Sleep-disordered Breathing In Heart Failure Patients Research Articles

Sleep Apnea and Heart Failure-Current State-of-The-Art.

Sleep-disordered breathing (SDB), including obstructive and central sleep apnea, significantly exacerbates heart failure (HF) through adverse cardiovascular mechanisms. This review aims to synthesize existing literature to clarify the relationship between SDB and HF, focusing on the pathophysiological mechanisms, diagnostic challenges, and the effectiveness of treatment modalities like continuous positive airway pressure (CPAP) and adaptive servo-ventilation ASV. We analyzed peer-reviewed articles from 2003 to 2024 sourced from PubMed, EMBASE, Scopus, and Web of Science databases. The prevalence of SDB in HF patients is high, often underdiagnosed, and underappreciated. Management strategies, including CPAP and ASV, have been shown to mitigate symptoms and improve cardiac function. However, despite the availability of effective treatments, significant challenges in screening and diagnosis persist, affecting patient management and outcomes. DB significantly impacts HF prognosis. Enhanced screening strategies and broader utilization of therapeutic interventions like CPAP and ASV are essential to improve the management and outcomes of HF patients with concomitant SDB. Future research should focus on refining diagnostic and treatment protocols to optimize care for HF patients with SDB.

Prevalence and Patterns of Sleep-Disordered Breathing in Indian Heart Failure Population

Background Sleep-disordered breathing (SDB) is a common yet a largely underdiagnosed entity in developing countries. It is one treatable condition that is known to adversely affect the mortality and morbidity in heart failure (HF). This study is one of the first attempts aimed at studying SDB in chronic HF patients from an Indian subcontinent. Objectives The aim of this study was to study the prevalence, type, and characteristics of SDB in chronic HF patients and their association with HF severity and left ventricular (LV) systolic function and also to determine the relevance of SDB symptoms and screening questionnaires such as the Epworth Sleepiness Scale (ESS), Berlins questionnaire, and STOP-BANG score in predicting SDB in chronic HF patients. Methods We enrolled 103 chronic heart failure patients aged more than 18 years. Patients with a history of SDB and recent acute coronary syndrome within 3 months were excluded. Relevant clinical data, anthropometric measures, echocardiographic parameters, and sleep apnea questionnaires were collected, and all patients underwent the overnight type 3 sleep study. Results The overall prevalence of SDB in our study was high at 81.55% (84/103), with a predominant type of SDB being obstructive sleep apnea (59.2%). The occurrence of SDB was significantly associated with the male gender (p = 0.002) and higher body mass index (BMI) values (p = 0.01). SDB symptoms and questionnaires like ESS, STOP-BANG, and Berlins also did not have a significant association with the occurrence of SDB in HF patients. Conclusions Our study showed a high prevalence of occult SDB predominantly OSA, in chronic HF patients. We advocate routine screening for occult SDB in HF patients.

Central Sleep Apnea in Heart Failure: Pathogenesis and Management

Sleep-disordered breathing (SDB) is a common comorbidity of heart failure (HF), which disrupts sleep. Indeed, patients with heart failure (HF) generally have quantitatively and qualitatively disturbed sleep. Central sleep apnea (CSA) is a unique feature of SDB in HF patients. CSA is likely a consequence, rather than a cause of HF, and results in further deterioration in cardiovascular function, consequently increasing morbidity and mortality. However, effects of treatment for CSA remain to be elucidated. This review article will highlight pathogenesis and pathophysiology of CSA and its management in patients with HF.

Heart failure and sleep disordered breathing.

Sleep-disordered breathing (SDB) is frequently observed in patients with heart failure (HF), and complex pathologic conditions exist between both conditions. In this review article, we describe the characteristics of SDB complicated with HF, the prognostic impact of SDB in HF patients, and the favorable effects of positive airway pressure in HF patients with SDB.

