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Circulation Journal : Official Journal... Jun 2017Sleep-disordered breathing (SDB) occurs in approximately 50% of patients with reduced left ventricular ejection fraction receiving contemporary heart failure (HF)... (Review)
Review
Sleep-disordered breathing (SDB) occurs in approximately 50% of patients with reduced left ventricular ejection fraction receiving contemporary heart failure (HF) therapies. Obstructive (OSA) and central sleep apneas (CSA) interrupt breathing by different mechanisms but impose qualitatively similar autonomic, chemical, mechanical, and inflammatory burdens on the heart and circulation. Because contemporary evidence-based drug and device HF therapies have little or no mitigating effect on the acute or long-term consequences of such stimuli, there is a sound mechanistic rationale for targeting SDB to reduce cardiovascular event rates and prolong life. However, the promise of observational studies and randomized trials of small size and duration describing a beneficial effect of treating SDB in HF via positive airway pressure was not realized in 2 recent randomized outcome-driven trials: SAVE, which evaluated the cardiovascular effect of treating OSA in a cohort without HF, and SERVE-HF, which reported the results of a strategy of random allocation of minute-ventilation-triggered adaptive servo-ventilation (ASV) for HF patients with CSA. Whether effective treatment of either OSA or CSA improves the HF trajectory by reducing cardiovascular morbidity or mortality has yet to be definitively established. ADVENT-HF, designed to determine the effect of treating both CSA and non-sleepy OSA HF patients with a peak-airflow triggered ASV algorithm, could resolve this present clinical equipoise concerning the treatment of SDB.
Topics: Heart Failure; Humans; Mortality; Observational Studies as Topic; Randomized Controlled Trials as Topic; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 28539541
DOI: 10.1253/circj.CJ-17-0440 -
The European Respiratory Journal Jul 2016
Topics: Exercise; Humans; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 27365507
DOI: 10.1183/13993003.00797-2016 -
European Journal of Medical Research Jul 2023Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnoea (OSA). Home sleep apnoea testing with peripheral arterial tonometry (PAT) is a...
BACKGROUND
Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnoea (OSA). Home sleep apnoea testing with peripheral arterial tonometry (PAT) is a recommended diagnostic alternative for patients with an increased risk for OSA. In a large clinical cohort, we investigated concordance and predictors for discordance in diagnosing OSA using PAT and PSG, and three-year cardiovascular risk in patients with discordant OSA diagnosis.
METHODS
Retrospective monocentric cohort study. Patients with a PAT AHI ≥ 5/h followed by an in-hospital PSG within three months were included. All patients with a PAT AHI ≥ 5/h but a PSG AHI < 5/h were classified as discordant. Patients with PAT and PSG AHI ≥ 5/h were classified as concordant. To ascertain cardiovascular risk, major adverse cardiovascular events (MACE) were analyzed in discordant patients and sex, age, body mass index (BMI) and cardiovascular disease-matched concordant patients over a follow-up time of 3.1 ± 0.06 years.
RESULTS
A total of 940 patients, 66% male with an average age of 55 ± 0.4 years and BMI of 31 ± 0.2 kg/m were included. Agreement in OSA diagnosis was observed in 80% of patients (55% in mild and 86% in moderate and severe OSA). Factors significantly associated with a discordant diagnosis were female sex, younger age and lower BMI, but not comorbidities. There was no significant difference in MACE (p = 0.920) between discordant patients (n = 155) and matched concordant patients (n = 274) with or without therapy.
CONCLUSIONS
Concordance between PAT and PSG diagnosis of sleep apnoea is good, particularly in moderate and severe OSA. Predictors for discordant results between PAT and PSG were age, sex and BMI. MACE risk is similar in those with OSA diagnosed by PAT or PSG.
Topics: Humans; Female; Male; Middle Aged; Polysomnography; Cohort Studies; Retrospective Studies; Sleep Apnea, Obstructive; Sleep Apnea Syndromes
PubMed: 37481575
DOI: 10.1186/s40001-023-01164-w -
Sleep Medicine Nov 2020Sleep-disordered breathing (SDB) is highly prevalent after stroke and is associated with poor outcomes. Currently, after stroke, objective testing must be used to...
