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Current Heart Failure Reports
Erschienen in: Current Heart Failure Reports 5/2020

17.08.2020 | Devices (C Veltmann, Section Editor)

Central Sleep Apnea in Patients with Heart Failure—How to Screen, How to Treat

verfasst von: Maria Rosa Costanzo

Erschienen in: Current Heart Failure Reports | Ausgabe 5/2020

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Abstract

Purpose of Review

Central sleep apnea occurs in up to 50% of heart failure patients and worsens outcomes. Established therapies are limited by minimal supporting evidence, poor patient adherence, and potentially adverse cardiovascular effects. However, transvenous phrenic nerve stimulation, by contracting the diaphragm, restores normal breathing throughout sleep and has been shown to be safe and effective. This review discusses the mechanisms, screening, diagnosis, and therapeutic approaches to CSA in patients with HF.

Recent Findings

In a prospective, multicenter randomized Pivotal Trial (NCT01816776) of transvenous phrenic nerve stimulation with the remedē System, significantly more treated patients had a ≥ 50% reduction in apnea-hypopnea index compared with controls, with a 41 percentage point difference between group difference at 6 months (p < 0.0001). All hierarchically tested sleep, quality of life, and daytime sleepiness endpoints were significantly improved in treated patients. Freedom from serious related adverse events at 12 months was 91%. Benefits are sustained to 36 months.

