Phrenic Nerve Stimulation in an LVAD Patient with Severe Sleep Apnea

We present a case of a patient with heart failure and CSA who underwent placement of a phrenic nerve stimulator and subsequently a left ventricular assist device (LVAD).
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Tags: 315 Source Type: research

Related Links:

Abstract Central sleep apnea/Hunter-Cheyne-Stokes Breathing (CSA/HCSB), is prevalent in patients with heart failure with reduced ejection fraction (HFrEF). The acute pathobiological consequences of CSA/HSCB eventually lead to sustained sympathetic over-activity, repeated hospitalization, and premature mortality. Few small randomized controlled trials (RCTs) have shown statistically significant and clinically important reduction in sympathetic activity when CSA/HCSB is attenuated by oxygen or positive airway pressure (PAP) therapy, both continuous PAP (CPAP) and Adaptive servo ventilation (ASV) devices. Yet, the tw...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
Conclusion: Chronic SF mimicking OSA did not induce echocardiographic changes in cardiac structure and function in both healthy and HF mice. Thus, the deleterious cardiac consequences of OSA are likely induced by other perturbations associated with this prevalent condition, or result from interactions with underlying comorbidities in OSA patients.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Background: Obstructive sleep apnea (OSA) has been associated with worsening heart failure. Sleep fragmentation (SF), one of the major hallmarks of OSA, induces inflammation, oxidative stress and sympathetic activation, and could potentially contribute to OSA-induced cardiovascular consequences. However, it remains unclear whether SF per se is deleterious to cardiac function.Aim: To evaluate the effect of SF mimicking OSA on echocardiographically-measured cardiac function (ECHO) in otherwise healthy mice and in a murine model of heart failure.Methods: Forty C57BL/6J male mice were randomized into 4 treatment groups: contro...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Sleep and control of breathing Source Type: research
CONCLUSION: Treatment of OSA in patients with systolic HF improves respiratory indices but does not have a favorable effect on sleep quality. While OSA per se was associated with an increase in sympathetic drive, APAP treatment was not associated with a reduction in sympathetic drive. After 6 months of treatment, there was even a trend towards additional increases in sympathetic drive in the APAP group. PMID: 31240541 [PubMed - as supplied by publisher]
Source: Sleep and Breathing - Category: Sleep Medicine Authors: Tags: Sleep Breath Source Type: research
ConclusionTreatment of OSA in patients with systolic HF improves respiratory indices but does not have a favorable effect on sleep quality. While OSA per se was associated with an increase in sympathetic drive, APAP treatment was not associated with a reduction in sympathetic drive. After 6  months of treatment, there was even a trend towards additional increases in sympathetic drive in the APAP group.
Source: Sleep and Breathing - Category: Respiratory Medicine Source Type: research
We examine recent findings that have revealed interdependence of function within the chemoreceptor pathway regulating breathing and sympathetic vasomotor activity and the hypersensitization of these reflexes in chronic disease states. Recommendations are made as to how these states of hyperreflexia in chemoreceptors and muscle afferents might be modified in treating sleep apnea, drug-resistant hypertension, chronic heart failure –induced sympathoexcitation, and the exertional dyspnea of chronic obstructive pulmonary disease.
Source: Clinics in Chest Medicine - Category: Respiratory Medicine Authors: Source Type: research
Cheyne-Stokes respiration (CSR) - a type of periodic breathing characterised by periods of hyperventilation (crescendo-decrescendo pattern) that alternate with central apneas - is highly prevalent in patients with systolic heart failure (HF) [1 –3]. CSR has been hypothesised to further increase sympathetic drive and stroke volume, thus exerting detrimental effects if left untreated [4]. At least, this is what most people thought prior to publication of the SERVE-HF trial in 2015 [5]. This trial enrolled more than 1300 patients with systo lic HF and central sleep apnea who were randomly assigned to adaptive servo-vent...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Editorial Source Type: research
The objective of this review is to incorporate recent advances in the field into a phenotype-based approach to the management of OSA in HF. PMID: 31047953 [PubMed - as supplied by publisher]
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research
Conclusions Aging leads to a progressive decrease in androgen production that, in turn, leads to the development of LOH, defined by significant low T serum levels (in the lowest quartile) in the presence of signs and symptoms of hypogonadism (51). LOH could be due to both testicular and hypothalamic-pituitary dysfunction (32), and ED is one of its main symptoms. ED in LOH is linked to increased oxidative stress, subclinical inflammation, and subsequent endothelial dysfunction (101). In elderly men, it has been shown that LOH is also linked to lower cAMP pool and to an alteration of the cGMP signaling pathway. PDE5 gene l...
Source: Frontiers in Endocrinology - Category: Endocrinology Source Type: research
Introduction/Purpose We demonstrated that patients with obstructive sleep apnea (OSA) have reduced muscle metaboreflex control of muscle sympathetic nerve activity (MSNA). In addition, exercise training increased muscle metaboreflex control in heart failure patients. Objective We tested the hypothesis that exercise training would increase muscle metaboreflex control of MSNA in patients with OSA. Methods Forty-one patients with OSA were randomized into the following two groups: 1) nontrained (OSANT, n = 21) and 2) trained (OSAT, n = 20). Muscle sympathetic nerve activity was assessed by microneurography technique, m...
Source: Medicine and Science in Sports and Exercise - Category: Sports Medicine Tags: CLINICAL SCIENCES Source Type: research
More News: Cardiology | Germany Health | Heart | Heart Failure | Reflex Sympathetic Dystrophy | Respiratory Medicine | Sleep Apnea | Sleep Disorders | Sleep Medicine | Study