Should All Congestive Heart Failure Patients Have a Routine Sleep Apnea Screening? Pro

Sleep-disordered breathing (SDB) is highly prevalent in heart failure (HF) patients. These breathing disturbances are independent predictors of increased morbidity and comorbid conditions that improve with SDB treatment. Considering the overlap between SDB-related and HF clinical symptoms reported by patients, objective tests need to be conducted for a diagnosis to be firmly established and to determine the type and severity of SDB that will dictate treatment alternatives. Considering the high success rate and diagnostic value of ambulatory monitoring techniques, they represent a practical, cost-effective, and accurate alternative to diagnosing SDB in HF patients.

Abstract 9391: Cyclic Variation of Heart Rate Score by Holter ECG for screening Sleep Disordered Breathing in Heart Failure Patients

Background: Sleep disordered breathing (SDB) has a critical association with cardiovascular mortality and morbidity, especially in patients with heart failure (HF). However, because of the complexity to refer the polysomnography, the majority of SDB patients remain undiagnosed. On the other hand, the abnormality of heart rate variability has been reported in patients with SDB. To explore an efficient ECG-based screening tool for SDB, we examined the usefulness of cyclic variation of heart rate score (CVHRS) by Holter ECG in HF patients. Methods and Results: In this study, 110 patients with HF (mean age 58.6 years, body mass index 23.6, left ventricular ejection fraction 45.5%) were enrolled. The exclusion criteria were the presence of atrial fibrillation and receiving implantable pacemaker device therapy. We simultaneously performed Holter ECG and polysomnography in night time, and measured apnea-hypopnea index (AHI) and CVHRS. We determined the temporal position of the individual dips comprising the CVHRS, using time-domain methods. CVHRS was measured as cyclic and auto correlated dips in smoothed interbeat interval time series. There were 77 patients with mild to moderate SDB (5≤AHI<30/h) and 26 patients with severe SDB (AHI ≥30/h). There was a significant positive correlation between CVHRS and AHI (R=0.60, P<0.001). From the ROC analysis, CVHRS (a cut off value of 30) identified severe SDB with sensitivity 82%, specificity 77%, positive predictive value (PPV) 78%, negative predictive value (NPV) 81% and area under the curve (AUC) 0.83. Conclusions: CVHRS determined by Holter ECG is a useful screening index for severe SDB in HF patients.

Can cardiorespiratory polygraphy replace portable polysomnography in the assessment of sleep-disordered breathing in heart failure patients?

Portable polysomnography (PSG) and cardiorespiratory polygraphy are increasingly being used in the assessment of sleep-disordered breathing (SDB) in heart failure patients. Scoring of SDB from cardiorespiratory polygraphy recordings is based only on respiratory signals, while electroencephalographic, electrooculographic and electromyographic channels are taken into account when using PSG recordings. The aim of this study was to assess the agreement between these two scoring methods. An overnight sleep study was performed in 67 heart failure patients using a standard portable polysomnograph. Each recording was scored twice, once using all acquired signals (PSG mode) and, after a median of 64 days, using only respiratory signals (cardiorespiratory mode). Agreement was assessed by Bland-Altman analysis and Cohen's kappa. We found that (1) more respiratory events were detected using cardiorespiratory analysis [median (25th percentile, 75th percentile), 75 (39, 200) events] compared to analysis of portable PSG [69 (29, 173) events, p < 0.0001], the extra events being, for the vast majority, central in origin; (2) the apnea/hypopnea index (AHI) estimated by cardiorespiratory polygraphy [11.9 (5.7, 30.8)/h] showed a negligible negative bias relative to portable PSG [15.1 (5.7, 33.6)/h; bias, -0.8 (-2.9, 0.4)/h, p = 0.0002]; (3) limits of agreement between the two systems (-6.2/h, 1.7/h) were much smaller than those previously observed between two nights using the same scoring modality; and (4) the kappa coefficient using categorised AHI was 0.89 (95% confidence interval (CI) 0.82, 0.96). We found a high degree of agreement between the AHIs obtained from the two scoring methods, thus suggesting that cardiorespiratory polygraphy may be used as an alternative to portable PSG in the assessment of SDB in heart failure patients.