Summary

Transvenous phrenic nerve stimulation improves quality of life in patients with heart failure and central sleep apnea. Controlled trials evaluating the impact of this therapy on mortality/heart failure hospitalizations and “real world” experience are needed to confirm safety and effectiveness.
Literatur
1.
Eckert DJ, Jordan AS, Merchia P, Malhotra A. Central sleep apnea: pathophysiology and treatment. Chest. 2007;131:595–607.PubMed
2.
Javaheri S, Dempsey JA. Central sleep apnea. Compr Physiol. 2013;3:141–63.PubMed
3.
Javaheri S, Parker TJ, Liming JD, Corbett WS, Nishiyama H, Wexler L, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalences, consequences, and presentations. Circulation. 1998;97:2154–9.PubMed
4.
• Javaheri S, Barbe F, Campos-Rodriguez F, et al. Sleep apnea: types, mechanisms, and clinical cardiovascular consequences. J Am Coll Cardiol. 2017;69:841–58 Superb and comprehensive review of the links between sleep disordered breathing and cardiovascular disease.PubMedPubMedCentral
5.
• Costanzo MR, Khayat R, Ponikowski P, et al. Mechanisms and clinical consequences of untreated central sleep apnea in heart failure. J Am Coll Cardiol. 2015;65:72–84 Comprehensive analysis of the pathophysiological consequences of central sleep apnea, including neuro-hormonal activation, oxidative stress, and inflammation.PubMedPubMedCentral
6.
Sin DD, Logan AG, Fitzgerald FS, Liu PP, Bradley TD. Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. Circulation. 2000;102:61–6.PubMed
7.
Jilek C, Krenn M, Sabeh D, et al. Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study. Eur J Heart Fail. 2011;13:68–75.PubMed
8.
Hanly P, Zuberi-Khokhar N. Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure. Am J Respir Crit Care Med. 1996;153:272–6.PubMed
9.
Leite JJ, Mansur AJ, de Freitas HFG, Chizola PR, Bocchi EA, Terra-Filho M, et al. Periodic breathing during incremental exercise predicts mortality in patients with chronic heart failure evaluated for cardiac transplantation. J Am Coll Cardiol. 2003;41:2175–81.PubMed
10.
Brack T, Thuer I, Clarenbach CF, et al. Daytime Cheyne-Stokes respiration in ambulatory patients with severe congestive heart failure is associated with increased mortality. Chest. 2007;132:1463–71.PubMed
11.
Javaheri S, Shukla R, Zeigler H, Wexler L. Central sleep apnea, right ventricular dysfunction and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol. 2007;49:2028–34.PubMed
12.
Silva RS, Figueiredo AC, Mady C, Lorenzi-Filho G. Breathing disorders in congestive heart failure: gender, etiology and mortality. Braz J Med Biol Res. 2008;41:215–22.PubMed
13.
Yoshihisa A, Shimizu T, Owada T, Nakamura Y, Iwaya S, Yamauchi H, et al. Adaptive servo ventilation improves cardiac dysfunction and prognosis in chronic heart failure patients with Cheyne-Stokes respiration. Int Heart J. 2011;52:218–23.PubMed
14.
Khayat R, Abraham W, Patt B, Brinkman V, Wannemacher J, Porter K, et al. Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure. J Card Fail. 2012;18:534–40.PubMedPubMedCentral
15.
•• Cowie MR, Woehrle H, Wegscheider K, et al. Adaptive servo-ventilation for central sleep apnea in systolic heart failure. N Engl J Med. 2015;373:1095–105 Main results of the SERVE-HF trial, in which adaptive servo-ventilation improved sleep measures but was associated with increased cardiovascular mortality in patients with central sleep apnea and advanced heart failure.PubMedPubMedCentral
16.
Mendonca F, Mostafa SS, Ravelo-Garcia AG, Morgado Dias F, Penzel T. Devices for home detection of obstructive sleep apnea: a review. Sleep Med Rev. 2018;41:149–60.PubMed
17.
• Bar A, Pillar G, Dvir I, Sheffy J, Schnall R, Lavie P. Evaluation of a portable device based on peripheral arterial tone for unattended home sleep studies. Chest. 2003;123(3):695e703 Informative analysis of home sleep studies devices. Home sleep studies are preferred by patients and are less expensive than in center polysomnograms.
18.
Pillar G, Bar A, Betito M, Schnall R, Dvir I, Sheffy J, et al. An automatic ambulatory device for detection of AASM defined arousals from sleep: the WP100. Sleep Med. 2003;4(3):207e12.
19.
Pittman S, Pittman N, MacDonald M, Malhotra A, Fogel R, White D. Using a wrist-worn device based on peripheral arterial tonometry to diagnose obstructive sleep apnea: in-laboratory and ambulatory validation. Sleep. 2004;27(5):923e33.
20.
Zou D, Grote L, Peker Y, Lindblad U, Hedner J. Validation a portable monitoring device for sleep apnea diagnosis in a population-based cohort using synchronized home polysomnography. Sleep. 2006;29(3):367e74.
21.
Pang K, Gourin C, Gourin T. A comparison of polysomnography and the WatchPAT in the diagnosis of obstructive sleep apnea. Otolaryngol Head Neck Surg. 2007;137(4):665e8.
