Cycle length identifies obstructive sleep apnea and central sleep apnea in heart failure with reduced ejection fraction
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To clarify whether unmasking of central sleep apnea during continuous positive airway pressure (CPAP) initiation can be identified from initial diagnostic polysomnography (PSG) in patients with heart failure with reduced ejection fraction (HFREF) and obstructive sleep apnea (OSA)
Materials and methods
Forty-three consecutive patients with obstructive sleep apnea and central sleep apnea (OSA/CSA) in HFREF were matched with 43 HFREF patients with OSA and successful CPAP initiation. Obstructive apneas during diagnostic PSG were then analyzed for cycle length (CL), ventilation length (VL), apnea length (AL), time to peak ventilation (TTPV), and circulatory delay (CD). We calculated duty ratio (DR) as the ratio of VL/CL and mathematic loop gain (LG).
While AL was similar, CL, VL, TTPV, CD, and DR was significantly longer in patients with OSA/CSA compared to those with OSA, and LG was significantly higher. Receiver operator curves identified optimal cutoff values of 50.2 s for CL (area under the curve (AUC) 0.85, 29.2 s for VL (AUC 0.92), 11.5 s for TTPV (AUC 0.82), 26.4 s for CD (AUC 0.79), and 3.96 (AUC 0.78)) respectively for LG to identify OSA/CSA.
OSA/CSA in HFREF can be identified by longer CL, VL, TTPV, and CD from obstructive events in initial diagnostic PSG. The underlying mechanisms seem to be the presence of an increased LG.
KeywordsSleep apnea Heart failure Treatment-emergent central sleep apnea Cycle length Complex sleep apnea
Compliance with ethical standards
The study was approved by the Ethical Review Board of the Ruhr University, Bochum, and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Conflict of interest
Olaf Oldenburg reports personal fees from ResMed, personal fees from LivaNova, personal fees from Novartis, and personal fees from Bayer, outside the submitted work. The other authors declare that they have no conflicts of interest.
- 1.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, ESC Scientific Document Group (2016) 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 37:2129–2200CrossRefPubMedGoogle Scholar
- 6.Bitter T, Westerheide N, Prinz C, Hossain MS, Vogt J, Langer C, Horstkotte D, Oldenburg O (2011) Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. Eur Heart J 32:61–74CrossRefPubMedGoogle Scholar
- 12.Sands SA, Edwards BA, Kee K, Turton A, Skuza EM, Roebuck T, O'Driscoll DM, Hamilton GS, Naughton MT, Berger PJ (2011) Loop gain as a means to predict a positive airway pressure suppression of Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med 184:1067–1075CrossRefPubMedGoogle Scholar
- 13.Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, Buyse B, de Backer W, Eckert DJ, Grote L, Hagmeyer L, Hedner J, Jennum P, la Rovere MT, Miltz C, McNicholas WT, Montserrat J, Naughton M, Pepin JL, Pevernagie D, Sanner B, Testelmans D, Tonia T, Vrijsen B, Wijkstra P, Levy P (2017) Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J 49:1600959CrossRefPubMedGoogle Scholar
- 14.Mayer G et al (2017) S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen–Kapitel “Schlafbezogene Atmungsstörungen”. Somnologie 20:597–S180Google Scholar
- 16.Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM, American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events. J Clin Sleep Med 8:597–619PubMedPubMedCentralGoogle Scholar
- 25.Churchill E, Cope O, Churchill E, Cope O (1929) The rapid shallow breathing resulting from pulmonary congestion and edema. ( From the Surgical Laboratories, Massachusetts General Host ~ tal, Boston.) ( Received for publication, December 12, 1928.) Experimental studies by Dunn ( 1 ) demonstrated. J Exp Med 49:531–537CrossRefPubMedPubMedCentralGoogle Scholar
- 31.Morgenthaler TI, Kuzniar TJ, Wolfe LF, Willes L, McLain WC III, Goldberg R (2014) The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy. Sleep 37:927–934CrossRefPubMedPubMedCentralGoogle Scholar