OBJECTIVE/BACKGROUND
Sleep-disordered breathing (SDB) is highly prevalent after stroke and is associated with poor outcomes. Currently, after stroke, objective testing must be used to differentiate patients with and without SDB. Within a large, population-based study, we evaluated the usefulness of a flexible statistical model based on baseline characteristics to predict post-stroke SDB.
PATIENTS/METHODS
Within a population-based study, participants (2010-2018) underwent SDB screening, shortly after ischemic stroke, with a home sleep apnea test. The respiratory event index (REI) was calculated as the number of apneas and hypopneas per hour of recording; values ≥10 defined SDB. The distributed random forest classifier (a machine learning technique) was applied to predict SDB with the following as predictors: demographics, stroke risk factors, stroke severity (NIHSS), neck and waist circumference, palate position, and pre-stroke symptoms of snoring, apneas, and sleepiness.
RESULTS
Within the total sample (n = 1330), median age was 65 years; 47% were women; 32% non-Hispanic white, 62% Mexican American, and 6% African American. SDB was found in 891 (67%). The area under the receiver operating characteristic curve, a measure of predictive ability, applied to the validation sample was 0.75 for the random forest model. Random forest correctly classified 72.5% of validation samples.
CONCLUSIONS
In this large, ethnically diverse, population-based sample of ischemic stroke patients, prediction models based on baseline characteristics and clinical measures showed fair rather than clinically reliable performance, even with use of advanced machine learning techniques. Results suggest that objective tests are still needed to differentiate ischemic stroke patients with and without SDB.
Topics: Aged; Female; Humans; Male; Polysomnography; Risk Factors; Sleep Apnea Syndromes; Snoring; Stroke
PubMed: 32835899
DOI: 10.1016/j.sleep.2020.05.004 -
Neurologia I Neurochirurgia Polska 2022This study aimed to assess the association between nocturnal hypoxemia and early acute ischaemic stroke (AIS) outcomes in patients without oxygen supplementation.
CLINICAL RATIONALE FOR THE STUDY
This study aimed to assess the association between nocturnal hypoxemia and early acute ischaemic stroke (AIS) outcomes in patients without oxygen supplementation.
MATERIAL AND METHODS
One hundred and six AIS patients consecutively admitted to the stroke unit were included in this study. Baseline demographic and medical data and arterial blood saturation (SpO2) measurements during night-sleep (from 10pm to 6am) were examined for their association with stroke outcomes, including the National Institutes of Health Stroke Scale (NIHSS) score on the 7th day or differences between the NIHSS score on the 1st day and the 7th day after stroke onset. Measurements of SpO2 were made using a pulse oximeter of the Spacelabs Medical Inc. (USA) monitoring system, and the number of apnoea episodes and their duration were recorded by ECG Holter with respiration monitoring (CardioMem®, Getamed, GE).
RESULTS
The study showed that age (Spearman's r = 0.207, p = 0.033) and parameters attributable to anaemia (RBC r = -0.205, p = 0.035, Hb r = -0.225, p = 0.02 and HCT r = -0.196, p = 0.044), atrial fibrillation and ischaemic changes in both brain hemispheres (p = 0.023 and 0.01, respectively) were correlated with the study outcomes. In terms of saturation parameters, we demonstrated that the 'total desaturation burden' (i.e. [100% minus actual measured SpO2%] x apnoea duration) and multiple apnoeas of longer than 20 seconds were correlated with worse functional outcomes. Measures of shorter desaturation episodes (i.e. SpO2 oxygen desaturation index (ODI) at 3% and 4%, and time-weighted desaturations below the determined thresholds (SpO2 from 95% to 85%) demonstrated non-significant associations with the study outcomes.
CONCLUSIONS AND CLINICAL IMPLICATIONS
This study demonstrated that long-lasting desaturation episodes during the night, depicted by the 'total desaturation burden', were correlated with worse functional outcomes in AIS, while measures of shorter desaturation episodes were not correlated. In future clinical trials, indications for oxygen supplementation should include the methodology of personalised medicine and introduce individual approaches based on specially formulated, novel multifactorial algorithms.
