Schlafbezogene Atmungsstörungen bei Patienten mit Herzinsuffizienz: Epiphänomen oder wechselseitige Krankheitsbeeinflussung

J. Zeller; A. Hetzenecker; M. Arzt

doi:10.1055/s-0032-1326221

Pneumologie, Table of Contents

Pneumologie 2013; 67(03): 150-156
DOI: 10.1055/s-0032-1326221

Serie: Schlafmedizin

Schlafbezogene Atmungsstörungen bei Patienten mit Herzinsuffizienz: Epiphänomen oder wechselseitige Krankheitsbeeinflussung

Sleep-Disordered Breathing in Patients with Chronic Heart Failure: Epiphenomenon or Bidirectional Relationship

Authors

J. Zeller

Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg (Direktor der Klinik: Prof. Dr. med. G. A. J. Riegger)
A. Hetzenecker

Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg (Direktor der Klinik: Prof. Dr. med. G. A. J. Riegger)
M. Arzt

Schlafmedizinisches Zentrum, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg (Direktor der Klinik: Prof. Dr. med. G. A. J. Riegger)

Subject Editor: A. Valipour, Wien; J. Ficker, Nürnberg

Abstract

Zusammenfassung

Schlafbezogene Atmungsstörungen (SBAS) stellen mit einer Prävalenz von ca. 45 % eine sehr häufige Komorbidität der Herzinsuffizienz (HI) dar. Die beiden Erkrankungen sind wechselseitig voneinander abhängig: Einerseits kann die obstruktive Schlafapnoe zur Entstehung einer HI beitragen. Die Apnoe-assoziierte Erhöhung der kardialen Nachlast, die Entwicklung einer arteriellen Hypertonie und negative intrathorakale Drücke können zu einer Myokardhypertrophie und somit zu einer HI führen. Außerdem erhöht die Schlafapnoe das Herzinfarktrisiko und begünstigt die Entstehung einer HI nach Herzinfarkt. Anderseits kann die HI zur Entstehung sowohl der zentralen als auch der obstruktiven Schlafapnoe beitragen. Die optimale Behandlung einer bestehenden HI ist daher ein wichtiger Teil der Therapie einer SBAS. Die Therapie einer SBAS mittels positivem Atemwegsdruck reduziert effektiv Apnoen und Hypopnoen, verbessert den Schlaf und kann sich positiv auf das Befinden, die Lebensqualität und die Herzfunktion der Betroffenen auswirken. Die hohe Koinzidenz der SBAS und der HI rechtfertigt daher eine schlafmedizinische Diagnostik und Evaluation der Therapieindikation der SBAS in einem spezialisierten Zentrum.

Abstract

Sleep-disordered breathing (SDB) constitutes a highly prevalent comorbidity in patients with chronic heart failure (HF, approximately 45 %). Both diseases are related in a bidirectional way: Obstructive sleep apnoea (OSA) can contribute to the development of HF via multiple mechanisms. Apnoea-related acute rise of cardiac afterload as well as manifest hypertension may contribute to the development of myocardial hypertrophy and thus HF. In addition, OSA increases the risk for myocardial infarction and impaired recovery of cardiac function after the event. Impaired cardiac function itself may contribute to the development of obstructive and central sleep apnoea (SA). Therefore, optimal medical management of HF is part of the therapy of SDB in such patients. Treatment of SDB with different modes of positive airway pressure suppresses apnoeas and hypopnoeas, improves sleep and may improve related symptoms and cardiac function of affected patients. Considering the high coincidence of SDB and HF, the adequate diagnosis of SDB and evaluation of indication for therapy of SDB performed in a specialised centre is advised.

