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Journal of Cardiology Aug 2012Sleep apnea is frequently observed in patients with heart failure (HF). In general, sleep apnea consists of two types: obstructive and central sleep apnea (OSA and CSA,... (Review)
Review
Sleep apnea is frequently observed in patients with heart failure (HF). In general, sleep apnea consists of two types: obstructive and central sleep apnea (OSA and CSA, respectively). OSA results from upper airway collapse, whereas CSA arises from reductions in central respiratory drive. In patients with OSA, blood pressure is frequently elevated as a result of sympathetic nervous system overactivation. The generation of exaggerated negative intrathoracic pressure during obstructive apneas further increases left ventricular (LV) afterload, reduces cardiac output, and may promote the progression of HF. Intermittent hypoxia and post-apneic reoxygenation cause vascular endothelial damage and possibly atherosclerosis and consequently coronary artery disease and ischemic cardiomyopathy. CSA is also characterized by apnea, hypoxia, and increased sympathetic nervous activity and, when present in HF, is associated with increased risk of death. In patients with HF, abolition of coexisting OSA by continuous positive airway pressure (CPAP) improves LV function and may contribute to the improvement of long-term outcomes. Although treatment options of CSA vary compared with OSA treatment, CPAP and other types of positive airway ventilation improve LV function and may be a promising adjunctive therapy for HF patients with CSA. Since HF remains one of the major causes of mortality in the industrialized countries, the significance of identifying and managing sleep apnea should be more emphasized to prevent the development or progression of HF.
Topics: Heart Failure; Humans; Risk Factors; Sleep Apnea Syndromes; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 22824295
DOI: 10.1016/j.jjcc.2012.05.013 -
IEEE Transactions on Bio-medical... May 2021In this work, a detection and classification method for sleep apnea and hypopnea, using photopletysmography (PPG) and peripheral oxygen saturation (SpO ) signals, is...
In this work, a detection and classification method for sleep apnea and hypopnea, using photopletysmography (PPG) and peripheral oxygen saturation (SpO ) signals, is proposed. The detector consists of two parts: one that detects reductions in amplitude fluctuation of PPG (DAP)and one that detects oxygen desaturations. To further differentiate among sleep disordered breathing events (SDBE), the pulse rate variability (PRV) was extracted from the PPG signal, and then used to extract features that enhance the sympatho-vagal arousals during apneas and hypopneas. A classification was performed to discriminate between central and obstructive events, apneas and hypopneas. The algorithms were tested on 96 overnight signals recorded at the UZ Leuven hospital, annotated by clinical experts, and from patients without any kind of co-morbidity. An accuracy of 75.1% for the detection of apneas and hypopneas, in one-minute segments,was reached. The classification of the detected events showed 92.6% accuracy in separating central from obstructive apnea, 83.7% for central apnea and central hypopnea and 82.7% for obstructive apnea and obstructive hypopnea. The low implementation cost showed a potential for the proposed method of being used as screening device, in ambulatory scenarios.
Topics: Arousal; Heart Rate; Humans; Polysomnography; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 32997622
DOI: 10.1109/TBME.2020.3028041 -
The European Respiratory Journal Apr 2022
Topics: Aged; Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
PubMed: 35483717
DOI: 10.1183/13993003.01627-2021 -
Current Neurology and Neuroscience... Jul 2022The purpose of this article is to review the recent literature on central apnea. Sleep disordered breathing (SDB) is characterized by apneas (cessation in breathing),... (Review)
Review
PURPOSE
The purpose of this article is to review the recent literature on central apnea. Sleep disordered breathing (SDB) is characterized by apneas (cessation in breathing), and hypopneas (reductions in breathing), that occur during sleep. Central sleep apnea (CSA) is sleep disordered breathing in which there is an absence or diminution of respiratory effort during breathing disturbances while asleep. In obstructive sleep apnea (OSA), on the other hand, there is an absence of flow despite ongoing ventilatory effort.