Topics: Apnea; Brain Ischemia; Humans; Ischemic Stroke; Oxygen; Stroke; United States
PubMed: 35607842
DOI: 10.5603/PJNNS.a2022.0033 -
Australian Journal of General Practice Sep 2023The cardiovascular outcomes of obstructive sleep apnoea (OSA) are well understood. The effects of OSA on the urological system are emerging and they have the potential... (Review)
Review
BACKGROUND
The cardiovascular outcomes of obstructive sleep apnoea (OSA) are well understood. The effects of OSA on the urological system are emerging and they have the potential to impact quality of life and patient outcomes.
OBJECTIVE
This article aims to strengthen the connection between OSA and urological complaints, summarise their response to CPAP treatment and discuss their clinical utility in OSA.
DISCUSSION
Common urological complaints associated with OSA are nocturnal polyuria, overactive bladder symptoms and erectile dysfunction. Urinary symptoms are thought to be related to recurrent hypoxic episodes and have a significant impact on quality of life. Multiple studies report that urological symptoms and quality of life improve with CPAP treatment. However, current OSA screening questionnaires rely heavily on cardiorespiratory symptoms and specific risk factors that are not present in all OSA population subgroups. We review data that support clinicians incorporating urological symptoms when screening for OSA.
Topics: Male; Humans; Quality of Life; Urological Manifestations; Continuous Positive Airway Pressure; Risk Factors; Sleep Apnea, Obstructive
PubMed: 37666780
DOI: 10.31128/AJGP-01-23-6666 -
Respirology (Carlton, Vic.) Feb 2017Heart failure (HF) and sleep apnoea are common disorders which frequently coexist. Two main types of apnoea occur: one is obstructive which, through recurring episodes... (Review)
Review
Heart failure (HF) and sleep apnoea are common disorders which frequently coexist. Two main types of apnoea occur: one is obstructive which, through recurring episodes of snoring, hypoxaemia, large negative intra-thoracic pressures and arousals from sleep leading to downstream inflammatory and autonomic nervous system changes, is thought to be a causative factor to the development of systemic hypertension and HF. The other type of apnoea, Cheyne-Stokes respiration with central sleep apnoea (CSR-CSA), is characterized by an oscillatory pattern of ventilation with a prevailing hyperventilation-induced hypocapnia, often in the absence of significant hypoxaemia and snoring, and is thought to be a consequence of advanced HF-related low cardiac output, high sympathetic nervous system activation and pulmonary congestion. CSR-CSA may be a compensatory response to advanced HF. Rostral fluid shift during sleep may play an important role in the pathogenesis of both obstructive sleep apnoea (OSA) and CSA. Studies of positive airway pressure (PAP) treatment of OSA and CSA in HF have shown short-term improvements in cardiac and autonomic function; however, there is no evidence of improved survival. Loop gain may provide useful marker of continuous PAP (CPAP) responsiveness in patients with central apnoea. A greater understanding of the pathophysiology of the interaction between obstructive and central apnoea and the various types of HF, and the mechanisms of therapies, such as PAP, is required to develop new strategies to overcome the disabling symptoms, and perhaps improve the mortality, that accompany HF with sleep apnoea.
Topics: Cheyne-Stokes Respiration; Continuous Positive Airway Pressure; Heart Failure; Humans; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 27998040
DOI: 10.1111/resp.12964 -
The European Respiratory Journal May 2021
Topics: Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 33958377
DOI: 10.1183/13993003.04644-2020 -
Respirology (Carlton, Vic.) Jun 2018
Topics: Humans; Polysomnography; Sleep Apnea, Obstructive
PubMed: 29527777
DOI: 10.1111/resp.13284 -
The Lancet. Respiratory Medicine Sep 2022
Topics: Humans; Obesity; Patient Outcome Assessment; Sleep Apnea, Obstructive
PubMed: 35461571
DOI: 10.1016/S2213-2600(22)00137-0