Olaf Hildebrandt

Autonomic dysfunction and cardiac arrhythmia in patients with obstructive and central sleep apnea

Obstructive sleep apnea and central sleep apnea with Cheyne-Stokes respiration are associated with an increased risk of cardiac arrhythmia. Apnea- associated arrhythmia may contribute to sudden cardiac death and premature mortality in those patients. Both forms of sleep apnea excert strong modulatory effects on the autonomic system with a special autonomic profile. Profound vagal activity is leading to bradyarrhythmias, and sypathico-excitation to tachyarrhythmias. Atrial fibrillation and ventricular arrhythmias in obstructive and central sleep apnea patients are mainly found in combination with cardiovascular comorbidity (coronary heart disease, hypertensive heart disease, chronic heart failure). Bradyarrhythmias in OSA are induced by a cardioinhibitory vagal reflex due to obstructed airway. CPAP-therapy has been demonstrated to reduce arrhythmias.

[Obstructive sleep apnea in neurological diseases: specially as a risk factor for stroke].

ZusammenfassungPatienten mit neurologischen Erkrankungen haben häufig schlafbezogene Atmungsstörungen als Begleiterkrankungen. Umgekehrt werden bei Patienten mit obstruktiver Schlafapnoe (OSA) gehäuft Erkrankungen des zerebro- und kardiovaskulären Systems gefunden. Epidemiologische Studien haben gezeigt, dass die unbehandelte OSA ein unabhängiger Risikofaktor für das Auftreten eines Schlaganfalls, einer arteriellen Hypertonie oder einer kardiovaskulären Erkrankung ist. Pathogenetisch bedeutsam sind apnoeassoziierte Faktoren wie die arterielle Hypertonie, das Auftreten von Vorhofflimmern, ein erhöhter Sympathikotonus, die intermittierende Hypoxie sowie eine vaskuläre Dysfunktion. Frühzeitige Diagnosestellung und Therapieeinleitung der schlafbezogenen Atmungsstörungen bei neurologischen Erkrankungen führen zu einem verbesserten Behandlungsergebnis der neurologischen Erkrankung und zu einer Reduktion zerebro- und kardiovaskulärer Folgeerkrankungen.SummaryNeurological diseases are frequently associated with sleep-related breathing disorders. In contrast patients with obstructive sleep apnea (OSA) suffer more often from cerebrovascular and cardiovascular diseases. Epidemiological studies have shown that OSA is common among patients with stroke, arterial hypertension or cardiovascular disease. In particular apnea-associated arterial hypertension, atrial fibrillation, activation of the sympathetic nervous system, recurrent hypoxemia and vascular inflammatory response should be considered as risk factors for the vascular system. Early diagnosis and treatment of sleep-related breathing disorders in neurological diseases are required to reduce the risk of subsequent cerebrovascular and cardiovascular diseases.Neurological diseases are frequently associated with sleep-related breathing disorders. In contrast patients with obstructive sleep apnea (OSA) suffer more often from cerebrovascular and cardiovascular diseases. Epidemiological studies have shown that OSA is common among patients with stroke, arterial hypertension or cardiovascular disease. In particular apnea-associated arterial hypertension, atrial fibrillation, activation of the sympathetic nervous system, recurrent hypoxemia and vascular inflammatory response should be considered as risk factors for the vascular system. Early diagnosis and treatment of sleep-related breathing disorders in neurological diseases are required to reduce the risk of subsequent cerebrovascular and cardiovascular diseases.

Excessive daytime sleepiness and central sleep apnea in patients with stable heart failure

including total sleep time sleep efficiency, and indices of oxygen desaturations also failed to show a significant association to EDS (Table 2). The only clinical variable associated with EDS was NYHA class III with a relative risk of 2.78 (95% CI: 1.30–5.91, p = 0.01) compared to NYHA class I or II (Fig. 2). Our study resulted in 3 clinically important observations: first, only 13% of patients with stable HF report EDS using the Epworth Sleepiness Scale with a cut-point ≥11. Second, EDS in HF patients is not associated with CSA, AHI and any other sleep study parameters. Finally, NYHA functional HF class is the only clinical variable with a significant association to EDS suggesting an important link between self-reported daytime sleepiness and functional HF severity. The median ESS score in our study was 6.0, which is consistent with the results of Riegel et al. [8], whoalso founda median ESS of 6.0in 280HFpatients withouta significant association between EDS and sleep-disordered breathing during diagnostic sleep studies. The variables associated with EDS in the

Severe central sleep apnea is associated with atrial fibrillation in patients with left ventricular systolic dysfunction.

