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The influence of cardiac resynchronization therapy on subjective and objective parameters of sleep, and their association with the function of the autonomous nervous system.
Postepy Kardiol Interwencyjnej 2019; 15(3):357-363PK

Abstract

Introduction

Cardiac resynchronization therapy (CRT) was a breakthrough in the treatment of heart failure, but data regarding the effect of this therapy on numerous disorders associated with heart failure are limited.

Aim

To assess the impact of CRT on sleep breathing disorders, and to determine the relationship between the changes in the autonomous nervous system and sleep disorders after CRT.

Material and methods

The study included 55 patients with chronic heart failure stable for at least last 3 months, in New York Heart Association (NYHA) class III or IV despite optimal medical therapy, with a reduced left ventricular ejection fraction (LVEF) ≤ 35%, QRS complex duration ≥ 120 ms, and sinus rhythm. Before and 3 months after implementation of CRT echocardiography, 6-minute walk test (6MWT), polysomnography with the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth Sleepiness Scale (ESS) were performed. Also baroreflex sensitivity (BRS) was evaluated.

Results

After implementation of CRT, the values of the apnea-hypopnea index (AHI), apnea index (AI), and central and mixed apnea indexes (CAI, MAI) were statistically significantly reduced. The strongest negative correlations were demonstrated for changes in CAI and changes in BRS. An improvement in sleep quality, daytime sleepiness, LVEF, NYHA class, and 6MWT was observed and was the most strongly associated with the improvement in CAI, too.

Conclusions

CRT has a beneficial effect on subjective and objective features of sleep, as well as on the function of the autonomous nervous system. In addition, patients with heart failure and coexisting central sleep apnea may benefit most from this therapy.

Authors+Show Affiliations

1 Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland.1 Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31592167

Citation

Przybyła, Anna, and Danuta Czarnecka. "The Influence of Cardiac Resynchronization Therapy On Subjective and Objective Parameters of Sleep, and Their Association With the Function of the Autonomous Nervous System." Postepy W Kardiologii Interwencyjnej = Advances in Interventional Cardiology, vol. 15, no. 3, 2019, pp. 357-363.
Przybyła A, Czarnecka D. The influence of cardiac resynchronization therapy on subjective and objective parameters of sleep, and their association with the function of the autonomous nervous system. Postepy Kardiol Interwencyjnej. 2019;15(3):357-363.
Przybyła, A., & Czarnecka, D. (2019). The influence of cardiac resynchronization therapy on subjective and objective parameters of sleep, and their association with the function of the autonomous nervous system. Postepy W Kardiologii Interwencyjnej = Advances in Interventional Cardiology, 15(3), pp. 357-363. doi:10.5114/aic.2019.87892.
Przybyła A, Czarnecka D. The Influence of Cardiac Resynchronization Therapy On Subjective and Objective Parameters of Sleep, and Their Association With the Function of the Autonomous Nervous System. Postepy Kardiol Interwencyjnej. 2019;15(3):357-363. PubMed PMID: 31592167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The influence of cardiac resynchronization therapy on subjective and objective parameters of sleep, and their association with the function of the autonomous nervous system. AU - Przybyła,Anna, AU - Czarnecka,Danuta, Y1 - 2019/09/18/ PY - 2019/04/15/received PY - 2019/06/13/accepted PY - 2019/10/9/entrez PY - 2019/10/9/pubmed PY - 2019/10/9/medline KW - baroreflex KW - biventricular pacing KW - heart failure KW - sleep-disordered breathing SP - 357 EP - 363 JF - Postepy w kardiologii interwencyjnej = Advances in interventional cardiology JO - Postepy Kardiol Interwencyjnej VL - 15 IS - 3 N2 - Introduction: Cardiac resynchronization therapy (CRT) was a breakthrough in the treatment of heart failure, but data regarding the effect of this therapy on numerous disorders associated with heart failure are limited. Aim: To assess the impact of CRT on sleep breathing disorders, and to determine the relationship between the changes in the autonomous nervous system and sleep disorders after CRT. Material and methods: The study included 55 patients with chronic heart failure stable for at least last 3 months, in New York Heart Association (NYHA) class III or IV despite optimal medical therapy, with a reduced left ventricular ejection fraction (LVEF) ≤ 35%, QRS complex duration ≥ 120 ms, and sinus rhythm. Before and 3 months after implementation of CRT echocardiography, 6-minute walk test (6MWT), polysomnography with the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth Sleepiness Scale (ESS) were performed. Also baroreflex sensitivity (BRS) was evaluated. Results: After implementation of CRT, the values of the apnea-hypopnea index (AHI), apnea index (AI), and central and mixed apnea indexes (CAI, MAI) were statistically significantly reduced. The strongest negative correlations were demonstrated for changes in CAI and changes in BRS. An improvement in sleep quality, daytime sleepiness, LVEF, NYHA class, and 6MWT was observed and was the most strongly associated with the improvement in CAI, too. Conclusions: CRT has a beneficial effect on subjective and objective features of sleep, as well as on the function of the autonomous nervous system. In addition, patients with heart failure and coexisting central sleep apnea may benefit most from this therapy. SN - 1734-9338 UR - https://www.unboundmedicine.com/medline/citation/31592167/The_influence_of_cardiac_resynchronization_therapy_on_subjective_and_objective_parameters_of_sleep,_and_their_association_with_the_function_of_the_autonomous_nervous_system DB - PRIME DP - Unbound Medicine ER -
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