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Sleep disorders are a common concomitant comorbidity in patients with heart failure. The aims of our study are to determine the incidence and phenotypic characteristics of sleep apnea in overweight patients with exacerbated heart failure and to assess the degree of involvement of systolic and diastolic function impairment in the individual group. F...
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Background
The impact of sleep disordered breathing (SDB) on heart failure (HF) is increasingly recognized. However, limited data exist in support of quantification of the clinical and financial impact of SDB on HF hospitalizations.
Methods
A sleep-heart registry included all patients who underwent inpatient sleep testing during hospitalization fo...
Citations
... Считается, что дыхание Чейна-Стокса отягощает прогноз при СН [7]. При анализе больных с ожирением и декомпенсацией СН выявлено, что фракция выброса левого желудочка (ЛЖ) значительно снижена у больных с центральным апноэ сна, чем с СОАС [25]. Поэтому снижение фракции выброса ЛЖ может быть предиктором развития центрального апноэ сна, в связи с этим в комплексное обследование больных со сниженной фракцией выброса ЛЖ должен быть включён рутинный скрининг апноэ сна. ...
Introduction. Sleep disorders are associated with the onset and progression of cardiovascular diseases, including hypertension, stroke, arrhythmias, coronary heart disease, and heart failure. However, awareness of the prevalence of sleep disorders and their impact on comorbidities, including cardiovascular diseases, remains insufficient. The aim of the review: to determine the importance of early detection of sleep disorders for improving the effectiveness of prevention of cardiovascular diseases. A literature search was conducted on the topic: sleep disorders as a trigger of cardiovascular pathology. Significant links have been established between sleep disorders and the development of various forms of pathology of the cardiovascular system, both in adults and children, which necessitates timely sleep screening. Conclusion. A certain connection between sleep disorders and cardiovascular diseases necessitates increased awareness in doctors regarding sleep disorders for the prevention of diseases of the cardiovascular system.
... OSA is characterized by repetitive and prolonged interruptions (apneas) or reductions (hypopneas) in airflow by over 50% for more than 10 seconds during sleep, accompanied by desaturation ≥ 4%, attributed to upper airway obstruction [5]. Up to 81% of patients with exacerbated heart failure are affected, as indicated by a Bulgarian study on the subject [6]. The pathophysiological mechanisms are well studied, with a pathological cycle rapidly leading to the progression of heart failure and higher rates of hospitalization and mortality. ...
The individual approach in the treatment of heart failure (HF) and personalized medicine have been the main topic in recent years in all scientific forums. The combination of chronic obstructive pulmonary disease (COPD) and sleep apnea (SA) further complicates the clinical presentation in patients with HF. The overlap of all three diseases requires a team of specialists and additional therapeutic approach for better control and to improve the prognosis. A large number of the pathophysiological mechanisms of the three diseases also overlap. The novel therapies for HF have shown good results, both in COPD and CA subgroups. Noninvasive ventilation during hospitalization and at home is an established method in the individual groups. In a combination of the three diseases, definitive data from randomized trials are still lacking.
... Sleep apnea is a condition that is currently mostly undiagnosed in the population (Heinzer et al., 2015), but is nevertheless associated with an increased risk of many comorbidities (Schreib et al., 2020;Kalaydzhiev et al., 2023). Attempts to automatically detect sleep apnea have been made in the last years either using deep learning from ECG data (Zhang et al., 2021;Kumar Tyagi and Agrawal, 2023) or even by detecting differences in the frequency power spectrum of EEG (Saha et al., 2019). ...
Introduction: ECG Derived Respiration (EDR) are a set of methods used for extracting the breathing rate from the Electrocardiogram (ECG). Recent studies revealed a tight connection between breathing rate and more specifically the breathing patterns during sleep and several related pathologies. Yet, while breathing rate and more specifically the breathing pattern is recognised as a vital sign it is less employed than Electroencephalography (EEG) and heart rate in sleep and polysomnography studies.
