Heart failure (HF) is known to be associated with sleep-disordered breathing(SDB). In addition to disturbing patients’ sleep, SDB is also associated with a deterioration in the cardiac function and an increased morta...Heart failure (HF) is known to be associated with sleep-disordered breathing(SDB). In addition to disturbing patients’ sleep, SDB is also associated with a deterioration in the cardiac function and an increased mortality and morbidity.Central sleep apnea (CSA), typically characterized by Cheyne-Stokes breathing(CSB), is increasingly found in patients with HF compared to the general population. An important pathogenetic factor of CSA seen in HF patients is an instability in the control of the respiratory system, characterized by both hypocapnia and increased chemosensitivity. Sympathetic overactivation,pulmonary congestion and increased chemosensitivity associated with HF stimulate the pulmonary vagal irritant receptor, resulting in chronic hyperventilation and hypocapnia. Additionally, the repetitive apnea and arousal cycles induce cyclic sympathetic activation, which may worsen the cardiac prognosis. Correcting CSB may improve both patient’s quality of life and HF syndrome itself. However, a treatment for HF in patients also experiencing CSA is yet to be found. In fact, conflicting results from numerous clinical studies investigating sleep apnea with HF guide to a troubling question, that is whether(or not) sleep apnea should be treated in patients with HF? This editorial attempts to both collect the current evidence about randomized control trials investigating CSA in patients with HF and highlight the effect of specific CSA treatments on cardiovascular endpoints.展开更多
Treatment-emergent central sleep apnea(TECSA)is a specific form of sleep-disordered breathing,characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea.The purpose of...Treatment-emergent central sleep apnea(TECSA)is a specific form of sleep-disordered breathing,characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea.The purpose of this review was to summarize the definition,epidemiology,potential mechanisms,clinical characteristics,and treatment of TECSA.We searched for relevant articles up to January 31,2020,in the PubMed database.The prevalence of TECSA varied widely in different studies.The potential mechanisms leading to TECSA included ventilatory control instability,low arousal threshold,activation of lung stretch receptors,and prolonged circulation time.TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure(CPAP).However,central apneas persist even with the regular CPAP therapy in some patients,and new treatment approaches such as adaptive servo-ventilation may be necessary.We concluded that several questions regarding TECSA remain,despite the findings of many studies,and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities.Further,it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.展开更多
To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 con...To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index(AHI)and oxygen desaturation index(ODI). The average AHI and ODI were significantly higher in CRVO patients(AHI:13.86±8.63, ODI: 9.21±4.47) than in control subjects(AHI:8.51±6.36, ODI: 5.87±3.18;P=0.008 and 0.001 respectively).Additionally, the AHI was positively correlated with body mass index(BMI;r=0.476, P=0.017) and ODI(r=0.921,P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two(73.33%) CRVO patients had OSA and 12(40.00%) control subjects had OSA, a difference that was statistically significant(P=0.019). OSA may be a risk factor for or a trigger of CRVO development.展开更多
文摘Heart failure (HF) is known to be associated with sleep-disordered breathing(SDB). In addition to disturbing patients’ sleep, SDB is also associated with a deterioration in the cardiac function and an increased mortality and morbidity.Central sleep apnea (CSA), typically characterized by Cheyne-Stokes breathing(CSB), is increasingly found in patients with HF compared to the general population. An important pathogenetic factor of CSA seen in HF patients is an instability in the control of the respiratory system, characterized by both hypocapnia and increased chemosensitivity. Sympathetic overactivation,pulmonary congestion and increased chemosensitivity associated with HF stimulate the pulmonary vagal irritant receptor, resulting in chronic hyperventilation and hypocapnia. Additionally, the repetitive apnea and arousal cycles induce cyclic sympathetic activation, which may worsen the cardiac prognosis. Correcting CSB may improve both patient’s quality of life and HF syndrome itself. However, a treatment for HF in patients also experiencing CSA is yet to be found. In fact, conflicting results from numerous clinical studies investigating sleep apnea with HF guide to a troubling question, that is whether(or not) sleep apnea should be treated in patients with HF? This editorial attempts to both collect the current evidence about randomized control trials investigating CSA in patients with HF and highlight the effect of specific CSA treatments on cardiovascular endpoints.
基金This work was supported by grants from the National Natural Science Foundation of China(No.81670084,No.81600067,and No.81970084)。
文摘Treatment-emergent central sleep apnea(TECSA)is a specific form of sleep-disordered breathing,characterized by the emergence or persistence of central apneas during treatment for obstructive sleep apnea.The purpose of this review was to summarize the definition,epidemiology,potential mechanisms,clinical characteristics,and treatment of TECSA.We searched for relevant articles up to January 31,2020,in the PubMed database.The prevalence of TECSA varied widely in different studies.The potential mechanisms leading to TECSA included ventilatory control instability,low arousal threshold,activation of lung stretch receptors,and prolonged circulation time.TECSA may be a self-limited disorder in some patients and could be resolved spontaneously over time with ongoing treatment of continuous positive airway pressure(CPAP).However,central apneas persist even with the regular CPAP therapy in some patients,and new treatment approaches such as adaptive servo-ventilation may be necessary.We concluded that several questions regarding TECSA remain,despite the findings of many studies,and it is necessary to carry out large surveys with basic scientific design and clinical trials for TECSA to clarify these irregularities.Further,it will be vital to evaluate the baseline demographic and polysomnographic data of TECSA patients more carefully and comprehensively.
基金Supported by Planned Science and Technology Project of Xi’an City, China [No.2017116SF/YX010(9)]
文摘To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index(AHI)and oxygen desaturation index(ODI). The average AHI and ODI were significantly higher in CRVO patients(AHI:13.86±8.63, ODI: 9.21±4.47) than in control subjects(AHI:8.51±6.36, ODI: 5.87±3.18;P=0.008 and 0.001 respectively).Additionally, the AHI was positively correlated with body mass index(BMI;r=0.476, P=0.017) and ODI(r=0.921,P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two(73.33%) CRVO patients had OSA and 12(40.00%) control subjects had OSA, a difference that was statistically significant(P=0.019). OSA may be a risk factor for or a trigger of CRVO development.