22.
Ponikowski P, Voors AA, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129–200.PubMed
23.
Yancy CW, Jessup M, Bozkurt B, et al. ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013;62:e147–239.PubMed
24.
Chenuel B, Smith C, Skatrud J, et al. Increased propensity of apnea in response to acute elevations in left atrial pressure during sleep in the dog. J Appl Physiol. 2006;101:76–83.PubMed
25.
Stoschizky K, Sakotnik A, Lercher P, et al. Influence of beta-blockers on melatonin release. Eur J Clin Pharmacol. 1999;55:111–5.
26.
Sinha AM, Skobel EC, Breithardt OA, Norra C, Markus KU, Breuer C, et al. Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure. JACC. 2004;44:68–71.PubMed
27.
Gabor JY, Newman DA, Barnard-Roberts V, Korley V, Mangat I, Dorian P, et al. Improvement in Cheyne-Stokes respiration following cardiac resynchronization therapy. Eur Respir J. 2005;26:95–100.PubMed
28.
Oldenburg O, Faber L, Vogt J, Dorszewski A, Szabados F, Horstkotte D, et al. Influence of cardiac resynchronization therapy on different types of sleep disordered breathing. Eur J Heart Fail. 2007;9:820–6.PubMed
29.
Kara T, Novak M, Nykodym J, Bybee KA, Meluzin J, Orban M, et al. Short-term effects of cardiac resynchronization therapy on sleep-disordered breathing in patients with systolic heart failure. Chest. 2008;134:87–93.PubMed
30.
Stanchina ML, Ellison K, Malhotra A, Anderson M, Kirk M, Benser ME, et al. The impact of cardiac resynchronization therapy on obstructive sleep apnea in heart failure patients. Chest. 2007;132:433–9.PubMed
31.
Javaheri S, Abraham W, Brown C, et al. Prevalence of obstructive sleep apnea and periodic limb movement in 45 subjects with heart transplantation. Eur Heart J. 2004;25:260–6.PubMed
32.
33.
Sasayama S, Izumi T, Matsuzaki M, Matsumori A, Asanoi H, Momomura SI, et al. Improvement of quality of life with nocturnal oxygen therapy in heart failure patients with central sleep apnea. Circ J. 2009;73:1255–62.PubMed
34.
Khayat RN, Xie A, Patel AK, Kaminski A, Skatrud JB. Cardiorespiratory effects of added dead space in patients with heart failure and central sleep apnea. Chest. 2003;123:1551–60.PubMed
35.
Szollosi I, Jones M, Morrel MJ, et al. Effect of CO2 inhalation on central sleep apnea and arousals from sleep. Respiration. 2004;71:493–8.PubMed
36.
Lorenzo-Filho G, Rankin F, Bies I, et al. Effects of inhaled carbon dioxide and oxygen on Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med. 1999;159:1490–8.
37.
Mebrate Y, Willson K, Manisty CH, Baruah R, Mayet J, Hughes AD, et al. Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes. J Appl Physiol. 2009;107:696–706.PubMedPubMedCentral
38.
Javaheri S, Sands SA, Edwards BA. Acetazolamide attenuates Hunter-Cheyne-Stokes breathing yet paradoxically augments the hypercapnic ventilatory response in patients with heart failure. Ann Am Thorac Soc. 2014;11:80–6.PubMed
39.
Biberdorf DJ, Steens R, Millar TW, Kryger MH. Benzodiazepines in congestive heart failure: effects of temazepam on arousability and Cheyne-Stokes respiration. Sleep. 1993;16:529–38.PubMed
40.
Bradley T, Logan A, Kimoff J, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2006;353:2025–33.
41.
Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D, et al. Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP). Circulation. 2007;115:3173–80.PubMed
42.
Javaheri S, Goetting MG, Khayat R, et al. The performance of two automatic servo-ventilation devices in the treatment of central sleep apnea. Sleep. 2011;34:1693–8.PubMedPubMedCentral
43.
Teschler H, Döhring J, Wang YM, et al. Adaptive pressure support servo-ventilation. Am J Respir Crit Care Med. 2001;64:614–9.
44.
Sharma BK, Bakker JP, McSharry DG, et al. Adaptive servo-ventilation for treatment of sleep-disordered breathing in heart failure: a systematic review and meta-analysis. Chest. 2012;142:1211–21.PubMedPubMedCentral
45.
Pepperell J, Maskell NA, Jones DR, et al. A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure. Am J Respir Crit Care Med. 2003;168:1109–14.PubMed
46.
Hetland A, Haugaa KH, Olseng M, Gjesdal O, Ross S, Saberniak J, et al. Three-month treatment with adaptive servo-ventilation improves cardiac function and physical activity in patients with chronic heart failure and Cheyne-Stokes respiration: a prospective randomized controlled trial. Cardiology. 2013;126:81–96.PubMed
47.
Arzt M, Schroll S, Series F, et al. Auto-servo-ventilation in heart failure with sleep apnoea: a randomized controlled trial. Eur Respir J. 2013;42:1244–54.PubMed
48.
Kasai T, Kasagi S, Maeno K-I, et al. Adaptive servo-ventilation in cardiac function and neurohormonal status in patients with heart failure and central sleep apnea nonresponsive to continuous positive airway pressure. JACC Heart Fail. 2013;1:58–63.PubMed