Methods: This study utilised open-access data from the ISRUC sleep database to test a novel spectral-based EDR technique (scEDR). In contrast to previous approaches, the novel method emphasizes spectral continuity and not only the power of the different spectral peaks. scEDR is then compared against a more widely used spectral EDR method that selects the frequency with the highest power as the respiratory frequency (Max Power EDR).
Results: scEDR yielded improved performance against the more widely used Max Power EDR in terms of accuracy across all sleep stages and the whole sleep. This study further explores the breathing rate across sleep stages, providing evidence in support of a putative sleep stage "REM0" which was previously proposed based on analysis of the Heart Rate Variability (HRV) but not yet widely discussed. Most importantly, this study observes that the frequency distribution of the heart rate during REM0 is closer to REM than other NREM periods even though most of REM0 was previously classified as NREM sleep by sleep experts following either the original or revised sleep staging criteria.
Discussion: Based on the results of the analysis, this study proposes scEDR as a potential low-cost and non-invasive method for extracting the breathing rate using the heart rate during sleep with further studies required to validate its accuracy in awake subjects. In this study, the autonomic balance across different sleep stages, including REM0, was examined using HRV as a metric. The results suggest that sympathetic activity decreases as sleep progresses to NREM3 until it reaches a level similar to the awake state in REM through a transition from REM0.
... Moreover, the sleep partner of the patient may observe their apneas, gasping, or choking [2]. The severity of obstructive sleep apnea is classified as mild (AHI = [5][6][7][8][9][10][11][12][13][14], moderate (AHI = [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29], or severe (AHI ≥ 30) [3]. The prevalence of OSA is estimated at 44% in the general European adult population, with approximately 23% of patients with moderate to severe OSA (AHI ≥ 15) [4]. ...
... In this study population, 50 individuals were diagnosed with OSA (82%), and 52% were male. The following parameters were estimated: left ventricular ejection fraction at 49.6 ± 8.5%, AHI at 41.8 ± 23.2, BMI at 38.5 ± 7.1, NTproBNP at 1359.12 ± 740.64 pg/mL, mean oxygen saturation (MOS) at 83.9 ± 6.8%, and the lowest oxygen saturation (LOS) at 65.3 ± 12.7% [28]. ...
... Especially OSA prevalence rates within the HF population, as demonstrated by studies conducted in 1997, 2007, and 2009 by Chan et al., Oldenburg et al. and Yumino et al., were reported as 63.64%, 48.21%, and 55.45%, with corresponding overall OSA prevalence rates of 35%, 36%, and 25.69% [16,25,26]. However, it's essential to consider that the more recent investigation by Kalaydzhiev et al. in 2023 reported a notably higher OSA prevalence of 81.97% among HF patients, while the overall OSA prevalence remained at 50% [28]. It's worth highlighting that the study by Kalaydzhiev et al. had a sample size of 100, which could potentially introduce a risk of bias due to its limited size [28]. ...
Background:
Heart failure (HF) patients commonly experience obstructive sleep apnea (OSA), which may worsen their condition. We reviewed a diverse range of studies to investigate the prevalence of OSA in HF patients, the effects of positive airway pressure (PAP) treatment, and the potential impact of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and sacubitril/valsartan on OSA outcomes.
Methods:
We analyzed case-control, observational studies, and randomized controlled trials. Prevalence rates, PAP treatment, and HF pharmacotherapy were assessed.
Results:
Numerous studies revealed a high prevalence of OSA in HF patients, particularly with preserved ejection fraction. PAP treatment consistently improved an apnea-hypopnea index, left ventricular ejection fraction, oxygen saturation, and overall quality of life. Emerging evidence suggests that SGLT2i and sacubitril/valsartan might influence OSA outcomes through weight loss, improved metabolic profiles, and potential direct effects on upper airway muscles.
Conclusions:
The complex interplay between OSA and HF necessitates a multifaceted approach. PAP treatment has shown promising results in improving OSA symptoms and HF parameters. Additionally, recent investigations into the effects of HF pharmacotherapy on OSA suggest their potential as adjunctive therapy. This review provides insights for clinicians and researchers, highlighting the importance of addressing OSA and HF in patient management strategies.
