Pulmonary capillary wedge pressure and pulmonary arterial pressure in heart failure patients with sleep-disordered breathing (original) (raw)
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European Journal of Heart Failure, 2007
Aim: Evaluation of the prevalence and nature of sleep-disordered breathing (SDB) in patients with symptomatic chronic heart failure (CHF) receiving therapy according to current guidelines. Methods and results: We prospectively screened 700 patients with CHF (NYHA class ≥ II, LV-EF ≤ 40%) for SDB using cardiorespiratory polygraphy (Embletta™). Furthermore, echocardiography, cardiopulmonary exercise and 6-min walk testing were performed. Medication included ACE-inhibitors and/or AT1-receptor blockers in at least 94%, diuretics in 87%, β-blockers in 85%, digitalis in 61% and spironolactone in 62% of patients.
Sleep and Breathing, 2011
Background In patients with chronic heart failure, sleepdisordered breathing (SDB) is a common co-morbidity worsening prognosis. The aim of this study was to investigate whether assessment of specific symptoms can elucidate presence of SDB in these patients. Methods A prospective questionnaire scoring investigation on possible symptoms of sleep apnoea (nocturia, fatigue, daytime sleepiness, snoring, nocturnal sweating, witnessed apnoea's, nap) was conducted in 1,506 consecutive patients with stable chronic heart failure (LVEF ≤45%, NYHA ≥2). Afterwards, polysomnography or polygraphy, capillary blood gas analysis, echocardiography, and cardiopulmonary exercise testing were performed. Results Adjusted for all significant covariates, snoring (p<0.01) was the only symptom independently associated with OSA, while witnessed apnoeas (p=0.02) and fatigue (p=0.03) independently predicted for CSR. As additional parameters, higher BMI (threshold 26.6; p<0.01) and higher pCO 2 (threshold 37.6 mmHg; p < 0.01) were independently associated with OSA and male gender (p< 0.001) and lower pCO 2 (threshold 35.0 mmHg; p<0.001) with CSA. Cumulative questionnaire score results did not sufficiently (OSA-sensitivity 0.40, specificity 0.74; CSAsensitivity 0.57, specificity 0.59) predict SDB. Conclusion Although in chronic heart failure patients with either OSA or CSA specific symptoms are apparent, combining clinical data, demographic data, and capillary blood gas analysis results appears favourable to determine the presence of SDB.
European Journal of Heart Failure, 2007
Background: Sleep disordered breathing (SDB) is common in severe chronic heart failure (CHF) and is associated with increased morbidity and mortality. The prevalence of SDB in mild symptomatic CHF is unknown. Aim: The aim of this study was to determine the prevalence and characteristics of SDB in male patients with NYHA class II symptoms of CHF. Methods and results: 55 male patients with mild symptomatic CHF underwent assessment of quality of life, echocardiography, cardiopulmonary exercise, chemoreflex testing and polysomnography. 53% of the patients had SDB. 38% had central sleep apnoea (CSA) and 15% had obstructive sleep apnoea. SDB patients had steeper VE/VCO 2 slope [median (inter-quartile range) 31.1 (28-37) vs. 28.1 (27-30) respectively; p = 0.04], enhanced chemoreflexes to carbon dioxide during wakefulness [mean ± sd: 2.4 ± 1.6 vs. 1.5 ± 0.7 %VE Max/ mmHg CO 2 respectively; p = 0.03], and significantly higher levels of brain natriuretic peptide and endothelin-1 compared to patients without SDB. No differences in left ventricular ejection fraction, percent predicted peak oxygen uptake, or symptoms of SDB were observed. Conclusions: A high prevalence of SDB was found in men with mild symptomatic CHF. Patients with SDB could not be differentiated by symptoms or by routine cardiac assessment making clinical diagnosis of SDB in CHF difficult.