The results of previous studies investigating the association between atrial fibrillation (AF) and central sleep apnea (CSA) in patients with left ventricular (LV) systolic dysfunction are contradictory.

Die Langzeit-Sauerstoff-Therapie (LTOT) – Was sollten Arzt, Versorger und Krankenkasse wissen?

Long-term oxygen treatment (LTOT) has been demonstrated to improve prognosis in patients with chronic respiratory insufficiency. In terms of pathogenesis, improved oxygenation, reduction of pulmonary artery pressure as well as reduction of respiratory work are important. Since there are considerable differences between the LTOT systems, individually tailored therapy is needed. In particular, the mobility aspects of the patients must be taken into consideration. It is important to distinguish between stationary/mobile devices with a liquid oxygen system and stationary/mobile devices with oxygen concentrator. Oxygen titration should be performed in relation to rest and activity phases (e. g. 6 minute walk test) as well as in relation to the sleep phase. Employing devices with demand-controlled valves should be critically examined. This can be undertaken only under physician orders and requires continuous monitoring.

Age-related differences in skeletal muscle microvascular response to exercise as detected by contrast-enhanced ultrasound (CEUS)

Background Aging involves reductions in exercise total limb blood flow and exercise capacity. We hypothesized that this may involve early age-related impairments of skeletal muscle microvascular responsiveness as previously reported for insulin but not for exercise stimuli in humans. Methods Using an isometric exercise model, we studied the effect of age on contrast-enhanced ultrasound (CEUS) parameters, i.e. microvascular blood volume (MBV), flow velocity (MFV) and blood flow (MBF) calculated from replenishment of Sonovue contrast-agent microbubbles after their destruction. CEUS was applied to the vastus lateralis (VLat) and intermedius (VInt) muscle in 15 middle-aged (MA, 43.6±1.5 years) and 11 young (YG, 24.1±0.6 years) healthy males before, during, and after 2 min of isometric knee extension at 15% of peak torque (PT). In addition, total leg blood flow as recorded by femoral artery Doppler-flow. Moreover, fiber-type-specific and overall capillarisation as well as fiber composition were additionally assessed in Vlat biopsies obtained from CEUS site. MA and YG had similar quadriceps muscle MRT-volume or PT and maximal oxygen uptake as well as a normal cardiovascular risk factors and intima-media-thickness. Results During isometric exercise MA compared to YG reached significantly lower levels in MFV (0.123±0.016 vs. 0.208±0.036 a.u.) and MBF (0.007±0.001 vs. 0.012±0.002 a.u.). In the VInt the (post-occlusive hyperemia) post-exercise peaks in MBV and MBF were significantly lower in MA vs. YG. Capillary density, capillary fiber contacts and femoral artery Doppler were similar between MA and YG. Conclusions In the absence of significant age-related reductions in capillarisation, total leg blood flow or muscle mass, healthy middle-aged males reveal impaired skeletal muscle microcirculatory responses to isometric exercise. Whether this limits isometric muscle performance remains to be assessed.

Obstruktive Schlafapnoe bei neurologischen Erkrankungen

ZusammenfassungPatienten mit neurologischen Erkrankungen haben häufig schlafbezogene Atmungsstörungen als Begleiterkrankungen. Umgekehrt werden bei Patienten mit obstruktiver Schlafapnoe (OSA) gehäuft Erkrankungen des zerebro- und kardiovaskulären Systems gefunden. Epidemiologische Studien haben gezeigt, dass die unbehandelte OSA ein unabhängiger Risikofaktor für das Auftreten eines Schlaganfalls, einer arteriellen Hypertonie oder einer kardiovaskulären Erkrankung ist. Pathogenetisch bedeutsam sind apnoeassoziierte Faktoren wie die arterielle Hypertonie, das Auftreten von Vorhofflimmern, ein erhöhter Sympathikotonus, die intermittierende Hypoxie sowie eine vaskuläre Dysfunktion. Frühzeitige Diagnosestellung und Therapieeinleitung der schlafbezogenen Atmungsstörungen bei neurologischen Erkrankungen führen zu einem verbesserten Behandlungsergebnis der neurologischen Erkrankung und zu einer Reduktion zerebro- und kardiovaskulärer Folgeerkrankungen.SummaryNeurological diseases are frequently associated with sleep-related breathing disorders. In contrast patients with obstructive sleep apnea (OSA) suffer more often from cerebrovascular and cardiovascular diseases. Epidemiological studies have shown that OSA is common among patients with stroke, arterial hypertension or cardiovascular disease. In particular apnea-associated arterial hypertension, atrial fibrillation, activation of the sympathetic nervous system, recurrent hypoxemia and vascular inflammatory response should be considered as risk factors for the vascular system. Early diagnosis and treatment of sleep-related breathing disorders in neurological diseases are required to reduce the risk of subsequent cerebrovascular and cardiovascular diseases.Neurological diseases are frequently associated with sleep-related breathing disorders. In contrast patients with obstructive sleep apnea (OSA) suffer more often from cerebrovascular and cardiovascular diseases. Epidemiological studies have shown that OSA is common among patients with stroke, arterial hypertension or cardiovascular disease. In particular apnea-associated arterial hypertension, atrial fibrillation, activation of the sympathetic nervous system, recurrent hypoxemia and vascular inflammatory response should be considered as risk factors for the vascular system. Early diagnosis and treatment of sleep-related breathing disorders in neurological diseases are required to reduce the risk of subsequent cerebrovascular and cardiovascular diseases.

