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Query: UMLS:C0037315 (sleep apnea)
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Cardiovascular disease remains the leading cause of morbidity and mortality for patients with end-stage renal disease. Conventional hemodialysis has had limited impact on cardiovascular risk factors and mortality. Increasing evidence suggests that nocturnal home hemodialysis has beneficial effects on cardiovascular parameter outcomes. This article reviews the documented effects of nocturnal home hemodialysis on blood pressure control, cardiac geometry and left ventricular systolic function, lipid profiles, calcium-phosphate metabolism, parathyroid hormone levels, homocysteine levels, sleep apnea, and autonomic modulation of heart rate. It discusses possible mechanisms to explain these observed changes.
Cardiol Clin 2005 Aug
PMID:Newer paradigms in renal replacement therapy: will they alter cardiovascular outcomes? 1608 86

This article reviews controversies in cardiac pacing in four areas: methods to prevent unnecessary right ventricular pacing and optimal ventricular pacing sites in the bradycardia population, pacing for prevention of atrial fibrillation (AF), a novel pacing technique for the treatment of heart failure, and pacing for the treatment of sleep apnea. Frequent right ventricular pacing has been reported to increase the incidence of AF and congestive heart failure. However, many patients with pacemakers for bradycardia have intrinsic atrioventricular conduction most of the time. Optimal programming of pacemakers and new algorithms designed to reduce unnecessary ventricular pacing are discussed. Pacing algorithms for prevention of AF have generally been shown to be ineffective. Atrial antitachycardia pacing has been shown to reduce the burden of atrial tachyarrhythmias in selected patients. Cardiac contractility modulation has recently been reported to be a promising new approach to the treatment of heart failure. Some pacing techniques may be effective in the treatment of sleep apnea but larger, long-term clinical trials are required to demonstrate a significant clinical benefit.
Curr Cardiol Rep 2005 Sep
PMID:Controversies in pacing: indications and programming. 1610 88

The treatment of patients with congestive heart failure has markedly improved over the past 25 years. The most successful therapy has been attenuation of neurohumoral overactivation with antagonists of the renin-angiotensin-aldosterone system, as well as beta-adrenergic blockade. Cardiac surgical interventions, which include not only aortocoronary artery bypass surgery but also interventions that remodel the heart and repair the mitral valve, have also been advocated. However, randomized clinical trials to prove their benefit and to identify which patients could derive the most benefit from these interventions are lacking. Cardiac devices, such as biventricular pacemakers (for cardiac resynchronization) and implantable cardiac defibrillators, have proved useful in improving survival and quality of life. The treatment of sleep apnea with continuous positive airway pressure has shown some promise, as has immune modulation therapy, but more research to conclusively prove their efficacy is necessary. Cell therapy with skeletal myoblasts or pluripotential stem cells is an interesting and emerging area of research that shows enormous promise. However, fundamental questions regarding the optimal use of this therapy remain unanswered. Finally, although exciting, these developments, along with the changing demographics of the Canadian population, will require a change in the way we provide care for patients with congestive heart failure. These changes will require greater involvement of health care professionals other than physicians, and greater emphasis on outpatient care, early detection and prevention, and evidence-based practice.
Can J Cardiol 2005 Oct
PMID:Treatment of congestive heart failure: present and future. 1623 94

Adverse effects on the pulmonary circulation in obstructive sleep disordered breathing (SDB) may place children with heart lesions affecting the right ventricle at increased risk for morbidity and mortality. We examined the distribution and effects of SDB in pediatric patients with tetralogy of Fallot (TOF). Families of 37 pediatric patients with TOF completed a survey of cardiac symptoms and school performance as well as a Pediatric Sleep Questionnaire (PSQ), a validated questionnaire for the screening of SDB in children 2-18 years of age. Medical records were reviewed for growth parameters, medical history, and most recent electrocardiogram (ECG) findings. Data from patients with SDB (PSQ score > or = 8, n = 14) were compared to data from patients without SDB (PSQ score < 8; n = 23). The prevalence of SDB in this population (38%) was significantly higher than the published prevalence of 5% in a healthy general pediatric population (p < 0.001). No significant difference was found in age, gender, or age and sex standardized body mass index between patients with or without SDB. No difference was seen in medication use or timing of surgical repair, whether primary or palliative. Patients with SDB had a significantly higher cardiac symptom score (p = 0.01) and increasing PSQ scores correlated with worsening cardiac symptom scores (p = 0.006). Increasing PSQ scores also correlated with worsening school performance (p = 0.001). No differences were seen in ECG data. The screened prevalence of SDB in the pediatric population with TOF is higher than in the general population; patients with TOF and SDB are more likely to have worse cardiac symptoms and poor school performance.
Pediatr Cardiol
PMID:Sleep disordered breathing in pediatric patients with tetralogy of Fallot. 1623 13

