Thomas Bitter

Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction

In patients with systolic heart failure (SHF) a high prevalence of sleep‐disordered breathing (SDB) has been documented. The purpose of this study was to investigate the prevalence and type of SDB in patients with heart failure with normal left ventricular ejection fraction (HFNEF).

Adaptive servoventilation in diastolic heart failure and Cheyne-Stokes respiration.

A high prevalence of nocturnal Cheyne–Stokes respiration (CSR) has been documented in patients with heart failure with normal left ventricular ejection fraction (HFNEF). The aim of the present study was to investigate the effects of adaptive servoventilation (ASV) for treatment of CSR in these patients. In 60 patients with HFNEF, defined according to current European Society of Cardiology guidelines, CSR was documented by polysomnography (apnoea/hypopnoea index (AHI) of >15 events·h−1). ASV treatment was offered to all patients; 21 initially rejected treatment, withdrew from treatment or presented noncompliant during follow-up (controls), whereas ongoing ASV therapy was initiated in 39 patients (ASV group). Echocardiography, cardiopulmonary exercise testing and measurement of N-terminal-pro-brain natriuretic peptide were performed at baseline and follow-up (11.6±3 months). ASV therapy led to a significant reduction in AHI, longest apnoea and hypopnoea length, maximum and mean oxygen desaturation by pulse oximetry, percentage of study time with an oxygen saturation of <90% and arousal index. In addition, significant positive effects could be confirmed on absolute and predicted peak oxygen consumption, oxygen consumption at the individual aerobic–anaerobic threshold, oxygen pulse, as well as left atrial size, and transmitral flow patterns (mean early diastolic lengthening velocity and the ratio of peak early Doppler mitral inflow velocity to this lengthening velocity). ASV effectively attenuates CSR in patients with HFNEF and improves heart failure symptoms and cardiac function. Whether or not this is accompanied by an improved prognosis remains to be determined.

Pulmonary capillary wedge pressure and pulmonary arterial pressure in heart failure patients with sleep-disordered breathing.

BACKGROUNDnThere is a high prevalence of central sleep apnea (CSA) in patients with chronic heart failure (CHF). The present study investigates the hypotheses that CSA in CHF patients reflects heart failure severity as measured by cardiac index (CI), pulmonary artery pressure (PAP) and pulmonary capillary wedge pressure (PCWP).nnnMETHODSnIn 105 patients with stable CHF (NYHAII, LV-EF40%) cardiorespiratory polygraphy and simultaneous right and left heart catheterization was performed.nnnRESULTSnCSA was present in 58% and obstructive sleep apnea (OSA) in 23% of patients. In CSA patients, PAP and PCWP were significantly higher when compared to patients without SDB. In CSA patients, but not in OSA patients, PCWP showed a significant correlation with apnea-hypopnea index (AHI; r=0.41, p=0.005), apnea index (AI; r=0.44, p=0.003) and central AI (cAI; r=0.358, p=0.015). Cardiac index was more impaired in CSA (1.93+/-0.5 l/min/m(2)) than in OSA patients (2.55+/-1.0 l/min/m(2)) or those without SDB (2.22+/-0.4 l/min/m(2)). A negative correlation of CI and cAI (r=-0.344, p=0.008), AI (r=-0.31, p=0.02) and AHI (r=-0.21, p<0.05) was documented exclusively in CSA patients.nnnCONCLUSIONnThe present study supports the hypotheses that the occurrence and severity of CSA in CHF patients reflects heart failure severity.

Predictors of recurrence in patients undergoing cryoballoon ablation for treatment of atrial fibrillation: the independent role of sleep-disordered breathing.

Predictors of AF Recurrence After Cryoballoon PVI.u2002Introduction: In patients with atrial fibrillation (AF) undergoing pulmonary vein isolation, cryoballoon technique (cryoPVI) has been adopted in many centers. This study aimed to evaluate predictors of AF recurrence including impact of sleep‐disordered breathing (SDB).