Long-term Recording of Night-Time Respiratory Symptoms in Patients with Stable COPD II–IV

ABSTRACT Introduction: Night-time respiratory symptoms have a considerable impact on sleep and life quality in patients with chronic obstructive pulmonary disease (COPD). Lack of awareness of night-time symptoms can lead to worsened COPD control. Automated long-term monitoring of respiratory symptoms with LEOSound enables assessment of nocturnal wheezing and cough. Methods: In this observational study we investigated the prevalence and severity of cough and wheezing in patients with stable COPD [Global Initiative for Chronic Obstructive Lung Disease (GOLD) II–IV] disease for two consecutive nights with the LEOSound system. 48 patients (30 males, 63%) were eligible for inclusion, median age was 67 years, and body mass index (BMI) was 25.3 kg/m2. Results: In 15 out of 48 patients (31%), we found wheezing periods for at least 10-minute duration. Wheezing periods >30 minutes were monitored in seven patients and wheezing periods >60 minutes were monitored in three patients. The maximum duration of wheezing was 470 minutes in one patient with COPD II. The median wheezing rate differed between the COPD stages and between active and non-active smokers. Cough was found in 42 patients (87.5%) with a range of 1–326 events. The cough-period-index in night one was 0.83 n/hour (P25:0.33||P75: 2.04) and night two 0.97 n/hour (P25:0.25||P75: 1.9). Most of the cough events were non-productive with a median of 0.86. Conclusions: Night-time symptoms are common in COPD patients. LEOSound offers an opportunity to evaluate objectively night-time symptoms like wheezing and cough in patients with COPD which remain otherwise unnoticed. We found a high incidence of night-time wheezing in these patients, which was related to persistant smoking.

Was ist für die Diagnostik und Therapieverlaufskontrolle von chronischem Husten wichtig

Within the last years there has been significant progress in the field of chronic cough. So far, the analysis and evaluation of chronic cough was done mainly on the basis of subjective methods such as manual counts of cough events, questionnaires and diaries. Testing cough hypersensitivity and monitoring 24 h cough represent objective criteria. Validated questionnaires on cough frequency and quality of life represent the impact of chronic cough. Cough frequency monitoring, the preferred tool to objectively assess cough, should be used as primary end-point in clinical trials. It will also be possible to discriminate between productive and non-productive cough. The relationship with subjective measures of cough is weak. In the future, cough and its therapy should therefore be assessed with a combination of subjective and objective tools.

[Cheyne-Stokes respiration in patients with chronic heart failure: only a diagnostic marker or also a cardiovascular risk factor?].

Sleep disordered breathing with predominant obstructive or central apnea is an under-recognized but highly prevalent comorbidity in patients with chronic heart failure. As the severity of heart failure increases the prevalence of central sleep apnea (CSA) and Cheyne-Stokes respiration (CSR) is also much more frequent. Cheyne-Stokes respiration is characterized by alternating periods of crescendo and decrescendo respiration followed by central apnea. Present data indicate that CSA-CSR is not only a compensatory response to severe heart failure but also a predictor of worse prognosis. However the results on long-term mortality are not consistent. The prognostic importance of night- and daytime CSR has to be further elucidated. Increased sympathetic nervous activity has been proposed to play a mayor role concerning progression and outcome of chronic heart failure by CSA-CSR.