Full Text

References

Literatur
1 Tkacova R, Rankin F, Fitzgerald FS et al. Effects of continuous positive airway pressure on obstructive sleep apnea and left ventricular afterload in patients with heart failure. Circulation 1998; 98: 2269-2275
2 Malone S, Liu PP, Holloway R et al. Obstructive sleep apnoea in patients with dilated cardiomyopathy: effects of continuous positive airway pressure. Lancet 1991; 338: 1480-1484
3 Verdecchia P, Schillaci G, Guerrieri M et al. Circadian blood pressure changes and left ventricular hypertrophy in essential hypertension. Circulation 1990; 81: 528-536
4 Sega R, Facchetti R, Bombelli M et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 2005; 111: 1777-1783
5 Suzuki M, Guilleminault C, Otsuka K et al. Blood pressure „dipping“ and „non-dipping“ in obstructive sleep apnea syndrome patients. Sleep 1996; 19: 382-387
6 Calhoun DA, Jones D, Textor S et al. Resistant hypertension: diagnosis, evaluation, and treatment: a scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Circulation 2008; 117: e510-526
7 Peppard PE, Young T, Palta M et al. Prospective Study of the Association between Sleep-Disordered Breathing and Hypertension. N Engl J Med 2000; 342: 1378-1384
8 Pepperell JCT, Ramdassingh-Dow S, Crosthwaite N et al. Ambulatory blood pressure after therapeutic and subtherapeutic nasal continuous positive airway pressure for obstructive sleep apnoea: a randomised parallel trial. Lancet 2002; 359: 204-210
9 Becker HF, Jerrentrup A, Ploch T et al. Effect of nasal continuous positive airway pressure treatment on blood pressure in patients with obstructive sleep apnea. Circulation 2003; 107: 68-73
10 Shivalkar B, van de Heyning C, Kerremans M et al. Obstructive sleep apnea syndrome: more insights on structural and functional cardiac alterations, and the effects of treatment with continuous positive airway pressure. J Am Coll Cardiol 2006; 47: 1433-1439
11 Ip MSM, Tse H, Lam B et al. Endothelial function in obstructive sleep apnea and response to treatment. Am J Respir Crit Care Med 2004; 169: 348-353
12 Minoguchi K, Yokoe T, Tazaki T et al. Increased carotid intima-media thickness and serum inflammatory markers in obstructive sleep apnea. Am J Respir Crit Care Med 2005; 172: 625-630
13 Drager LF, Bortolotto LA, Lorenzi MC et al. Early signs of atherosclerosis in obstructive sleep apnea. Am J Respir Crit Care Med 2005; 172: 613-618
14 Marin JM, Carrizo SJ, Vicente E et al. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005; 365: 1046-1053
15 Ross R. Atherosclerosis -- an inflammatory disease. N Engl J Med 1999; 340: 115-126
16 Shimokawa H. Primary endothelial dysfunction: atherosclerosis. J Mol Cell Cardiol 1999; 31: 23-37
17 Schulz R, Seeger W, Fegbeutel C et al. Changes in extracranial arteries in obstructive sleep apnoea. Eur Respir J 2005; 25: 69-74
18 Kuniyoshi FHS, Garcia-Touchard A, Gami AS et al. Day-night variation of acute myocardial infarction in obstructive sleep apnea. J Am Coll Cardiol 2008; 52: 343-346
19 Barbé F, Durán-Cantolla J, Sánchez-de-la-Torre M et al. Effect of continuous positive airway pressure on the incidence of hypertension and cardiovascular events in nonsleepy patients with obstructive sleep apnea: a randomized controlled trial. JAMA 2012; 307: 2161-2168
20 McKee PA, Castelli WP, McNamara PM et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med 1971; 285: 1441-1446
21 Hetzenecker A, Buchner S, Greimel T et al. Cardiac workload in patients with sleep-disordered breathing early after acute myocardial infarction. Chest 2012; epub ahead of print
22 Nakashima H, Katayama T, Takagi C et al. Obstructive sleep apnoea inhibits the recovery of left ventricular function in patients with acute myocardial infarction. Eur Heart J 2006; 27: 2317-2322
23 Yoshinaga K, Burwash IG, Leech JA et al. The effects of continuous positive airway pressure on myocardial energetics in patients with heart failure and obstructive sleep apnea. J Am Coll Cardiol 2007; 49: 450-458
24 Gottlieb DJ, Yenokyan G, Newman AB et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation 2010; 122: 352-360
