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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One of the most common yet unidentified conditions in heart disease is sleep-disordered breathing (SDB). Although it is most prevalent in patients with heart failure, it has been epidemiologically and pathophysiologically linked to ischemic heart disease, hypertension, sudden cardiac death, atrial fibrillation, and stroke. There are two primary SDB syndromes: obstructive sleep apnea (OSA) and central sleep apnea (CSA; also known as Cheyne-Stokes respiration). The pathophysiologic mechanisms that underlie these disorders appear to be distinct but both involve recurrent cycles of excessive sympathetic activation, hypoxemias and hypercapnias, and increases in ventricular wall stress. Signs and symptoms may include daytime somnolence, snoring, difficult-to-control hypertension, and refractory arrhythmias or angina. In heart failure, half of patients will have SDB and most patients will exhibit evidence of both OSA and CSA, although one or the other may predominate. The current standard diagnostic method is overnight laboratory polysomnography. Primary therapies for OSA include lifestyle changes, various facial and oral appliances, head and neck surgery, and continuous positive airway pressure (CPAP). CPAP is the most effective form of therapy for OSA, with few side effects, but is limited by compliance because of comfort-related issues. In patients with cardiovascular disease who predominantly suffer from OSA, treatment recommendations should be based on current guidelines for OSA. For patients with heart failure with predominant CSA, the current cornerstone of therapy is the optimization of medical therapy and resynchronization therapy when indicated. When SDB persists despite optimal medical management, referral to a sleep medicine consultant should be considered.
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PMID:Diagnosis and treatment of sleep apnea in heart disease. 1822 2

Ventilation during sleep is under tight metabolic control, and can be destabilized by upper airway obstruction leading to snoring or obstructive apneas, inadequate respiratory pump muscle activity leading to hypoventilation, and central control instability leading to changes in metabolic feedback and loop gain. These three physiologic disturbances can lead to obstructive sleep apnea hypopnea syndrome (OSAHS), hypoventilation syndromes, and periodic breathing. OSAHS places a strain on the cardiac output by virtue of hypoxemia, large negative intrathoracic pressures, and high swings in systemic blood pressure. Periodic breathing, also known as central sleep apnea with Cheyne-Stokes pattern of respiration, is likely to be a product of advanced heart failure.
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PMID:Common sleep problems in ICU: heart failure and sleep-disordered breathing syndromes. 1853 1

Brain natriuretic peptide(BNP) and the N-terminal pro-brain natriuretic peptide (NTproBNP)are important cardiac biomarkers secreted by the heart in response to increased ventricular wall stress associated with heart failure. The aim of our case series was to prospectively evaluate the influence of vagus nerve stimulation (VNS) on the release of NTproBNP.Three children with medically refractory epilepsy and scheduled for implantation of the VNS device were included. Pre-implantation,NT-proBNP measurements were taken at two different occasions after seizure-free periods of at least three days. After implantation,NT-proBNP measurements were taken every 2 to 4 weeks, immediately before and immediately after up-regulation of the VNS. After VNS implantation, the pattern of NT-proBNP increase was consistent for all children. In a 12 year-old girl, NT-proBNP concentrations reached a maximum of an almost 10-fold increase. Thereafter, NTproBNP concentrations returned continuously to baseline. In a three year-old boy, NT-proBNP concentrations reached a maximum of an almost 7-fold increase, accompanied by manifestation of side effects(voice alterations, snoring).Thereafter, NT-proBNP concentrations decreased to almost 4-fold those at baseline. In an 8 year-old girl, NT-proBNP concentrations increased slightly without yet reaching a plateau. This case series suggests that NT-proBNP concentrations increase in response to VNS-induced autonomic influences involving endocrinological stress-response mechanisms typically associated with cardiac injury.Especially in patients with pre-existing cardiovascular dysfunction,measurement of NT-proBNP concentrations may help to identify patients with high baseline concentrations and possibly at greater risk for cardiac side effects.
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PMID:N-terminal pro-brain natriuretic peptide (NT-proBNP) release in children with vagus nerve stimulation. A prospective case series. 1858 Oct 38

