Adaptive servo-ventilation in patients with chronic heart failure and sleep disordered breathing: predictors of usage
AbstractPurposeAdaptive servo-ventilation (ASV) is a therapy designed for patients with central sleep apnea (CSA) and Cheyne Stokes respiration. The aim of this study was to find predictors of ASV usage in patients with CSA in a routine sleep clinic cohort.MethodsIn this retrospective study, consecutive patients in whom ASV therapy was initiated at the University Hospital Regensburg between 2011 and 2015, were analyzed. Analysis included polysomnographies of diagnostic and ASV initiation nights, a phone questionnaire on ASV usage, readout of the ASV device 1 month after initiation ( “early ASV usage,” 1 month after ASV initiation), and the readout of the last month before a reappointment date set in 2015 (“late ASV usage,” median 17 months after ASV initiation).ResultsIn 69 consecutive patients, the mean early and late ASV usage per night was 4.8 ± 2.5 h and 4.1 ± 3.0 h, respectively. Seventeen months after initiation, 57% of patients used the device ≥ 4 h per night, and of those 91% reported a subjective benefit from ASV therapy. Early ASV usage was significantly associated with late ASV usage (univariable regression: Beta 0.8, 95%CI [ 0.6; 1.0]p
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...
To investigate the prevalence and clinical factors correlated with phenotypes of sleep apnea (SA) in acute decompensated heart failure (ADHF).
The most common type of central sleep apnea (CSA) breathing pattern in patients with heart failure (HF) is Cheyne-Stokes respiration (CSR). CSR manifests as a cyclical pattern of apnea and hyperventilation, with absence of airflow and respiratory effort followed by hyperventilation in a crescendo-decrescendo pattern. CSR may be a predictor of negative clinical outcomes in HF patients.
Central sleep apnea (CSA) and heart failure (HF) often present with similar symptoms. Treatment of CSA primarily focuses on management of CSA-related symptoms such as frequent night-time awakenings or arousals, daytime sleepiness and reduced quality of life (QoL). Transvenous phrenic nerve stimulation (TPNS) has demonstrated improvements in sleep metrics and patient reported outcomes (PROs).
Central sleep apnea (CSA) has been associated with a poor prognosis in patients with heart failure (HF). CSA in HF is associated with fatigue, daytime sleepiness, higher rates of HF-related readmission within 6 months and. Treatment of CSA using transvenous phrenic nerve stimulation (TPNS) with the remed ē system has been shown to be safe and effective through 36 months of therapy in those with moderate-to-severe CSA with underlying HF, demonstrating improvement in sleep metrics, daytime sleepiness and quality of life regardless of HF.
Central sleep apnea (CSA) has a high prevalence in hospitalized patients with heart failure with reduced ejection fraction and is independently associated with increased readmissions in these patients. However, the economic impact of previously undiagnosed CSA on heart failure related readmissions remains poorly understood.
Central sleep apnea is a frequent finding in heart failure (HF) and is being increasingly reported in heart failure patients with preserved ejection fraction (HFpEF). Mechanisms of CSA occurrence in those with HFpEF may be similar to CSA in HF with reduced ejection fraction (HFrEF). While treatment of CSA in HFrEF has been reported to be safe and associated with improved sleep metrics, long-term follow-up in patients with moderately reduced ejection fraction (HFmrEF - EF 40-50%) or HFpEF (EF> 50%) and CSA is not well understood.
Sleep apnea is widely reported as an independent predictor for the development of heart failure (HF), with a 2.6-fold increase in incidence after adjusting for age, sex, body mass index (BMI) and smoking. The accepted gold standard for sleep apnea diagnosis is polysomnography (PSG); however, access to PSG is limited and more so in the COVID-19 pandemic crisis. WatchPAT Home Sleep Testing (WPHST) has been validated to accurately detect both obstructive (OSA) as well as central sleep apnea (CSA) in the general population.
Conditions: Sleep Apnea; Diabetic Nephropathy Type 2; Coronary Atheroscleroses; Heart Insufficiency; Arterial Stiffness; Kidney Diseases; Vascular Diseases Intervention: Sponsor: University of Aarhus Recruiting
The authors regret that the disclosure information was omitted in this article. Please find here the following disclosure information: