive servoventilation and individual components of the primary endpoint to try to better understand the mechanisms underlying the observed increased mortality. METHODS: In SERVE-HF, participants were randomly assigned to receive either optimum medical treatment for heart failure alone (control group), or in combination with adaptive servoventilation. We analysed individual components of the primary SERVE-HF endpoint separately in a multistate model, with and without three covariates suggested for effect modification (implantable cardioverter defibrillator at baseline, left ventricular ejection fraction [LVEF], and proportion of Cheyne-Stokes Respiration [CSR]). The SERVE-HF study is registered with ClinicalTrials.gov, number NCT00733343. FINDINGS: Univariate analysis showed an increased risk of both cardiovascular death without previous hospital admission (hazard ratio [HR] 2·59, 95% CI 1·54-4·37, p<0·001) and cardiovascular death after a life-saving event (1·57, 1·01-2·44, p=0·045) in the group receiving adaptive servoventilation versus the control group. Adjusted analysis showed that the increased risk attributed to adaptive servoventilation of cardiovascular death without previous hospital admission for worsening heart failure varied with LVEF and that the risk attributed to adaptive servoventilation of hospital admission for worsening heart failure varied with LVEF and CSR. In patients with LVEF less than or equal to 30%, use of adaptive servoventilation markedly increased the risk of cardiovascular death without previous hospital admission (HR 5·21, 95% CI 2·11-12·89, p=0·026). INTERPRETATION: Adaptive servoventilation is associated with an increased risk of cardiovascular death in patients with heart failure and reduced ejection fraction (LVEF ≤45%) treated for predominant central sleep apnoea. This multistate modelling analysis shows that this risk is increased for cardiovascular death in patients not previously admitted to hospital, presumably due to sudden death, and in patients with poor left ventricular function. FUNDING: ResMed.


Subject(s)
Cheyne-Stokes Respiration/mortality , Heart Failure/mortality , Interactive Ventilatory Support/mortality , Sleep Apnea, Central/mortality , Ventricular Dysfunction, Left/mortality , Aged , Cause of Death , Cheyne-Stokes Respiration/etiology , Death, Sudden, Cardiac/etiology , Female , Heart Failure/complications , Heart Failure/therapy , Hospitalization/statistics & numerical data , Humans , Interactive Ventilatory Support/methods , Male , Middle Aged , Proportional Hazards Models , Sleep Apnea, Central/complications , Sleep Apnea, Central/therapy , Stroke Volume/physiology , Treatment Outcome , Ventricular Dysfunction, Left/etiology , Ventricular Function, Left
19.
Ideggyogy Sz ; 69(1-2): 66-72, 2016 Jan 30.
Article in English | MEDLINE | ID: mdl-26987242

ABSTRACT

Cheyne-Stokes respiration (CSR) is a form of sleep-disordered breathing characterised by recurrent central sleep apnoea alternating with a crescendo-decrescendo pattern of tidal volume, relatively rare observation in sleep labs. It is mainly seen in severe heart failure and stroke. We report the case of a young man with CSR after sudden onset of seizure in the context of hypertensive exacerbation leading to the diagnosis of a leukoencephalopathy, and comment on differential diagnoses, prognostic and therapeutic outcomes. The very uniqueness of this case consists in the extremely young age for developing a vascular encephalopathy in the absence of genetic diseases and without previous diagnosis of hypertension. There is no adequate explanation for the origin of vascular encephalopathy; also there is lack of evidence regarding the benefits and modality of treatment for CSR in neurologic diseases. Thus, we were forced to find the best compromise in a nocturnal oxygen therapy and follow-up.


Subject(s)
Brain/blood supply , Cheyne-Stokes Respiration/etiology , Cheyne-Stokes Respiration/therapy , Leukoencephalopathies/complications , Leukoencephalopathies/diagnosis , Oxygen Inhalation Therapy , Oxygen/administration & dosage , Sleep , Adult , Brain/diagnostic imaging , Brain/pathology , Brain/physiopathology , Cerebrovascular Circulation , Diagnosis, Differential , Humans , Leukoencephalopathies/pathology , Leukoencephalopathies/physiopathology , Magnetic Resonance Imaging/methods , Male , Polysomnography , Prognosis , Severity of Illness Index , Tomography, X-Ray Computed , White Matter/pathology
20.
Heart Lung ; 45(3): 199-211, 2016.
Article in English | MEDLINE | ID: mdl-26995256

ABSTRACT

To summarize the current evidence for adaptive servo ventilation (ASV) in Cheyne-Stokes respiration (CSR) with central sleep apnea (CSA) in heart failure (HF) and advance a research agenda and clinical considerations for ASV-treated CSR-CSA in HF. CSR-CSA in HF is associated with higher overall mortality, worse outcomes and lower quality of life (QOL) than HF without CSR-CSA. Five databases were searched using key words (n = 234). Randomized controlled trials assessed objective sleep quality, cardiac, and self-reported outcomes in adults (≥18 years) with HF (n = 10). ASV has a beneficial effect on the reduction of central sleep apnea in adult patients with CSR-CSA in HF, but it is not be superior to CPAP, bilevel PPV, or supplemental oxygen in terms of sleep quality defined by polysomnography, cardiovascular outcomes, subjective daytime sleepiness, and quality of life. ASV is not recommended for CSR-CSA in HF. It is important to continue to refer HF patients for sleep evaluation to clearly discern OSA from CSR-CSA. Symptom management research, inclusive of objective and subjective outcomes, in CSR-CSA in HF adults is needed.


Subject(s)
Cheyne-Stokes Respiration/therapy , Continuous Positive Airway Pressure/methods , Heart Failure/complications , Quality of Life , Sleep Apnea, Central/therapy , Sleep Stages/physiology , Cheyne-Stokes Respiration/etiology , Cheyne-Stokes Respiration/physiopathology , Heart Failure/physiopathology , Humans , Polysomnography , Sleep Apnea, Central/complications , Sleep Apnea, Central/physiopathology
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