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

This overview discusses pathogenesis, clinical presentation, prognostic implications and therapy of central sleep apnea with special reference to Cheyne-Stokes-Respiration or periodic breathing. In contrast to obstructive sleep apnea due to upper airway collapse during sleep, central sleep apnea (CSA) is mainly due to an instability of the breathing control system. Causes of central sleep apnea include alveolar hypoventilation disorders, heart failure, neurologic and autonomic disorders and idiopathic forms of CSA. Patients with idiopathic CSA often complain of insomnia and awakening during sleep but may also suffer from daytime sleepiness. Cheyne-Stokes-Respiration or peridic breathing is often associated with heart failure and neurological disorders especially those involving the brainstem. In heart failure periodic breathing has enormous prognostic implications. Treatment options for central sleep apnea are oxygen supplementation, medical therapy (i.e. acetazolamide) and CPAP. For patients with central sleep apnoea associated with alveolar hypoventilation nasal ventilation is treatment of choice. Newer nasal ventilation techniques (BiPAP, AutoSetCS) are under investigation for heart failure patients with Cheyne-Stokes-Respiration.
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PMID:[Central sleep apnea syndrome and Cheyne-Stokes respiration]. 1095 54

Heart failure has an increasing prevalence in middle age adults. The prognosis is very poor even with improved medical therapy and heart transplants. The outcome is related to the neurohumoral disease resulting from heart failure which leads to sympathetic activation that in turns worsens the prognosis. About half of the patients have sleep breathing disorders with variable proportions of central and obstructive apneas. Obstructive apneas are acutely deleterious to ventricular function. On the long run, they may be responsible for a worsening of the disease due to the permanent sympathetic activation seen in obstructive sleep apnea. It is therefore important to detect sleep apnea in patients and to apply a treatment. The best therapeutic procedure in obstructive events appears to be CPAP, provided hemodynamic status is closely monitored.
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PMID:[Obstructive sleep apnea syndrome and heart failure]. 1192 36

The high incidence of association between sleep apnea syndrome and cardiac disturbance was widely descripted during the last decade and has been the target of intensive investigation. Our retrospective study included 12 patients with sleep apnea syndrome diagnosed by polysomnography. 7 patients had HTA with left ventricular hypertrophy (5 cases). The CPAP stabilise blood pressure in 6 of them, 3 patients had ventricular or atrial arrhythmia. CPAP resolved 2 of them. 3 other patients had coronaropathy. Another one presented stoke. The sleep apnea syndrome has been descripted in association with heart failure or unstable HTA.
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PMID:[Cardiovascular complications of sleep apnea syndromes]. 1266 5

Sleep apnea syndrome (SAS) in patients with chronic heart failure (CHF) increases the risk of death. SAS was divided into 4 types: obstructive sleep apnea-hypopnea syndrome (OSAHS), upper airways resistance syndrome (UARS), central sleep apnea syndrome (CSAS), and sleep hypoventilation syndrome (SHVS). CSAS is caused by temporary cessation of central drive to respiratory muscles, OSAHS results from partial or complete collapse of the pharynx, UARS have typical symptoms of OSAHS and no changes on polysomnography, whereas SHVS results from pathological PCO2 increase with subsequent hypoxemia. Increase in sympathetic activity, renin-angiotensin-aldosterone activation, impaired baroreflex and tonic vagal heart rate control are markers of increased risk of sudden death. CSAS is frequent in patients with CHF. Decreased cardiac output causes delayed transmission of changes in arterial blood gas tensions from the lungs to the chemoreceptors. Increase chemoreceptor sensitivity results from hypoxia and pulmonary congestion. Both types of apneas (OSAHS and CSAS) may occur in the same patient. Periodic cessation in central drive to respiratory muscles (CSAS) causes obstructive apneas/hypopneas by decreased tone of pharyngeal muscles and their collapse. Obstructive apneas (OSAHS) may lead to central apneas by frequent arousals, decreased left ventricular function and prolongation of circulation. Treatment of SAS is based on improvement of cardiovascular function, nocturnal supplementation of O2 and various forms of noninvasive positive airway pressure (i.e. CPAP).
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PMID:[Sleep apnea syndrome in patients with chronic heart failure]. 1530 26

Chronic heart failure with its age-dependent prevalence and incidence is one of the most frequent diseases. Due to high mortality and morbidity there is the necessity of early diagnosis and therapeutic measures being as causal as possible. The medical graded therapy is based on the combination of ACE-inhibitors/AT1-blockers, beta-blockers, diuretics and digitalis. Cardiac resynchronization therapy represents a novel option of treatment for only 25% of patients. Nevertheless the prognosis of patients with chronic heart failure with conventional medical therapy is remaining poor. Additional improvement in the treatment of patient with chronic heart failure remains a priority medical task. The results of this case report argues for CPAP as further adjunctive treatment option in patients with chronic heart failure.
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PMID:[CPAP as adjunctive treatment option for chronic heart failure]. 1624 Jan 42

We studied 44-year old man with heart failure (ejection fraction -25%). Obesity, arterial hypertension, snoring and excessive daytime sleepiness suggested concomitant obstructive sleep apnoea. Limited polysomnography with Polymesam revealed typical Cheyne-Stokes respiration with mainly central apnoeas (RDI=48/hour). We did not find any obstructive episodes during sleep study. Patient responded to CPAP therapy and apnoea hypopnoe index decreased to 12/hour on 8 mbar pressure.
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PMID:[Central sleep apnoea (CSA) in male with heart failure]. 1742 54