A 74-year-old man with ischemic cardiomyopathy was repeatedly admitted for congestive heart failure. His left ventricular ejection fraction was 21% and diastolic left ventricular dimension was 73.5mm by echocardiography. He was treated with biventricular pacing and heart failure improved from New York Heart Association class III to II. Before the treatment, brain natriuretic peptide was 600.5 pg/ml. Apnea hypopnea index was 23.8 and all events were central type. After biventricular pacing, apnea hypopnea index was improved to 21.9 after 11 days, 14.0 after 33 days, and 4.8 after 48 days. His left ventricular ejection fraction was 36%, diastolic left ventricular dimension was 71.4mm, and brain natriuretic peptide was 383.8 pg/ml. In this patient, central sleep disordered breathing was improved by biventricular pacing therapy after only 48 days.
J Cardiol 2006 Jan
PMID:[Improvement of central sleep disordered breathing with severe congestive heart failure by biventricular pacing therapy: a case report]. 1647 70

Currently, three areas of active development in cardiac pacing are of particular interest to clinical cardiologists. Biventricular pacing is now considered a type-I indication for adjuvant treatment in advanced and refractory heart failure. Consequently, some changes in everyday clinical practice will be seen when patients with end-stage heart failure start to receive resynchronization therapy. Secondly, the Cardiac Pacing Working Group of the Spanish Society of Cardiology has developed a national consensus document on sleep apnea and cardiac rhythm abnormalities. It appears that a novel way of tackling the current growing epidemic could be to use permanent cardiac pacing in an attempt to modify the cardiac rhythm alterations, mainly bradyarrhythmias, related to sleep apnea. Finally, promising developments are taking place in systems designed to reduce the unwanted right ventricular stimulation sometimes observed with antibradycardia pacing modalities. These new systems are expected to minimize significantly the well-known deleterious hemodynamic effects sometimes seen in our patients.
Rev Esp Cardiol 2006
PMID:[Current topics (2005) in cardiac pacing]. 1654 22

The following article reviews some of the most recent data that have come to light in the field of hypertension during the last year, including the long lasting controversy USA/Europe on the definition and treatment of hypertension, the importance of the interrelationship hypertension/sleep apnea syndrome, to conclude by discussing some of the most compelling implications of the main trials that have been published during the last few months.
Rev Esp Cardiol 2006
PMID:[Last developments on hypertension]. 1654 23

Sleep apnea may be associated to psychological symptoms and to increase use of antidepressant drugs. It is unknown if the use of benzodiazepines, psychoactive drugs with a depressant effect on the brain, is similar, in this regard, to antidepressant drugs use. Thirty patients with treated arterial hypertension and excessive weight (body mass index >25), either regularly using (13 patients) or not using (17 patients) benzodiazepines, were studied, by comparing the apnea/hypopnea index measured in a sleep study in both groups. Cardiac left chamber dimensions, corrected QT interval, body weight, height and mass index, as well as cervical and abdominal circumferences, were additional parameters under study. The mean apnea/hypopnea index was found to be significantly greater in patients not under chronic benzodiazepine use, when compared to the other group of patients (21.8+/-12.4, n=17 versus 9.7+/-11.3, n=13, p<0.05). Mean cervical and abdominal diameters were also greater in patients not treated with benzodiazepines. We conclude that, in this small group of patients with treated arterial hypertension and excessive weight, chronic benzodiazepine therapy was not associated with a greater mean apnea/hypopnea index. Further studies are needed to establish if, in fact, an inverse association might exist.
Int J Cardiol 2007 Jan 18
PMID:Apnea/hypopnea index and benzodiazepine use in patients with arterial hypertension and excessive weight. 1664 69

One hundred twenty-six eligible consecutive Chinese heart failure (HF) patients classified by New York Heart Association (NYHA) Classes II-IV underwent historic data collection and a sleep study. Seventy-one percent of HF patients were diagnosed with sleep apnea (SA), of which 65% were central sleep apnea (CSA) and 35% were obstructive sleep apnea (OSA). Higher body mass index (BMI), metabolic syndrome, habitual snoring, and nocturia were independent risk factors for OSA; NYHA classes III and IV were independent risk factors for CSA in the HF patients. There was a high prevalence of SA in Chinese patients with HF. HF patients with obesity, metabolic syndrome, snoring, nocturia and NYHA classes III and IV were more susceptible to OSA and CSA.
Int J Cardiol 2007 May 16
PMID:Prevalence and clinical characteristics of sleep apnea in Chinese patients with heart failure. 1691 41

Cardiovascular and cerebrovascular diseases are the most common diseases in industrialized societies. The main objectives of this article were to summarize the physiological effects of sleep apnea on the circulatory system and to review how treatment of this condition influences cardiovascular disease. Acute sleep apnea has a number of hemodynamic consequences, such as pulmonary and systemic hypertension, increased ventricular afterload and reduced cardiac output, all of which result from sympathetic stimulation, arousal, alterations in intrathoracic pressure, hypoxia and hypercapnia. When chronic, sleep apnea-hypopnea syndrome is associated with systemic hypertension, ischemic heart disease, congestive heart failure, and Cheyne-Stokes respiration in patients with congestive heart failure. Nocturnal treatment with continuous positive airway pressure decreases both the number of central apneic episodes and blood pressure in patients with sleep apnea-hypopnea syndrome and arterial hypertension.
Rev Esp Cardiol 2006 Jul
PMID:[Sleep apnea-hypopnea syndrome and the heart]. 1693 14


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