49.
Kasai T, Usui Y, Yoshioka T, et al. Effect of flow-triggered adaptive servo-ventilation compared with continuous positive airway pressure in patients with chronic heart failure with coexisting obstructive sleep apnea and Cheyne-Stokes respiration. Circ Heart Fail. 2010;3:140–8.PubMed
50.
Randerath WJ, Nothofer G, Priegnitz C, et al. Long-term auto-servo-ventilation or constant positive pressure in heart failure and coexisting central with obstructive sleep apnea. Chest. 2012;142:440–7.PubMed
51.
Galetke W, Ghassemi BM, Priegnitz C, Stieglitz S, Anduleit N, Richter K, et al. Anticyclic modulated ventilation versus continuous positive airway pressure in patients with coexisting obstructive sleep apnea and Cheyne–Stokes respiration: a randomized crossover trial. Sleep Med. 2014;15:874–9.PubMed
52.
Cowie MR, Wegscheider K, Teschler H. Adaptive servo-ventilation for central sleep apnea in heart failure. N Engl J Med. 2016;374:690–1.PubMed
53.
Costanzo MR, Augostini R, Goldberg LR, Ponikowski P, Stellbrink C, Javaheri S. Design of the remedē System Pivotal Trial: a prospective, randomized study in the use of respiratory rhythm management to treat central sleep apnea. J Card Fail. 2015;21:892–902.PubMed
54.
Augostini RS, Afzal MR, Costanzo MR, et al. How to implant a phrenic nerve stimulator for treatment of central sleep apnea? J Cardiovasc Electrophysiol. 2019;30:792–9.PubMedPubMedCentral
55.
• Costanzo MR, Ponikowski P, Javaheri S, Augostini R, Goldberg L, Holcomb R, et al. remede System Pivotal Trial Study Group. Transvenous neurostimulation for central sleep apnoea: a randomised controlled trial. Lancet. 2016;388:974–82 Main results of the pivotal trial of transvenous phrenic nerve stimulation.PubMed
56.
Fox H, Oldenburg O, Javaheri S, et al. Long-term efficacy and safety of phrenic nerve stimulation for the treatment of central sleep apnea. SLEEPJ. 2019;42:1–9.
57.
Fudim M, Spector AR, Costanzo MR, Pokorney SD, Mentz RJ, Jagielski D, et al. Phrenic nerve stimulation for the treatment of central sleep apnea: a pooled cohort analysis. J Clin Sleep Med. 2019;15:1747–55.PubMedPubMedCentral
58.
Abraham WT, Jagielski D, Oldenburg O, Augostini R, Krueger S, Kolodziej A, et al. Phrenic nerve stimulation for the treatment of central sleep apnea. JCHF. 2015;3:360e9.
59.
Alonso C, Leclercq C, d’Allonnes FR, Pavin D, Victor F, Mabo P, et al. Six year experience of transvenous left ventricular lead implantation for permanent biventricular pacing in patients with advanced heart failure: technical aspects. Heart. 2001;86:405e10.
60.
Jagielski D, Ponikowski P, Augostini R, Kolodziej A, Khayat R, Abraham WT. Transvenous stimulation of the phrenic nerve for the treatment of central sleep apnoea: 12 months’ experience with the Remedē ® System. Eur J Heart Fail. 2016;18:1386–93.PubMed
61.
Takama N, Kurabayashi M. Effect of adaptive servo-ventilation on 1-year prognosis in heart failure patients. Circ J. 2012;76:661–7.PubMed
62.
Hetzenecker A, Escourrou P, Kuna ST, Series F, Lewis K, Birner C, et al. Treatment of sleep apnea in chronic heart failure patients with auto-servo ventilation improves sleep fragmentation: a randomized controlled trial. Sleep Med. 2016;17:25–31.PubMed
63.
Oldenburg O, Wellmann B, Buchholz A, Bitter T, Fox H, Thiem U, et al. Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. Eur Heart J. 2016;37:1695–703.PubMed
64.
Costanzo MR, Ponikowski P, Javaheri S, et al. Sustained 12 month benefit of phrenic nerve stimulation for central sleep apnea. Am J Cardiol. 2018;121:1400–8.PubMed
65.
Costanzo MR, Ponikowski P, Coats A, Javaheri S, Augostini R, Goldberg LR, et al. Phrenic nerve stimulation to treat patients with central sleep apnoea and heart failure. Eur J Heart Fail. 2018;20:1746–54.PubMed
66.
67.
Arzt M. Neurostimulation in patients with heart failure and central sleep apnoea. Lancet. 2016;388:938–40.PubMed
68.
Valika A, Costanzo MR. Sleep-disordered breathing during congestive heart failure: to intervene or not to intervene? Card Fail Rev. 2017 Nov;3(2):134–9.PubMedPubMedCentral
69.
Abraham WT, Pleister A, Germany R. Identification and treatment of central sleep apnoea: beyond SERVE-HF Card. Fail Rev. 2018;4:50–3.
Metadaten
Titel
Central Sleep Apnea in Patients with Heart Failure—How to Screen, How to Treat
verfasst von
Maria Rosa Costanzo
Publikationsdatum
17.08.2020
Verlag
Springer US
Erschienen in
Current Heart Failure Reports / Ausgabe 5/2020
Print ISSN: 1546-9530
Elektronische ISSN: 1546-9549
DOI
https://doi.org/10.1007/s11897-020-00472-0

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