Patients with heart failure or OSA (obstructive sleep apnoea) have reduced HF-HRV (high-frequency heart rate variability), indicating reduced cardiac vagal modulation, a marker of poor prognosis. CPAP (continuous positive airway pressure) abolishes OSA in patients with heart failure, but effects on daytime HF-HRV have not been determined. We hypothesized that, in patients with heart failure, treatment of coexisting OSA by CPAP would increase morning HF-HRV. In 19 patients with heart failure (left ventricular ejection fraction <45%) and OSA (>/=20 apnoeas and hypopnoeas/h of sleep), HF-HRV was quantified before and 1 month after randomization to a control or CPAP-treated group. In the control group (n=7), there were no changes in HF-HRV over the 1 month study during wakefulness in the morning. In the CPAP-treated group (n=12) HF-HRV increased significantly during wakefulness in the morning [from 2.43+/-0.55 to 2.82+/-0.50 log(ms(2)/Hz); P=0.002] due to an increase in transfer function between changes in lung volume and changes in HF-HRV (92.37+/-96.03 to 219.07+/-177.14 ms/l; P=0.01). In conclusion, treatment of coexisting OSA by nocturnal CPAP in patients with heart failure increases HF-HRV during morning wakefulness, indicating improved vagal modulation of heart rate. This may contribute to improved prognosis.
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PMID:Continuous positive airway pressure increases heart rate variability in heart failure patients with obstructive sleep apnoea. 1782 46

The following review summarises the most important articles published on sleep apnea-hypopnea syndrome (SAHS) during the current year. The analysis of the many factors implicated in the risk of cardiovascular diseases associated with SAHS is currently of great interest to the scientific community. There are many studies on this subject that demonstrate the role of inflammatory and immunological mediators, their relationship with endothelial damage and their influence in the genesis of cardiovascular disease in patients with SAHS. The role of CPAP in preventing this cardiovascular risk has had varied results. Although there is no evidence of benefit or harm in its use in heart failure, in cerebrovascular accidents SAHS has been confirmed as a predisposing factor and the reported increase in mortality would justify the intention to treat SAHS in these patients. Likewise, the reduction in blood pressure found with CPAP treatment could reduce the risk of cardio-cerebrovascular disease. The recent knowledge that there is expression of multiple phenotypes of SAHS gives a glimpse in the future of a disease based on different specific phenotypes, where the traditional symptomatology that defined the syndrome does not limit its treatment. To obtain a reliable and cost-effective diagnostic method that responds to the demands of the public health problem that is SAHS, particularly in sectors of the population that remain under-diagnosed and less well known, such as children, women and the elderly population is another one of the challenges reflected in published studies. In short, the growing knowledge on the biology of SAHS, its cardiovascular implications and its effect on the morbidity and mortality of the population will enable us to understand the true dimension of this disease in the next few years.
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PMID:[Innovations in the epidemiology, natural history, diagnosis and treatment of sleep apnea-hypopnea syndrome]. 1930 23

Obstructive Sleep Apnea Syndrome (OSAS) is a recognized risk factor for cardiovascular disorders and in some cases is complicated with Pulmonary Arterial Hypertension (PAH), as the endothelium is affected. Recent studies provide strong evidence for endothelial dysfunction in obstructive sleep apnea. The resultant vasoconstriction, abnormal cell proliferation and hyper-coagulability may lead to the initiation or progression of atherosclerotic cardiovascular and cerebrovascular disorders, which are frequently encountered in OSA patients. While the currently available therapies for OSAS, such as Continuous Positive Airway Pressure therapy (CPAP therapy), improve endothelial dysfunction, they are not well-tolerated by patients. CPAP therapy can reduce nocturnal hypoxemias and decrease noradrenaline circulating levels, but does not affect ET-1 plasma levels. Potent and selective Endothelin-1 receptor antagonists have been developed and have shown promising results in the treatment of cardiovascular diseases such as pulmonary arterial hypertension, acute and chronic heart failure, hypertension, renal failure, and atherosclerosis. However, results are often contrasting and complicated because of the tissue-specific vasoconstrictor actions of Endothelin-B receptors and the fact that endothelin is an autocrine and paracrine factor whose activity is difficult to measure in vivo.
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PMID:The role of Endothelin-1 in obstructive sleep apnea syndrome and pulmonary arterial hypertension: pathogenesis and Endothelin-1 antagonists. 2015 59

Noncardiac Comorbidities are frequent and may be overlooked during routine CHF management. They have great impact on hospitalisations and mortality. The most important comorbidities in heart failure patients are renal insufficiency, diabetes mellitus, chronic obstructive pulmonary disease, sleeping disorders like obstructive and central apnea syndrom, and anemia. The most powerful predictor for mortality is renal insufficiency. It's important to recognize the different causes of renal failure. Defining the volume status and the cardiac output is crucial for the guidance of therapy. The management of diuretic resistance is of special interest and often challenging. Diabetes mellitus is an independent risk factor for heart failure. The benefit of ACE inhibitors and Angiotensin receptor blockers for HF and DM is accepted. The management of Diabetes in HF depends on side-effect profiles of the numerous anti-diabetic drugs. Metformin is safe even in HF patients. Thiazolidinediones should be avoided in NYHA class III/IV because of fluid retention. In COPD patients there is an underuse of betablockers and the prediction of mortality with this comorbidity could be partially caused by that. The principle goal of treatment of sleeping disorders is to avoid hypoxia during night. CPAP therapy improves live quality and HF symptoms. Anemia is often diagnosed, the best therapy - erythropoetin plus iron or iron alone - remains controversial. Iron supplementation without anemia could be an option for better quality of life. To handle all these comorbidities in heart failure patients becomes more and mor complex. Heart failure nurses can help us to manage these growing population.
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PMID:[Comorbidity in heart failure]. 2127 41


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