RECENT FINDINGS
Central sleep apnea is a heterogeneous disease with multiple clinical manifestations. OSA is by far the more common condition; however, CSA is highly prevalent among certain patient groups. Complex sleep apnea (CompSA) is defined as the occurrence/emergence of CSA upon treatment of OSA. Similarly, there is considerable overlap between CSA and OSA in pathogenesis as well as impacts. Thus, understanding sleep disordered breathing is important for many practicing clinicians.
Topics: Humans; Sleep; Sleep Apnea Syndromes; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 35588042
DOI: 10.1007/s11910-022-01199-2 -
British Journal of Hospital Medicine... Feb 2024Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is... (Review)
Review
Paediatric sleep-disordered breathing is a common condition which varies in severity from snoring to obstructive sleep apnoea. Paediatric sleep-disordered breathing is usually diagnosed clinically, with investigations such as polysomnography reserved for more complex cases. Management can involve watching and waiting, medical or adjunct treatments and adenotonsillectomy. National working groups have sought to standardise the pathway for surgery and improve the management of surgical and anaesthetic complications. Current guidelines use age, weight and comorbidities to stratify risk for these surgical cases. This article summarises these recommendations and outlines the important factors that indicate cases that may be more suitable for management in secondary and tertiary units. Appropriate case selection will reduce pressure on tertiary units while maintaining training opportunities in district general hospitals.
Topics: Child; Humans; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Adenoidectomy; Tonsillectomy
PubMed: 38416524
DOI: 10.12968/hmed.2023.0275 -
European Respiratory Review : An... Mar 2016Sleep apnoea is a disorder characterised by repetitive pauses in breathing during sleep caused by airway occlusion (obstructive sleep apnoea) or altered control of... (Review)
Review
Sleep apnoea is a disorder characterised by repetitive pauses in breathing during sleep caused by airway occlusion (obstructive sleep apnoea) or altered control of breathing (central sleep apnoea). In this Clinical Year in Review, we summarise high-impact research from the past year pertaining to management, diagnosis and cardio-metabolic consequences of sleep apnoea.
Topics: Animals; Comorbidity; Humans; Prognosis; Risk Factors; Sleep Apnea, Central; Sleep Apnea, Obstructive
PubMed: 26929416
DOI: 10.1183/16000617.0077-2015 -
European Respiratory Review : An... Jan 2024Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse... (Review)
Review
Obstructive sleep apnoea (OSA) can occur in both rapid eye movement (REM) and non-REM sleep or be limited to REM sleep, when the upper airway is most prone to collapse due to REM sleep atonia. Respiratory events are usually longer and more desaturating in REM than in NREM sleep. The prevalence of REM OSA is higher in women than in men and REM OSA usually occurs in the context of mild-moderate OSA based on the apnoea-hypopnoea index calculated for the entire sleep study. Studies have highlighted some detrimental consequences of REM OSA; for example, its frequent association with systemic hypertension and a degree of excessive daytime sleepiness similar to that found in nonsleep-stage-dependent OSA. Moreover, REM OSA could increase cardiometabolic risk. Continuous positive airway pressure (CPAP) treatment aimed at preventing REM OSA should be longer than the 4 h usually considered as good compliance, since REM sleep occurs mostly during the second half of the night. Unfortunately, patients with REM OSA show poor adherence to CPAP. Alternative non-CPAP treatments might be a good choice for REM OSA, but data are lacking. This review summarises the available data on REM OSA and critically examines the weaknesses and strengths of existing literature.
