- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- There are multiple types of normal and abnormal respiration. They include apnea, eupnea, orthopnea, dyspnea, hyperpnea, hyperventilation, hypoventilation, tachypnea, Kussmaul respiration, Cheyne-Stok...
There are multiple types of normal and abnormal respiration. They include apnea, eupnea, orthopnea, dyspnea, hyperpnea, hyperventilation, hypoventilation, tachypnea, Kussmaul respiration, Cheyne-Stokes respiration, sighing respiration, Biot respiration, apneustic breathing, central neurogenic hyperventilation, and central neurogenic hypoventilation. Each pattern is clinically important and useful in evaluating patients.
- Phenotyping of Sleep-Disordered Breathing in Patients With Chronic Heart Failure With Reduced Ejection Fraction-the SchlaHF Registry. [Journal Article]
- JAJ Am Heart Assoc 2017 Nov 29; 6(12)
- CONCLUSIONS: SchlaHF data show that there is wide interindividual variability in the SDB phenotype of HFrEF patients, suggesting that individualized management is appropriate.
- The lives and works of John Cheyne (1777-1836) and William Stokes (1804-1878). [Journal Article]
- JIJ Intensive Care Soc 2017; 18(4):323-325
- Cheyne-Stokes respiration - an abnormal pattern of breathing, oscillating between hyperventilation and apnoea - was first described in the 19th century by Dr John Cheyne and Dr William Stokes. Althou...
Cheyne-Stokes respiration - an abnormal pattern of breathing, oscillating between hyperventilation and apnoea - was first described in the 19th century by Dr John Cheyne and Dr William Stokes. Although primarily known for this condition, both men contributed a lot more to the understanding and practice of medicine than this eponym.
- Sleep Apnea and Cardiovascular Disease: Lessons From Recent Trials and Need for Team Science. [Review]
- CircCirculation 2017 Nov 07; 136(19):1840-1850
- Emerging research highlights the complex interrelationships between sleep-disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patien...
Emerging research highlights the complex interrelationships between sleep-disordered breathing and cardiovascular disease, presenting clinical and research opportunities as well as challenges. Patients presenting to cardiology clinics have a high prevalence of obstructive and central sleep apnea associated with Cheyne-Stokes respiration. Multiple mechanisms have been identified by which sleep disturbances adversely affect cardiovascular structure and function. Epidemiological research indicates that obstructive sleep apnea is associated with increases in the incidence and progression of coronary heart disease, heart failure, stroke, and atrial fibrillation. Central sleep apnea associated with Cheyne-Stokes respiration predicts incident heart failure and atrial fibrillation; among patients with heart failure, it strongly predicts mortality. Thus, a strong literature provides the mechanistic and empirical bases for considering obstructive sleep apnea and central sleep apnea associated with Cheyne-Stokes respiration as potentially modifiable risk factors for cardiovascular disease. Data from small trials provide evidence that treatment of obstructive sleep apnea with continuous positive airway pressure improves not only patient-reported outcomes such as sleepiness, quality of life, and mood but also intermediate cardiovascular end points such as blood pressure, cardiac ejection fraction, vascular parameters, and arrhythmias. However, data from large-scale randomized controlled trials do not currently support a role for positive pressure therapies for reducing cardiovascular mortality. The results of 2 recent large randomized controlled trials, published in 2015 and 2016, raise questions about the effectiveness of pressure therapies in reducing clinical end points, although 1 trial supported the beneficial effect of continuous positive airway pressure on quality of life, mood, and work absenteeism. This review provides a contextual framework for interpreting the results of recent studies, key clinical messages, and suggestions for future sleep and cardiovascular research, which include further consideration of individual risk factors, use of existing and new multimodality therapies that also address adherence, and implementation of trials that are sufficiently powered to target end points and to support subgroup analyses. These goals may best be addressed through strengthening collaboration among the cardiology, sleep medicine, and clinical trial communities.
- Microstructural cerebral lesions are associated with the severity of central sleep apnea with Cheyne-Stokes-respiration in heart failure and are modified by PAP-therapy. [Journal Article]
- RPRespir Physiol Neurobiol 2018; 247:181-187
- This study investigated the association of microstructural cerebral lesions with central sleep apnea with Cheyne-Stokes-respiration (CSA-CSR) in heart failure (HF) patients and the effect of positive...