Sleep apnea is common in patients with coronary artery disease

ZusammenfassungSchlafapnoe hat eine prognostisch ungünstige Bedeutung für Herzpatienten. Wir schlossen 257 konsekutive Patienten mit erhaltener linksventrikulärer Pumpfunktion und angiographisch gesicherter koronarer Herzerkrankung (KHK) in unsere Studie ein. Alle Patienten erhielten eine kardiorespiratorische Polygraphie. Bei 251 Patienten wurde hochsensitives C-reaktives Protein (hsCRP) und Fibrinogen bestimmt. 188 Patienten demonstrierten eine Schlafapnoe (Apnoe-Hypopnoe-Index [AHI] 16,4±1,9/h): 58 Patienten präsentierten eine zentrale (CSA) und 130 Patienten eine obstruktive Schlafapnoe (OSA). Alle Schlafapnoeiker (73 %) zeigten höhere Fibrinogenspiegel als die Patienten ohne Schlafapnoe (p = 0,01). Wir fanden 197 Patienten mit CRP-Werten unter einem cut-off von 0,5 mg/dl (Gruppe 1) und 54 Patienten ohne aktive Infektion, aber mit CRP-Werten >0,5 mg/dl (Gruppe 2). Die Gruppe 2 wies eine deutlich schwerere Schlafapnoe auf (p = 0,01). Schlafapnoe hatte eine hohe Prävalenz bei unseren KHK-Patienten und scheint mit chronischer Inflammation assoziiert zu sein, die wiederum eine Progression der KHK oder akute koronare Ereignisse triggern könnte.SummarySleep-disordered breathing (SDB) has a prognostic impact in patients with cardiac diseases. We included 257 patients with preserved left ventricular function and angiographically proven coronary artery disease (CAD). All patients underwent cardiorespiratory polygraphy. In 251 patients high-sensitive C-reactive protein and fibrinogen were measured. SDB was documented in 188 patients (apnea-hypopnea-index [AHI] 16.4± 1.9/h): 58 patients presented central sleep apnea (CSA) and 130 patients obstructive sleep apnea (OSA). All patients (73%) with SDB had higher blood fibrinogen levels than those without SDB (p = 0.01). We found 197 patients with CRP-values below the cut-off of 0.5 mg/dl (group 1) and 54 patients with no active infection but CRP>0.5 mg/dl (group 2). Severity of SDB was significantly higher in group 2 (p = 0.01). SDB has a high prevalence in CAD patients and seems to be associated with chronic inflammation, which may be linked to CAD progression and/or acute coronary events.

Low night-to-night variability of sleep disordered breathing in patients with stable congestive heart failure

Sleep disordered breathing (SDB) has a high prevalence and prognostic impact in patients with chronic heart failure (CHF). Aim of this study was to investigate variability of SDB parameters in patients with stable CHF. Cardiorespiratory polygraphy was used to determine SDB in two consecutive nights in 50 CHF patients (NYHA classxa0≥xa0II, LV-EF ≤xa040%). The apnoea—hypopnoea—index (AHI) and apnoea—index (AI) were used to quantify SDB severity. Central, obstructive or mixed SDB were classified according to the majority of events. There was an excellent correlation in AHI (rxa0=xa00.948, Pxa0<xa00.001) and AI (rxa0=xa00.842, Pxa0<xa00.001) results of both nights. The overall number of detected apnoea and hypopnoea during the first night as compared to the maximum of both nights was 85% for the AHI and 77% for the AI. The reproducibility was dependent on SDB severity: AHI 15–29/hxa0=xa087%, AHI ≥xa030/hxa0=xa092% and AI ≥xa010/hxa0=xa083%. Classification was identical in 17 out of 19 patients with AI ≥xa010/h. In patients with stable CHF a single night of cardiorespiratory monitoring leads to representative results on severity and type of SDB. This may enhance the applicability and dissemination of cardiorespiratory polygraphy in clinical practice.

Sleep-Disordered Breathing and Cardiac Arrhythmias.

Over the past few years sleep-disordered breathing has been identified as an important factor in arrhythmogenesis and a potential target of therapy to prevent cardiac arrhythmias in selected patients. In this review we highlight the role of obstructive sleep apnea and Cheyne-Stokes respiration in the pathophysiology of arrhythmias, address their clinical effect in supraventricular and ventricular tachyarrhythmias, and in conduction disturbances, and address the role of current treatment options for sleep-disordered breathing in the primary and secondary prevention of arrhythmic events.

Delayed Recovery From Cheyne-Stokes Respiration in Heart Failure After Successful Cardiac Transplantation: A Case Report

BACKGROUNDnSleep-disordered breathing (SDB), especially central sleep apnea with Cheyne-Stokes respiration (CSA-CSR), is highly prevalent in patients with severe heart failure (HF). SDB, and predominantly CSR, may improve after recovery of cardiac function, but available data are limited and inconclusive, particularly in patients who have undergone heart transplantation (HTX).nnnCASE REPORTnThe case of a 59-year-old man with dilated cardiomyopathy and advanced chronic HF, plus CSA-CSR, is reported. The patient showed normalization of cardiac function after successful HTX, with delayed but gradual stepwise improvements in CSA-CSR over time.nnnCONCLUSIONSnAlthough there is a close relationship between cardiac function and manifestations of SDB and CSA-CSR, stabilization of nocturnal respiration after improvement in cardiac function may be delayed rather than immediate.