S119 Is the hypercapnic ventilatory response still relevant to central sleep apnoea in the era of modern heart failure management?

IntroductionA brisk ventilatory response to carbon dioxide (CO2) is integral to the development of central sleep disordered breathing (SDB) in heart failure (HF) patients. Modern treatments for HF enhance cardiac...

Non-invasive mechanical ventilation for sleep disordered breathing and cardiac function in chronic heart failure. More CPAP or more ASV? That is the question

Patients with chronic heart failure (CHF) represent a major health problem, especially when sleep disordered breathing (SDB) coexists [1,2]. Non-invasive mechanical ventilation (NIV) can be a useful alternative for treating such SDB in heart failure patients. In general, there are two major ventilation modes such as continuous positive airway pressure (CPAP) mode and adaptive servo ventilation (ASV).

Atrial Fibrillation Was Associated with Sleep-Disordered Breathing in Heart Failure Patients

Background: Sleep-disordered breathing (SDB) is frequently observed in heart failure patients. Central sleep apnea and Cheyne-Stokes respiration (CSR) have been reported predictors of mortality in systolic heart failure patients. However, little is known about association between atrial fibrillation and SDB in heart failure patients among Japanese population. Methods: Consecutive patients (n=45) with congestive heart failure admitted to our hospital between June 2009 and August 2010 were enrolled. SDB examination was performed using portable monitoring and polysomnography immediately before discharge after stabilizing heart failure by optimal pharmacological therapy. Those patients were classified into two groups according to apnea hypopnea index (AHI): L group (AHI 15). Clinical characteristics were compared between the groups. Results: Twenty-three (51%) patients were classified into L group (AHI=6.9±4.6) and 22 (49%) patients into H group (AHI=33.0±12.6). There was no significant difference in age, body mass index, medication (β-blocker, angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker, spironolactone), cardiac function and eGFR between the groups. Prevalence of atrial fibrillation (33% vs. 16%, p=0.025) and CSR (47% vs. 2%, p<0.001) and plasma BNP level (480±443 pg/ml vs. 246±262 pg/ml, p=0.035) were significantly higher in H than in L group. Conclusions: Japanese heart failure patients with SDB had higher prevalence of atrial fibrillation and CSR and higher plasma BNP level compared with the patients without SDB.

Right Phrenic Nerve Stimulation for Apnea in Heart Failure Patients Using a Novel Intravenous Lead

Introduction: Treatment of sleep disordered breathing (SDB) in heart failure (HF) patients (pts) may improve their HF status. Stimulation of the phrenic nerve (PN) via surgically implanted cuff electrodes has been shown to be effective in modulating respiratory function. Unilateral transvenous stimulation of the PN may allow for treatment of SDB in HF patients. Methods: The right brachiocephalic vein (BCV) was selectively engaged and a venogram performed in pts with HF (mean NYHA Class 2.4) and SDB.

Cardiorespiratory screening for sleep-disordered breathing

To the Editor: Sleep-disordered breathing (SDB) is associated with an increasing mortality 1, 2. The prevalence of SDB, in particular central sleep apnoea and Cheyne–Stokes respiration, is remarkably high in heart failure patients 3. Therefore, screening for SDB in heart failure patients is an emerging clinical problem. Waiting times for in-hospital polysomnography (PSG), which still represents the gold standard for SDB diagnosis, are increasing. Consequently, cardiorespiratory polygraphy (PG) devices for the diagnosis of SDB have been introduced. Two studies of PG devices have previously been published in the European Respiratory Journal . Dingli et al. 4 compared data of PSG with those obtained with a portable PG device (Embletta: Medcare, Reykjavik, Iceland) to detect obstructive sleep apnoea. Using simultaneous measurements they found a close agreement in …