This study investigated the association of microstructural cerebral lesions with central sleep apnea with Cheyne-Stokes-respiration (CSA-CSR) in heart failure (HF) patients and the effect of positive airway pressure therapy (PAP) of CSA-CSR on these lesions. PAP-therapy was initiated in patients with HF with midrange and with reduced ejection fraction (NYHA≥II; left ventricular ejection fraction <50%) and proven CSA-CSR. Cerebral magnetic resonance imaging (MRI) scans at 3T including diffusion tensor imaging were obtained before and after 4 months of PAP-therapy. Cerebral MRI scans revealed microstructural lesions in all 11 patients with HF with midrange or reduced ejection fraction and CSA-CSR (64±8years, 82% male, left ventricular ejection fraction 37±11%) that were focussed on the brainstem and frontal cerebral regions. This microstructural damage correlated with the severity of CSA-CSR and 4 months of PAP-therapy lead to voxel clusters of altered fiber integrity in these lesions. Microstructural cerebral lesions might contribute to the pathophysiology of CSA-CSR in HF. In these patients PAP-therapy induces neuronal plasticity.
- Distinct Patterns of Hyperpnea During Cheyne-Stokes Respiration: Implication for Cardiac Function in Patients With Heart Failure. [Journal Article]
- JCJ Clin Sleep Med 2017 Nov 15; 13(11):1235-1241
- CONCLUSIONS: Patients with HF and a negative CSR-CSA pattern have evidence of worse cardiac function than those with a positive pattern. Greater positive expiratory pressure during hyperpnea is likely generated during the negative pattern and might support stroke volume in patients with worse cardiac function.A commentary on this article appears in this issue on page 1227.
- Monitoring of nocturnal central sleep apnea in Heart failure patients using noncontact respiratory differences. [Journal Article]
- CPConf Proc IEEE Eng Med Biol Soc 2017; 2017:1534-1538
- Monitoring of respiration patterns allows the early detection of various breathing disorders and may better identify those at risk for adverse acute outcomes in a variety of clinical settings. In thi...
Monitoring of respiration patterns allows the early detection of various breathing disorders and may better identify those at risk for adverse acute outcomes in a variety of clinical settings. In this paper, we report on the use of SleepMinder (SM), a bedside non-contact Doppler-based biomotion recording sensor, to monitor remotely the nocturnal respiration patterns of 50 patients with systolic Heart failure (HF) while undergoing a lab based Polysomnography (PSG) test. A new respiration rate (RR) monitoring algorithm was developed based on the collected overnight radar signals. Two schemes of RR scoring were utilized: respiratory rate count (RRC) and instantaneous respiratory rates (IRR). Analysis of SM vs. PSG revealed that the mean/median IRR scored by SM is highly correlated with that scored on the nasal flow/effort signals from the corresponding PSG studies on all patients, with a significant correlation coefficient of 0.98 (average absolute difference of 0.31 breaths/min), and 0.97 (p<;0.01, average absolute difference of 0.38 breaths/min) for the median and mean of RR respectively. Our experimental results also show that the difference between the RR estimations from IRR and RRC schemes can be utilized to identify central sleep apnea (CSA)/Cheyne-Stokes respiration (CSR) sections without additional apnea detection modules. As a result, with a sensitivity and specificity of 71% and 88% respectively, and an accuracy of 86%, our CSA/CSR screener, plugged with our RR estimation, can play an important role in the remote management of HF patients.
- A novel method for the quantitative evaluation of diurnal respiratory instability in patients with heart failure: A pilot study. [Journal Article]
- JCJ Cardiol 2018; 71(2):159-167
- CONCLUSIONS: The RI index stratified functional severity of HF well, and was a significant independent predictor of poor outcomes.
- Characteristics of sleep-disordered breathing in patients with atrial fibrillation and preserved left ventricular ejection fraction. [Journal Article]
- CRClin Res Cardiol 2018; 107(2):120-129
- CONCLUSIONS: SDB was highly prevalent in this cohort of patients with Afib and PEF. The proportion of patients with moderate-to-severe OSA, for whom treatment is recommended by current guidelines, was about 15%. With 36% of patients presenting with moderate-to-severe mixed sleep apnea and almost 10% of patients having CSA, treatment guidelines for these types of SDB in the setting of Afib are needed.
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- Ambulatory Apnea Monitoring in Heart Failure: Proceed With Caution. [Editorial]
- JACCJ Am Coll Cardiol 2017 Sep 12; 70(11):1365-1367