[Sleep-related breathing disorders and (resulting) cardiovascular diseases].

ZusammenfassungSchlafbezogene Atmungsstörungen kommen bei kardiologischen Patienten meist in Form der obstruktiven (OSA) oder zentralen Schlafapnoe (CSA) mit Cheyne-Stokes-Atmung vor. Die Prävalenzen und Inzidenzen sind gegenüber der Allgemeinbevölkerung deutlich erhöht. Abhängig von der kardiologischen Grunderkrankung können bis zu 75% eine OSA oder CSA aufweisen, bis zu 50% haben eine nach aktuellen Leitlinien bestehende Therapieindikation. Die OSA wird für viele kardiovaskuläre Herzerkrankungen als eigenständiger und gut behandelbarer Risikofaktor für die Entstehung und Verschlechterung angesehen. Beispielhaft beschreibt diese Übersichtsarbeit in Kurzform die Prävalenzen, die Pathophysiolgie und die aktuelle Studienlage zum Zusammenhang von schlafbezogenen Atmungsstörungen und arterieller Hypertonie, Vorhofflimmern, Arteriosklerose mit koronarer Herzerkrankung (KHK) und Myokardinfarkt sowie der Herzinsuffizienz. Während für diese Erkrankungen die Rolle der OSA als Risikofaktor für ihre Entstehung gut belegt ist, wird die CSA weniger als Risikofaktor per se, sondern vielmehr als Ausdruck einer kardialen Grunderkrankung mit dann weiteren negativen Auswirkungen für diese angesehen. Nicht die Schlafapnoe als solche, sondern die kardiovaskulären Folgeerkrankungen limitieren die Prognose dieser Patienten und rücken sie somit in den kardiologischen Fokus. Durch verschiedene nächtliche Beatmungstherapien können OSA und CSA erfolgversprechend und nachhaltig therapiert werden. Darüber hinaus sind weitere Therapieverfahren in der Erprobung; ihre Wertigkeit wird in den kommenden Jahren untersucht werden.AbstractSleep-related breathing disorders occur in cardiology patients mostly as obstructive or central sleep apnea with Cheyne-Stokes respiration. The prevalence and incidence are clearly increased in comparison to the general population. Depending on the underlying cardiac disease up to 75% of patients can have obstructive or central sleep apnea and up to 50% have indications for therapy according to the current guidelines. Obstructive sleep apnea is considered to be an independent and well treatable risk factor for the development and deterioration of many cardiovascular diseases. This review briefly describes examples of prevalence, pathophysiology and current study situation with respect to the association between sleep-related breathing disorders and arterial hypertension, atrial fibrillation, arteriosclerosis with coronary heart disease, myocardial infarction and heart failure. Although the role of obstructive sleep apnea as a risk factor for the development of these diseases is well documented, central sleep apnea is less of a risk factor per se but is considered to mirror an underlying cardiac disease with then further negative consequences for this disease. It is not the sleep apnea per se but the subsequent cardiovascular diseases which limit the prognosis of these patients and therefore bring them into the focus of cardiology. Obstructive and central sleep apnea can be successfully and sustainably treated by various forms of nocturnal positive airway pressure therapy. Furthermore, there are several therapeutic procedures which are currently being tested and the significance will be investigated in the coming years.Sleep-related breathing disorders occur in cardiology patients mostly as obstructive or central sleep apnea with Cheyne-Stokes respiration. The prevalence and incidence are clearly increased in comparison to the general population. Depending on the underlying cardiac disease up to 75% of patients can have obstructive or central sleep apnea and up to 50% have indications for therapy according to the current guidelines. Obstructive sleep apnea is considered to be an independent and well treatable risk factor for the development and deterioration of many cardiovascular diseases. This review briefly describes examples of prevalence, pathophysiology and current study situation with respect to the association between sleep-related breathing disorders and arterial hypertension, atrial fibrillation, arteriosclerosis with coronary heart disease, myocardial infarction and heart failure. Although the role of obstructive sleep apnea as a risk factor for the development of these diseases is well documented, central sleep apnea is less of a risk factor per se but is considered to mirror an underlying cardiac disease with then further negative consequences for this disease. It is not the sleep apnea per se but the subsequent cardiovascular diseases which limit the prognosis of these patients and therefore bring them into the focus of cardiology. Obstructive and central sleep apnea can be successfully and sustainably treated by various forms of nocturnal positive airway pressure therapy. Furthermore, there are several therapeutic procedures which are currently being tested and the significance will be investigated in the coming years.

