scholarly journals CON: Persistent Central Sleep Apnea/Hunter-Cheyne-Stokes Breathing, Despite Best Guideline-Based Therapy of Heart Failure With Reduced Ejection Fraction, Is Not a Compensatory Mechanism and Should Be Suppressed

2018 ◽  
Vol 14 (06) ◽  
pp. 915-921 ◽  
Author(s):  
Shahrokh Javaheri ◽  
Lee K. Brown ◽  
Rami Khayat
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Central Sleep Apnea ◽  
Compensatory Mechanism ◽  
Reduced Ejection Fraction ◽  
Cheyne Stokes Breathing

Cycle length identifies obstructive sleep apnea and central sleep apnea in heart failure with reduced ejection fraction

2018 ◽  
Vol 22 (4) ◽  
pp. 1093-1100 ◽  
Author(s):  
Thomas Bitter ◽  
Burak Özdemir ◽  
Henrik Fox ◽  
Dieter Horstkotte ◽  
Olaf Oldenburg
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Cycle Length ◽  
Central Sleep Apnea ◽  
Reduced Ejection Fraction ◽  
Obstructive Sleep

scholarly journals Transvenous Phrenic Nerve Stimulation and Positive Airway Pressure devices for Central Sleep Apnea in Patients with Heart Failure with Reduced Ejection Fraction: A Network Meta-analysis

2021 ◽  
Author(s):  
IMRAN HASAN IFTIKHAR ◽  
Rami N Khayat
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Central Sleep Apnea ◽  
Phrenic Nerve Stimulation ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Abstract Purpose: Adaptive servo-ventilation (ASV) is contraindicated for central sleep apnea (CSA) treatment in patients with heart failure with reduced ejection fraction (HFrEF) limiting treatment options. Though, continuous positive airway pressure (CPAP), bi-level PAP with back-up rate (BPAP-BUR) and transvenous phrenic nerve stimulation (TPNS) are alternatives, not much is known about their comparative efficacies, which formed the basis of this network meta-analysis, in which their effects on apnea hypopnea index (AHI) and subjective daytime sleepiness (based on Epworth sleepiness score (ESS)), were analyzed.Methods: PubMed was searched for potentially includable randomized controlled trials and network meta-analysis was conducted in R program using package netmeta.Results: Network meta-analysis showed no statistically significant differences between interventions in AHI reduction. In exploring heterogeneity, sensitivity analysis elicited statistically significant differences in AHI reduction between ASV and TPNS (-18.30 [-27.8; -8.79]), with BPAP-BUR (-21.90 [-30.79; -13.01]) and CPAP (-23.10 [-29.22; -16.98]), favoring ASV. Of all the interventions, only TPNS showed a statistically significant decrease in ESS (-3.70 (-5.58; -1.82)) when compared to guideline directed medical therapy (used as a common comparator across trials), while also showing significant differences when compared with ASV (-3.20 (-5.86; -0.54)), BPAP-BUR (-4.00 (-7.33; -0.68)), and CPAP (-4.45 (-7.75; -1.14)). Hasse diagram, accounting for both AHI and ESS as outcomes for relative hierarchy showed relative superiority of both ASV and TPNS over BPAP-BUR and CPAP.Conclusions: Results indicate relative superiority of TPNS and ASV to BPAP-BUR and CPAP in their effects on AHI and ESS reduction in patients with CSA and HFrEF.

scholarly journals Sleep-Disordered Breathing During Congestive Heart Failure: To Intervene or Not to Intervene?

2017 ◽  
Vol 3 (2) ◽  
pp. 134 ◽  
Author(s):  
Ali Valika ◽  
Maria Rosa Costanzo ◽  
◽  
Keyword(s):  
Heart Failure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Sleep Disordered Breathing ◽  
Treatment Strategies ◽  
Central Sleep Apnea ◽  
Reduced Ejection Fraction ◽  
Obstructive Sleep ◽  
Disordered Breathing

Sleep-disordered breathing is common in heart failure patients and is associated with increased morbidity and mortality. Central sleep apnea occurs more commonly in heart failure-reduced ejection fraction, and obstructive sleep apnea occurs more frequently in heart failure with preserved ejection fraction. Although the two types of sleep-disordered breathing have distinct pathophysiologic mechanisms, both contribute to abnormal cardiovascular consequences. Treatment with continuous positive airway pressure for obstructive sleep apnea in heart failure has been well defined, whereas treatment strategies for central sleep apnea in heart failure continue to evolve. Unilateral transvenous neurostimulation has shown promise for the treatment of central sleep apnea. In this paper, we examine the current state of knowledge of treatment options for sleep-disordered breathing in heart failure.

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