25 Lorenzi-Filho G, Azevedo ER, Parker JD et al. Relationship of carbon dioxide tension in arterial blood to pulmonary wedge pressure in heart failure. Eur Respir J 2002; 19: 37-40
26 Solin P, Bergin P, Richardson M et al. Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation 1999; 99: 1574-1579
27 Arzt M, Harth M, Luchner A et al. Enhanced ventilatory response to exercise in patients with chronic heart failure and central sleep apnea. Circulation 2003; 107: 1998-2003
28 Tkacova R, Hall MJ, Liu PP et al. Left ventricular volume in patients with heart failure and Cheyne-Stokes respiration during sleep. Am J Respir Crit Care Med 1997; 156: 1549-1555
29 Naughton M, Benard D, Tam A et al. Role of hyperventilation in the pathogenesis of central sleep apneas in patients with congestive heart failure. Am Rev Respir Dis 1993; 148: 330-338
30 Leung RST, Floras JS, Lorenzi-Filho G et al. Influence of Cheyne-Stokes respiration on cardiovascular oscillations in heart failure. Am J Respir Crit Care Med 2003; 167: 1534-1539
31 Arzt M, Young T, Finn L et al. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Arch Intern Med 2006; 166: 1716-1722
32 Redolfi S, Yumino D, Ruttanaumpawan P et al. Relationship between overnight rostral fluid shift and Obstructive Sleep Apnea in nonobese men. Am J Respir Crit Care Med 2009; 179: 241-246
33 Yumino D, Redolfi S, Ruttanaumpawan P et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation 2010; 121: 1598-1605
34 Dark DS, Pingleton SK, Kerby GR et al. Breathing pattern abnormalities and arterial oxygen desaturation during sleep in the congestive heart failure syndrome. Improvement following medical therapy. Chest 1987; 91: 833-836
35 Walsh JT, Andrews R, Starling R et al. Effects of captopril and oxygen on sleep apnoea in patients with mild to moderate congestive cardiac failure. Br Heart J 1995; 73: 237-241
36 Kato I, Shiomi T, Sasanabe R et al. Effects of physiological cardiac pacing on sleep-disordered breathing in patients with chronic bradydysrhythmias. Psychiatry Clin Neurosci 2001; 55: 257-258
37 Gabor JY, Newman DA, Barnard-Roberts V et al. Improvement in Cheyne-Stokes respiration following cardiac resynchronisation therapy. Eur Respir J 2005; 26: 95-100
38 Sinha A, Skobel EC, Breithardt O et al. Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure. J Am Coll Cardiol 2004; 44: 68-71
39 Garrigue S, Bordier P, Jais P et al. Benefit of atrial pacing in sleep apnea syndrome. N Engl J Med 2002; 346: 404-412
40 Buchner S, Greimel T, Hetzenecker A et al. Natural course of sleep-disordered breathing after acute myocardial infarction. Eur Respir J 2012; 40: 1173-1179
41 Mansfield DR, Solin P, Roebuck T et al. The effect of successful heart transplant treatment of heart failure on central sleep apnea. Chest 2003; 124: 1675-1681
42 Javaheri S, Abraham WT, Brown C et al. Prevalence of obstructive sleep apnoea and periodic limb movement in 45 subjects with heart transplantation. Eur Heart J 2004; 25: 260-266
43 Yumino D, Wang H, Floras JS et al. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. J Card Fail 2009; 15: 279-285
44 Wang H, Parker JD, Newton GE et al. Influence of Obstructive Sleep Apnea on Mortality in Patients With Heart Failure. Journal of the American College of Cardiology 2007; 49: 1625-1631
45 Javaheri S, Shukla R, Zeigler H et al. Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol 2007; 49: 2028-2034
46 Lanfranchi PA, Braghiroli A, Bosimini E et al. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. Circulation 1999; 99: 1435-1440
47 Corra U, Pistono M, Mezzani A et al. Sleep and exertional periodic breathing in chronic heart failure: prognostic importance and interdependence. Circulation 2006; 113: 44-50
48 Bakker JP, Campbell AJ, Neill AM. Increased mortality risk in congestive heart failure patients with comorbid sleep apnoea: 10-year follow up. Intern Med J 2012; 42: 1264-1268
49 Damy T, Margarit L, Noroc A et al. Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure. Eur J Heart Fail 2012; 14: 1009-1019