Topics: Male; Humans; Female; Sleep, REM; Sleep Apnea, Obstructive; Patient Compliance; Continuous Positive Airway Pressure; Polysomnography
PubMed: 38355150
DOI: 10.1183/16000617.0166-2023 -
Neurologic Clinics Aug 1996A central sleep apnea is the absence of respiratory effect, and, thus, the absence of airflow during sleep. Central hypopnea, a related disorder, is also discussed. The... (Review)
Review
A central sleep apnea is the absence of respiratory effect, and, thus, the absence of airflow during sleep. Central hypopnea, a related disorder, is also discussed. The sensory component of central sleep apnea; defects involving the integrative and executive neurons; non-neurologic causes of central sleep apneas, including chronic obstructive pulmonary disease and congestive heart failure; diagnosis; treatment; and other topics are reviewed in detail.
Topics: Airway Resistance; Heart Failure; Humans; Lung Diseases, Obstructive; Neuromuscular Diseases; Respiration; Sleep; Sleep Apnea Syndromes
PubMed: 8871979
DOI: 10.1016/s0733-8619(05)70276-0 -
Journal of Neuroscience Methods Jul 2023Sleep apnea, the most widespread sleep-related breathing disorder (SBD), consists of recurrent episodes of breathing cessation during sleep. This condition can be... (Review)
Review
Sleep apnea, the most widespread sleep-related breathing disorder (SBD), consists of recurrent episodes of breathing cessation during sleep. This condition can be classified as either central (CSA) or obstructive (OSA) sleep apnea, with the latest being the most common and toxic. Due to the complexity of living organisms, animal models and, particularly, mice still represent an essential tool for the study of SBD. In the present review we first discuss the methodological pros and cons in the use of whole-body plethysmography to coupling respiratory and sleep measurements and to characterize CSA and OSA in mice; then, we draw an updated and objective picture of the methods used so far in the study of sleep apnea in mice. Most of the studies present in the literature used intermittent hypoxia to mimic OSA in mice and to investigate consequent pathological correlates. On the contrary, few studies using genetic manipulation or high-fat diets investigated the pathogenesis or potential treatments of sleep apnea. To date, mice lacking orexins, hemeoxygenase-2, monoamine oxidase A, Phox2b or Cdkl5 can be considered validated mouse models of sleep apnea. Moreover, genetically- or diet-induced obese mice, and mice recapitulating Down syndrome were proposed as OSA models. In conclusion, our review shows that despite the growing interest in the field and the need of new therapeutical approaches, technical complexity and inter-study variability strongly limit the availability of validated mouse of sleep apnea, which are essential in biomedical research.
Topics: Humans; Mice; Animals; Sleep Apnea, Obstructive; Sleep Apnea Syndromes; Sleep; Respiration; Disease Models, Animal
PubMed: 37459897
DOI: 10.1016/j.jneumeth.2023.109923 -
European Respiratory Review : An... Jan 2024Recent scientific findings in the field of sleep disordered breathing have characterised a variety of phenotypes in obstructive sleep apnoea. These findings have... (Review)
Review
Recent scientific findings in the field of sleep disordered breathing have characterised a variety of phenotypes in obstructive sleep apnoea. These findings have prompted investigations aiming to achieve a more precise differentiation and description of the entities of central sleep apnoea (CSA). There is increasing evidence for the heterogeneity of CSA in terms of underlying aetiology, pathophysiological concepts, treatment response and outcome. Assigning patients to these phenotypes allows for the selection of individualised therapies. Major pathophysiological characteristics include loop gain, apnoeic threshold, breathing regulation and neuromuscular mechanics. Chronic heart failure is the most important underlying disease, leading to nonhypercapnic CSA based on increased loop and controller gain. Although many questions remain, this review tries to describe the current knowledge on the pathophysiology of the clinical entities. The description of prognostic aspects may guide treatment indication and the selection of pharmacotherapy and invasive options. In addition, the paper provides an update on the current understanding of adaptive servo-ventilation and its role in the treatment of CSA.
Topics: Humans; Sleep Apnea, Central; Sleep Apnea Syndromes; Sleep Apnea, Obstructive; Respiration; Continuous Positive Airway Pressure; Heart Failure
PubMed: 38537948
DOI: 10.1183/16000617.0141-2023