... In addition, an association between OSA and increased cardiovascular risk and mortality has been suggested in the field [16,17]. OSA episodes are accompanied by hemodynamic imbalance and endothelial dysfunction due to sympathetic hyperactivity, increased blood pressure during sleep, hypoxic episodes that favor the presence of cardiac arrhythmia, changes in intrathoracic pressure, increased heart rates, sleep fragmentation, and arousal or microarousals that cause increased muscle tone in the oropharyngeal dilator muscles [42][43][44]. Regarding OSA and durations of sleep patterns, the findings of a study by Risso T.T. et al., in which the objective was to analyze sleep durations in OSA patients, showed that patients with short sleep patterns had higher AHI values (50.18 ± 30.86 events/h) compared with those who slept for about 7 h (23.21 ± 20.45 events/h) [45]. In addition, a study by Priou P. et al. suggested that a combination of severe OSA and a short sleep pattern will increase the risk of hypertension up to four times compared with that of normal sleepers who do not have OSA [46]. ...
Abstract: Sleep is essential for life, and inappropriate sleep duration patterns may lead to chronic consequences regarding human health. Several studies have confirmed the presence of a U-shaped association between sleep duration and mortality. Moreover, many consequences related to car- diometabolic aspects have been suggested in patients with abnormal sleep durations. In this study, we analyzed the associations between sleep duration, total sleep time (TST), the risk of all-cause mortality, and 10-year cardiovascular risk in a cohort of patients at a sleep medicine center in Santiago, Chile. We conducted a prospective cohort study of patients (SantOSA). A short TST was defined as ≤6 h, a normal TST as 6 to 9 h, and a long TST as ≥9 h. Adjusted hazard ratios (aHRs) for all-cause mortality were calculated. A cross-sectional analysis between TST and 10-year cardiovascular risk (calculated using the Framingham 2008 formula) was determined using logistic regression models. A total of 1385 subjects were included in the results (78% male; median age: 53, interquartile range (IQR): 42–64 years; median BMI: 29.5, IQR: 16.7–33.1). A total of 333 subjects (24%) reported short TSTs, 938 (67.7%) reported normal TSTs, and 114 (8.3%) reported long TSTs. In the fully adjusted model, the association remained significant for short (aHR: 2.51 (1.48–4.25); p-value = 0.01) and long TSTs (aHR: 3.97 (1.53–10.29); p-value = 0.04). Finally, a U-shaped association was found between short and long TSTs, with an increase in cardiovascular risk at 10 years. Compared with normal TSTs, short (≤6 h) and long (≥9 h) TSTs were significantly associated with all-cause mortality and increased 10-year cardiovascular risk.
Introdução - A Insuficiência Cardíaca (IC) é caracterizada pela incapacidade do coração em suprir as necessidades fisiológicas do corpo. Afeta aproximadamente cerca de 26 milhões de pessoas no mundo. A IC tem sido associada à ocorrência de disfunção sexual masculina (DS) e distúrbios do sono. Neste contexto, o exercício físico é uma estratégia terapêutica com elevado nível de evidências científicas bem documentadas. Objetivos: descrever os principais mecanismos fisiopatológicos e a repercussão terapêutica do exercício físico nas três morbidades (IC, DE e DRS). Método: Revisão da literatura. As buscas por artigos científicos foram conduzidas de forma manual e intencional, por um único pesquisador, as buscas foram realizadas nas bases de dados eletrônicas (PubMed, LILACS, Cochrane-Library, Science Direct). Considerações Finais: Os resultados apresentados nesta revisão demonstram a relação positiva entre o exercício físico e o controle dessas três condições (IC, DE e DRS), sendo, portanto, fortemente recomendado o seu uso como no tratamento da IC e de algumas morbidades a ela associadas (comorbidades), como a DE e o DRS.