50 Bitter T, Westerheide N, Prinz C et al. 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 2011; 32: 61-74
51 Jilek C, Krenn M, Sebah D et al. Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study. Eur J Heart Fail 2011; 13: 68-75
52 Light RW, George RB. Serial pulmonary function in patients with acute heart failure. Arch Intern Med 1983; 143: 429-433
53 Hosenpud JD, Stibolt TA, Atwal K et al. Abnormal pulmonary function specifically related to congestive heart failure: comparison of patients before and after cardiac transplantation. Am J Med 1990; 88: 493-496
54 Naum CC, Sciurba FC, Rogers RM. Pulmonary function abnormalities in chronic severe cardiomyopathy preceding cardiac transplantation. Am Rev Respir Dis 1992; 145: 1334-1338
55 Naughton MT, Benard DC, Liu PP et al. Effects of nasal CPAP on sympathetic activity in patients with heart failure and central sleep apnea. Am J Respir Crit Care Med 1995; 152: 473-479
56 Krachman SL, Crocetti J, Berger TJ et al. Effects of nasal continuous positive airway pressure on oxygen body stores in patients with Cheyne-Stokes respiration and congestive heart failure. Chest 2003; 123: 59-66
57 Naughton MT, Rahman MA, Hara K et al. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 1995; 91: 1725-1731
58 Usui K, Bradley TD, Spaak J et al. Inhibition of awake sympathetic nerve activity of heart failure patients with obstructive sleep apnea by nocturnal continuous positive airway pressure. J Am Coll Cardiol 2005; 45: 2008-2011
59 Kaneko Y, Floras JS, Usui K et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med 2003; 348: 1233-1241
60 Ryan CM, Usui K, Floras JS et al. Effect of continuous positive airway pressure on ventricular ectopy in heart failure patients with obstructive sleep apnoea. Thorax 2005; 60: 781-785
61 Ruttanaumpawan P, Gilman MP, Usui K et al. Sustained effect of continuous positive airway pressure on baroreflex sensitivity in congestive heart failure patients with obstructive sleep apnea. J Hypertens 2008; 26: 1163-1168
62 Gilman MP, Floras JS, Usui K et al. Continuous positive airway pressure increases heart rate variability in heart failure patients with obstructive sleep apnoea. Clin Sci 2008; 114: 243-249
63 Sin DD, Logan AG, Fitzgerald FS et al. Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. Circulation 2000; 102: 61-66
64 Arzt M, Schulz M, Wensel R et al. Nocturnal continuous positive airway pressure improves ventilatory efficiency during exercise in patients with chronic heart failure. Chest 2005; 127: 794-802
65 Naughton MT, Liu PP, Bernard DC et al. Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure. Am J Respir Crit Care Med 1995; 151: 92-97
66 Tkacova R, Liu PP, Naughton MT et al. Effect of continuous positive airway pressure on mitral regurgitant fraction and atrial natriuretic peptide in patients with heart failure. J Am Coll Cardiol 1997; 30: 739-745
67 Bradley TD, Logan AG, Kimoff RJ et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med 2005; 353: 2025-2033
68 Arzt M, Floras JS, Logan AG et al. Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure Trial (CANPAP). Circulation 2007; 115: 3173-3180
69 Aurora RN, Chowdhuri S, Ramar K et al. The treatment of central sleep apnea syndromes in adults: practice parameters with an evidence-based literature review and meta-analyses. Sleep 2012; 35: 17-40
70 Sharma BK, Bakker JP, McSharry DG et al. Adaptive servo-ventilation for treatment of sleep-disordered breathing in heart failure: A systematic review and meta-analysis. Chest 2012; 142: 1211-1221
71 Kasai T, Floras JS, Bradley TD. Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation 2012; 126: 1495-1510
72 Arzt M, Schroll S, Series F et al. Auto-servo ventilation in heart failure with sleep apnea – a randomized controlled trial. Eur Respir J 2012; epub ahead of print
73 Pepperell JC. Sleep apnoea syndromes and the cardiovascular system. Clin Med 2011; 11: 275-278
74 Randerath WJ, Nothofer G, Priegnitz C et al. Long-term auto-servoventilation or constant positive pressure in heart failure and coexisting central with obstructive sleep apnea. Chest 2012; 142: 440-447