Obstructive sleep apnea is the most frequent sleep disorder. The prevalence of sleep apnea in the general population is 2-4% and the main characteristic of the disease is the intermittent cessation or substantial reduction of airflow during sleep, caused by complete, or near complete upper airway obstruction. Decreased airflow is followed by oxygen desaturation and intermittent arousals. The clinical presentation of the disorder is complex. Loud snoring with breathing pauses and daytime sleepiness should raise the suspicion of sleep apnea, but we have to consider this disease if the patient has therapy resistant hypertension, heart failure, arrhythmias, stroke, depression or memory problems. Family physicians have an important role in recognizing sleep apnea. High risk patients can easily be identified by the main symptoms and using the Berlin sleep apnea questionnaire. These patients should be referred to a sleep laboratory for polysomnographic assessment and, if necessary, for further treatment.
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PMID:[The role of family physicians in the recognition and screening of obstructive sleep apnea]. 1902 51

Obstructive sleep apnoea (OSA) syndrome in adult is defined as an Apnoea-Hypopnoea Index (AHI) of 5 or more per hour of sleep in a context of excessive daytime sleepiness and snoring. OSA is considered as mild with an AHI of 5-15, moderate with an AHI of 15-30, and severe with an AHI greater than 30. OSA is a highly prevalent disease since it should affect 7-15% of the middle-aged population, but most patients are not yet diagnosed for OSA. Middle age, male gender, obesity and arterial hypertension are main risk factors for OSA in adults. OSA patients are exposed to higher neurological and cardiovascular morbidity, including stroke, depression, hypertension, coronary artery disease, heart failure, arrhythmias. Because OSA may lead to life-threatening problems if undiagnosed, anaesthesiologists should be aware of their screening role in the preoperative period. In that way, the STOP-BANG questionnaire is a well-adapted instrument to screen patients for OSA during the preoperative visit. OSA patients are exposed to higher preoperative morbidity in relation with OSA severity, particularly difficult manual ventilation with mask, difficult tracheal intubation and postoperative upper airway obstruction. The unknown diagnosis of OSA is one major contributor to facilitate the occurrence of those events. In the postoperative period, early resuming continuous positive airway pressure and installing the OSA patient in a nonsupine position could be effective in preventing pharyngeal obstruction. Considering the timing of postoperative complications, a careful monitoring in the post-anesthesia care unit for three hours is an appropriate strategy for a majority of OSA patients. Alternatives to opioids should be promoted for postoperative pain control.
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PMID:[Obstructive sleep-apnoea syndrome in adult and its perioperative management]. 2096 87

Obstructive sleep apnea (OSA) is a condition in which the upper airway becomes constricted or occluded during sleep, leading to decreased or absent airflow, hypoxia, and sympathetic activation. This chain of events, occurring dozens of times an hour, can contribute to the development of hypertension, coronary artery disease, heart failure, and stroke. This article discusses the epidemiology of comorbid OSA and cardiovascular disease, the pathophysiology of OSA, how it acts as a risk factor for cardiovascular problems, and how appropriate treatment of OSA ameliorates the consequences. The importance of having a high suspicion for OSA in people with risk factors (including obesity, middle age, male or postmenopausal female) or symptoms (snoring, excessive daytime sleepiness, difficulty concentrating) is pointed out. The article concludes with clinical and research implications.
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PMID:Obstructive sleep apnea: a risk factor for cardiovascular disease. 2107 17

The prevalence of pediatric obstructive sleep apnea syndrome (OSAS) is approximately 3% in children. Adenotonsillar hypertrophy is the most common cause of OSAS in children, and obesity, hypotonic neuromuscular diseases, and craniofacial anomalies are other major risk factors. Snoring is the most common presenting complaint in children with OSAS, but the clinical presentation varies according to age. Agitated sleep with frequent postural changes, excessive sweating, or abnormal sleep positions such as hyperextension of neck or abnormal prone position may suggest a sleep-disordered breathing. Night terror, sleepwalking, and enuresis are frequently associated, during slow-wave sleep, with sleep-disordered breathing. Excessive daytime sleepiness becomes apparent in older children, whereas hyperactivity or inattention is usually predominant in younger children. Morning headache and poor appetite may also be present. As the cortical arousal threshold is higher in children, arousals are not easily developed and their sleep architectures are usually more conserved than those of adults. Untreated OSAS in children may result in various problems such as cognitive deficits, attention deficit/hyperactivity disorder, poor academic achievement, and emotional instability. Mild pulmonary hypertension is not uncommon. Rarely, cardiovascular complications such as cor pulmonale, heart failure, and systemic hypertension may develop in untreated cases. Failure to thrive and delayed development are serious problems in younger children with OSAS. Diagnosis of pediatric OSAS should be based on snoring, relevant history of sleep disruption, findings of any narrow or collapsible portions of upper airway, and confirmed by polysomnography. Early diagnosis of pediatric OSAS is critical to prevent complications with appropriate interventions.
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PMID:Obstructive sleep apnea syndrome in children: Epidemiology, pathophysiology, diagnosis and sequelae. 2118 56

