Update on Apneas of Heart Failure with Reduced Ejection Fraction: Emphasis on the Physiology of Treatment Part 2: Central Sleep Apnea.

Update on Apneas of Heart Failure with Reduced Ejection Fraction: Emphasis on the Physiology of Treatment Part 2: Central Sleep Apnea. Chest. 2020 Jan 17;: Authors: Javaheri S, Brown LK, Khayat RN 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 two largest PAP trials in patients with HFrEF, one with CPAP and the other with an ASV, were negative with respect to their primary outcomes, and both associated with excess mortality. However, both trials suffered from significant deficiencies casting doubt on their results. A second RCT evaluating an ASV device with advanced algorithm is ongoing. A new modality of therapy, unilateral phrenic nerve stimulation, has undergone an RCT that demonstrated an improvement in CSA that was associated with a reduction in arousals, improvement in sleepiness and quality of life. However, a long-term mortality trial has not been performed with this modality. Most rec...
Source: Chest - Category: Respiratory Medicine Authors: Tags: Chest Source Type: research

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Abstract Neural control of the heart is regulated by sympathetic and parasympathetic divisions of the autonomic nervous system, both opposing each other to maintain cardiac homeostasis via regulating heart rate, conduction velocity, force of contraction and coronary blood flow. Sympathetic hyperactivity and diminished parasympathetic activity are the characteristic features of many cardiovascular disease states including hypertension, myocardial ischemia, and arrhythmias that result in heart failure. Restoring parasympathetic activity to the heart has recently been identified as the promising approach to treat suc...
Source: American Journal of Physiology. Heart and Circulatory Physiology - Category: Physiology Authors: Tags: Am J Physiol Heart Circ Physiol Source Type: research
CONCLUSION: Effects of central apneas on SVB during sleep depend on underlying systolic heart failure, with neutral effects in heart failure and increased sympathetic drive in idiopathic central apneas. PMID: 32700287 [PubMed - as supplied by publisher]
Source: Sleep and Breathing - Category: Sleep Medicine Authors: Tags: Sleep Breath Source Type: research
ConclusionEffects of central apneas on SVB during sleep depend on underlying systolic heart failure, with neutral effects in heart failure and increased sympathetic drive in idiopathic central apneas.
Source: Sleep and Breathing - Category: Respiratory Medicine Source Type: research
Abstract BACKGROUND: Obstructive sleep apnea (OSA) is characterized by augmented sympathetic nerve activity. In our previous study, patients with OSA and an apnea-hyperpnea index (AHI)>55events/h showed increased single-unit muscle sympathetic nerve activity compared to patients with OSA and AHI of 30-55events/h. However, the prognostic impact in these patients remains unclear. METHODS: Ninety-one OSA patients were included. All patients who had indication for continuous positive airway pressure (CPAP) were treated with CPAP. Patients were divided into three groups: mild/moderate OSA (S), AHI55events/h (n=...
Source: Journal of Cardiology - Category: Cardiology Authors: Tags: J Cardiol 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
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
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
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