STUDY OBJECTIVES: At termination of obstructive apneas, arousal is a protective mechanism that facilitates restoration of upper airway patency and airflow. Treating obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) reduces arousal frequency indicating that such arousals are caused by OSA. In heart failure (HF) patients with central sleep apnea (CSA), however, arousals frequently occur several breaths after apnea termination, and there is uncertainty as to whether arousals from sleep are a consequence of CSA. If so, they should diminish in frequency when CSA is attenuated. We therefore sought to determine whether attenuation of CSA by CPAP reduces arousal frequency. DESIGN: Randomized controlled clinical trial. PATIENTS AND SETTING: We examined data from 205 HF patients with CSA (apnea-hypopnea index [AHI] > or =15, > 50% were central) randomized toCPAP or control who had polysomnograms performed at baseline and 3 months later. MEASUREMENTS AND RESULTS: In the control group, there was no change in AHI or frequency of arousals. In the CPAP-treated group, the AHI decreased significantly (from [mean +/- SD] 38.9 +/- 15.0 to 17.6 +/- 16.3, P < 0.001) but neither the frequency of arousals nor sleep structure changed significantly. CONCLUSION: These data suggest that attenuation of CSA by CPAP does not reduce arousal frequency in HF patients. We conclude that arousals were not mainly a consequence of CSA, and may not have been acting as a defense mechanism to terminate apneas in the same way they do in OSA.
RCT Entities:
STUDY OBJECTIVES: At termination of obstructive apneas, arousal is a protective mechanism that facilitates restoration of upper airway patency and airflow. Treating obstructive sleep apnea (OSA) by continuous positive airway pressure (CPAP) reduces arousal frequency indicating that such arousals are caused by OSA. In heart failure (HF) patients with central sleep apnea (CSA), however, arousals frequently occur several breaths after apnea termination, and there is uncertainty as to whether arousals from sleep are a consequence of CSA. If so, they should diminish in frequency when CSA is attenuated. We therefore sought to determine whether attenuation of CSA by CPAP reduces arousal frequency. DESIGN: Randomized controlled clinical trial. PATIENTS AND SETTING: We examined data from 205 HF patients with CSA (apnea-hypopnea index [AHI] > or =15, > 50% were central) randomized to CPAP or control who had polysomnograms performed at baseline and 3 months later. MEASUREMENTS AND RESULTS: In the control group, there was no change in AHI or frequency of arousals. In the CPAP-treated group, the AHI decreased significantly (from [mean +/- SD] 38.9 +/- 15.0 to 17.6 +/- 16.3, P < 0.001) but neither the frequency of arousals nor sleep structure changed significantly. CONCLUSION: These data suggest that attenuation of CSA by CPAP does not reduce arousal frequency in HF patients. We conclude that arousals were not mainly a consequence of CSA, and may not have been acting as a defense mechanism to terminate apneas in the same way they do in OSA.
Authors: Yasuyuki Kaneko; John S Floras; Kengo Usui; Julie Plante; Ruzena Tkacova; Toshihiko Kubo; Shin-ichi Ando; T Douglas Bradley Journal: N Engl J Med Date: 2003-03-27 Impact factor: 91.245
Authors: Don D Sin; Fabia Fitzgerald; John D Parker; Gary E Newton; Alexander G Logan; John S Floras; T Douglas Bradley Journal: Chest Date: 2003-05 Impact factor: 9.410
Authors: Darren R Mansfield; Peter Solin; Teanau Roebuck; Peter Bergin; David M Kaye; Matthew T Naughton Journal: Chest Date: 2003-11 Impact factor: 9.410
Authors: R Nisha Aurora; Susmita Chowdhuri; Kannan Ramar; Sabin R Bista; Kenneth R Casey; Carin I Lamm; David A Kristo; Jorge M Mallea; James A Rowley; Rochelle S Zak; Sharon L Tracy Journal: Sleep Date: 2012-01-01 Impact factor: 5.849
Authors: Katharina Heider; Michael Arzt; Christoph Lerzer; Leonie Kolb; Michael Pfeifer; Lars S Maier; Florian Gfüllner; Maximilian Valentin Malfertheiner Journal: Clin Res Cardiol Date: 2018-01-25 Impact factor: 5.460
Authors: Andrea Hetzenecker; Tatjana Roth; Christoph Birner; Lars S Maier; Michael Pfeifer; Michael Arzt Journal: Clin Res Cardiol Date: 2015-09-05 Impact factor: 5.460