Sleep apnea, defined as a pathologic pause in breathing during sleep >10 s, promotes the progression of chronic heart failure and may be a predictor of poor prognosis. It causes, in fact, several mechanical, hemodynamic, chemical and inflammatory changes that negatively compromise cardiovascular homeostasis of heart failure patients. Sleep apnea is recognized as sleep apnea syndrome when specific symptoms, such as sleepiness and headache during the daytime and snoring, are present and is diagnosed with an overnight test called polysomnography. There are two different forms of sleep apnea, central and obstructive. Breathing is interrupted by the loss of respiratory drive and the lack of respiratory effort in the central form, which affects about 40-60% of heart failure patients. In obstructive sleep apnea, breathing stops when throat muscles relax, despite respiratory effort. This form affects about 3% of the general population, while it is present in at least 30% of heart failure patients. The diagnosis of sleep disorders in heart failure becomes very important to help patients adopting lifestyle changes and starting specific therapies to improve quality of life and retard the progression of chronic heart failure.
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PMID:[Sleep apnea and heart failure: pathophysiology, diagnosis and therapy]. 2134 18

Diagnosis and treatment of sleep related breathing disorders have become an essential challenge of internal medicine. They are highly important clinically because of the impairment of daytime performance, attention and concentration with elevated risk of accidents in workplace and traffic and because of their consequences on cardiovascular and metabolic disorders. The obstructive sleep apnoea syndrome (OSAS) has proven to be one of the most important risk factors for arteriosclerosis, especially in the cerebral vessels. OSAS induces arterial hypertention and increases mortality due to cardiovascular diseases. Sleep related breathing disorders induce hyperglycemia and dyslipidemia. OSAS and the metabolic syndrome increase the cardiovascular risk additively. Moreover, cardiac disorders, such as arterial hypertention, heart failure and arterial fibrillation, can induce central breathing disturbances. This impairs the prognosis of affected patients substantially. Atypical symptoms of obstructive sleep apnoea (daytime sleepiness, snoring, witnessed apnoea) are often absent in these patients. In contrast patients often suffer from fatigue, reduced daytime performance, and depression which is a major challenge to diagnosis. This review presents new data on these aspects. Moreover, the association of sleep apnoea and pulmonary embolism and the question of optimal sleep duration are addressed.
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PMID:[Sleep medicine in pneumology]. 2144 32

Obstructive sleep apnea syndrome (OSAS) is a chronic disease characterized by recurrent episodes of partial or complete upper airway collapse and obstruction during sleep, associated with intermittent oxygen desaturation, sleep fragmentation, and symptoms of disruptive snoring and daytime sleepiness. Increasing focus is being placed on the relationship between OSAS and all-cause and cardiovascular disease-related mortality, but it still largely unclear whether this association is causative or simply speculative and epidemiological. Basically, reliable clinical evidence supports the hypothesis that OSAS might be associated with essential and resistant hypertension, as well as with an incremental risk of developing stroke, cardiac rhythm perturbations (e.g., atrial fibrillation, bradyarrhythmias, supraventricular and ventricular arrhythmias), coronary artery disease, acute myocardial infarction, and heart failure. Although it is still unclear whether OSAS might represent an independent risk factor for several acute or chronic conditions, or rather might trigger cardiovascular disease in the presence of traditional cardiovascular risk factors (e.g., obesity, diabetes, and dyslipidemia), there is a plausible biological background underlying this association, in that most of the mechanisms implicated in the pathogenesis of OSAS (i.e., hypoxia, hypercapnia, negative intrathoracic pressure, micro-arousal, sympathetic hyperactivity, metabolic and hormonal changes, oxidative stress, phlogosis, endothelial dysfunction, hypercoagulability, and genetic predisposition) might also be involved in the pathogenesis of cardiovascular disorders. In this article we discuss the different aspects of the relationship between OSAS and pathogenically different conditions such as systemic hypertension, coronary artery disease, stroke, metabolic abnormalities, arrhythmias, and heart failure, and we also discuss the kaleidoscope of phenomena implicated in the pathogenesis of this challenging disease.
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PMID:Obstructive sleep apnea syndrome and cardiovascular diseases. 2145 62


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