Sleep-disordered breathing in ischemic cardiomyopathy and hypertensive heart failure patients
Egyptian Journal of Bronchology, 2017
Aims The aims of this study are to (a) detect the effect of different types of heart diseases [ischemic, cardiomyopathy, hypertensive heart failure (HF)] on the association with sleep disorders, and to (b) identify the relationship between Cheyne-Stokes respiration (CSR) and left ventricular dysfunction. Materials and methods In a cross-sectional study involving 100 HF patients, we performed echocardiography and a fullnight attended polysomnography for all patients. Results In all, 47.9% of patients with ischemic heart disease had obstructive sleep apnea (OSA), whereas 37.5% had central sleep apnea (CSA). OSA was highly prevalent in patients with hypertensive heart disease (79.2%). On the other hand, 50.0% patients with dilated cardiomyopathy (DCM) had CSA, whereas 39.3% had OSA. Patients with DCM had a significant increase in the central apnea index (11.05±9.19 events/h), as well cycle length of CSR (68.14 ±13.26 s), as compared with other groups. There was an inverse increase of cycle length with reduction in left ventricular ejection fraction (LVEF) (LVEF≥50% had a cycle length of 41.55±10.84 s, whereas those with LVEF≤30% had a longer mean cycle length of 69.23±18.09 s). Conclusion Sleep-disordered breathing is a common disorder in different groups of HF. OSA was prevalent in ischemic and hypertensive heart disease, whereas CSA was prevalent in DCM. There was a significant increase in cycle length of CSR with a reduction in LVEF.
Folia Medica, 2016
Chronic heart failure (CHF) is a major health problem associated with increased mortality, despite modern treatment options. Central sleep apnea (CSA)/Cheyne-Stokes breathing (CSB) is a common and yet largely under-diagnosed co-morbidity, adding significantly to the poor prognosis in CHF because of a number of acute and chronic effects, including intermittent hypoxia, sympathetic overactivation, disturbed sleep architecture and impaired physical tolerance. It is characterized by repetitive periods of crescendo-decrescendo ventilatory pattern, alternating with central apneas and hypopneas. The pathogenesis of CSA/CSB is based on the concept of loop gain, comprising three major components: controller gain, plant gain and feedback gain. Laboratory polysomnography, being the golden standard for diagnosing sleep-disordered breathing (SDB) at present, is a costly and highly specialized procedure unable to meet the vast diagnostic demand. Unlike obstructive sleep apnea, CSA/CSB has a low c...
Archives of Cardiovascular Diseases, 2009
Sleep apnoea syndromes;Prevalence; Congestive heart failure Summary Background. -Heart failure with systolic dysfunction occurs frequently. Studies in North America and Germany have shown a high prevalence of sleep-disordered breathing in patients with heart failure. Aims. -To assess the prevalence of sleep-disordered breathing and its associated risk factors in French patients with heart failure.
Respiratory Medicine, 2008
Background: Over 50% of patients with chronic heart failure (CHF) have sleep-disordered breathing (SDB). Any variation in the type of SDB in CHF will have implications for patient management. Currently there is good evidence for treatment of obstructive sleep apnea (OSA) in CHF with continuous positive airway pressure; however, for central sleep apnea (CSA) the treatment is less clear. Aims: The aim of this study was to investigate the variation in the severity and type of SDB (OSA vs. CSA) throughout 4 consecutive nights in CHF patients with SDB. Methods: Nineteen male CHF patients (mean7sd: age 6179 years; left ventricular ejection fraction: 34710% and percent predicted peak VO 2 : 67719%) underwent cardiorespiratory monitoring in their own home throughout 4 consecutive nights. Results: There was minimal variation in apnea-hypopnea index (AHI) throughout 4 nights in CHF patients with SDB [intraclass correlation coefficient (95% confidence interval ): 0.97 (95% CI 0.76 and 0.97)]. Eight patients [42% (95% CI 20% and 64%)] demonstrated a shift in the type of their SDB, from CSA to OSA or vice versa; these patients had significantly smaller neck circumference (group mean7sd) 4272 vs. 4472 cm; p ¼ 0.04), and had significant variation in the central AHI [intraclass correlation coefficient: 0.51 (95% CI 0.16 and 0.85)]. Conclusions: A single night of cardiorespiratory monitoring is representative of moderateto-severe SDB in patients with CHF. However, a high proportion of patients shift their type ARTICLE IN PRESS 0954-6111/$ -see front matter & (A. Vazir). Respiratory Medicine (2008) 102, 831-839