Schlafbezogene Atmungsstörungen und kardiovaskuläre (Folge-)Erkrankungen@@@Sleep-related breathing disorders and (resulting) cardiovascular diseases

ZusammenfassungSchlafbezogene Atmungsstörungen kommen bei kardiologischen Patienten meist in Form der obstruktiven (OSA) oder zentralen Schlafapnoe (CSA) mit Cheyne-Stokes-Atmung vor. Die Prävalenzen und Inzidenzen sind gegenüber der Allgemeinbevölkerung deutlich erhöht. Abhängig von der kardiologischen Grunderkrankung können bis zu 75% eine OSA oder CSA aufweisen, bis zu 50% haben eine nach aktuellen Leitlinien bestehende Therapieindikation. Die OSA wird für viele kardiovaskuläre Herzerkrankungen als eigenständiger und gut behandelbarer Risikofaktor für die Entstehung und Verschlechterung angesehen. Beispielhaft beschreibt diese Übersichtsarbeit in Kurzform die Prävalenzen, die Pathophysiolgie und die aktuelle Studienlage zum Zusammenhang von schlafbezogenen Atmungsstörungen und arterieller Hypertonie, Vorhofflimmern, Arteriosklerose mit koronarer Herzerkrankung (KHK) und Myokardinfarkt sowie der Herzinsuffizienz. Während für diese Erkrankungen die Rolle der OSA als Risikofaktor für ihre Entstehung gut belegt ist, wird die CSA weniger als Risikofaktor per se, sondern vielmehr als Ausdruck einer kardialen Grunderkrankung mit dann weiteren negativen Auswirkungen für diese angesehen. Nicht die Schlafapnoe als solche, sondern die kardiovaskulären Folgeerkrankungen limitieren die Prognose dieser Patienten und rücken sie somit in den kardiologischen Fokus. Durch verschiedene nächtliche Beatmungstherapien können OSA und CSA erfolgversprechend und nachhaltig therapiert werden. Darüber hinaus sind weitere Therapieverfahren in der Erprobung; ihre Wertigkeit wird in den kommenden Jahren untersucht werden.AbstractSleep-related breathing disorders occur in cardiology patients mostly as obstructive or central sleep apnea with Cheyne-Stokes respiration. The prevalence and incidence are clearly increased in comparison to the general population. Depending on the underlying cardiac disease up to 75% of patients can have obstructive or central sleep apnea and up to 50% have indications for therapy according to the current guidelines. Obstructive sleep apnea is considered to be an independent and well treatable risk factor for the development and deterioration of many cardiovascular diseases. This review briefly describes examples of prevalence, pathophysiology and current study situation with respect to the association between sleep-related breathing disorders and arterial hypertension, atrial fibrillation, arteriosclerosis with coronary heart disease, myocardial infarction and heart failure. Although the role of obstructive sleep apnea as a risk factor for the development of these diseases is well documented, central sleep apnea is less of a risk factor per se but is considered to mirror an underlying cardiac disease with then further negative consequences for this disease. It is not the sleep apnea per se but the subsequent cardiovascular diseases which limit the prognosis of these patients and therefore bring them into the focus of cardiology. Obstructive and central sleep apnea can be successfully and sustainably treated by various forms of nocturnal positive airway pressure therapy. Furthermore, there are several therapeutic procedures which are currently being tested and the significance will be investigated in the coming years.Sleep-related breathing disorders occur in cardiology patients mostly as obstructive or central sleep apnea with Cheyne-Stokes respiration. The prevalence and incidence are clearly increased in comparison to the general population. Depending on the underlying cardiac disease up to 75% of patients can have obstructive or central sleep apnea and up to 50% have indications for therapy according to the current guidelines. Obstructive sleep apnea is considered to be an independent and well treatable risk factor for the development and deterioration of many cardiovascular diseases. This review briefly describes examples of prevalence, pathophysiology and current study situation with respect to the association between sleep-related breathing disorders and arterial hypertension, atrial fibrillation, arteriosclerosis with coronary heart disease, myocardial infarction and heart failure. Although the role of obstructive sleep apnea as a risk factor for the development of these diseases is well documented, central sleep apnea is less of a risk factor per se but is considered to mirror an underlying cardiac disease with then further negative consequences for this disease. It is not the sleep apnea per se but the subsequent cardiovascular diseases which limit the prognosis of these patients and therefore bring them into the focus of cardiology. Obstructive and central sleep apnea can be successfully and sustainably treated by various forms of nocturnal positive airway pressure therapy. Furthermore, there are several therapeutic procedures which are currently being tested and the significance will be investigated in the coming years.