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Over the past decade, the diagnosis and management of obstructive sleep apnea has received considerable attention in sleep medicine. Its impact on daytime cognitive function and cardiovascular health is increasingly recognized, and its frequency in the adult population renders it the most common pathologic diagnosis in sleep laboratories. However, among cardiac patients with left ventricular dysfunction, Cheyne-Stokes respiration with Central Sleep Apnea (CSR-CSA) is more prevalent, and mounting evidence suggests that this diagnosis may have important implications for outcome and management of CHF. Although Central sleep apnea (CSA) may be idiopathic (rare), or secondary to CNS pathology (typically CVA), the most frequent association is chronic CHF.

Resources

Pembrey's Dream: The Time Has Come for a Long-term Trial of Nocturnal Supplemental Nasal Oxygen to Treat Central Sleep Apnea in Congestive Heart Failure
S. Javaheri
Chest, February 1, 2003; 123(2): 322 - 325.
[Full Text] [PDF]

Effect of Nasal Continuous Positive Airway Pressure Treatment on Blood Pressure in Patients With Obstructive Sleep Apnea
Heinrich F. Becker, Andreas Jerrentrup, Thomas Ploch, Ludger Grote, Thomas Penzel, Colin E. Sullivan, and J. Hermann Peter
Circulation, Jan 2003; 107: 68 - 73. [Abstract] [Full text] [PDF]  

Cheyne-Stokes Respiration and Congestive Heart Failure: Are Oxygen Stores the Critical Factor?
M. R. Littner and S. Han
Chest, January 1, 2003; 123(1): 7 - 9.
[Full Text] [PDF]

Apnea–Hypopnea Threshold for CO₂ in Patients with Congestive Heart Failure
Ailiang Xie, James B. Skatrud, Dominic S. Puleo, Peter S. Rahko, Jerome A. Dempsey
Am. J. Respir. Crit. Care Med. 2002 165: 1245-1250.
[Abstract] [Full Text] [PDF]

Sleep Apnea and Cardiovascular Disease
Richard S. T. Leung and T. Douglas Bradley
Am. J. Respir. Crit. Care Med. 2001 164: 2147-2165
[Full Text] | [PDF]

Risk Factors for Central and Obstructive Sleep Apnea in 450 Men And Women with Congestive Heart Failure
Don D. Sin, Fabia Fitzgerald, John D. Parker, Gary Newton,
John S. Floras, T. Douglas Bradley
Am. J. Respir. Crit. Care Med. 1999 160: 1101-1106.
[Abstract] [Full Text] [PDF]

Other Clinical Articles

1. Young T, Palta M, Dempsey J, et al: The occurrence of sleep disordered breathing among middle-age adults. N Engl J Med 328:1230-1235, 1993

2. Franklin KA, Nilsson JB, Sahlin C, Naslund U. Sleep apnea and nocturnal angina. Lancet 1995; 345:1085.

3. Javaheri S, Parker TJ, Wexler L, et al: Occult sleep-disordered breathing in stable congestive heart failure. Ann Intern Med 1995; 122:487

4. Hanly P, Zuberi, N, Gray R. Pathogenesis of Cheyne-Stokes respiration in patients with congestive heart failure. Relationship to arterial pCO2. Chest 1993; 104:1079.

5. Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure: Types and their prevalences, consequences, and presentations. Circulation 1998; 97:2154.

6. Tremel F, Pepin J, Veale D, et al. High prevalence and persistence of sleep apnoea in patients referred for acute left ventricular failure and medically treated over 2 months. Eur Heart J. 1999; 20:1201-1209.

7. Hanly P, Zuberi-Khokhar N. Daytime sleepiness in patients with congestive heart failure and Cheyne-Stokes respiration. Chest 1995; 107:952-58.

8. Hanly PJ, Zuberi-Khokhar NS: Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure. Am J Respir Crit Care Med 153:272-276, 1996

9. Lanfranchi, P, Braghirol, A, Bosimini, E, et al. Prognostic value of nocturnal Cheyne-Stokes respiration in congestive hear failure, Circulation 1999;99:1435-1440

10. The SOLVD Investigators: Effects of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure. N Engl J Med 325:293-302, 1991

11. Hanly P, Millar TW, Steljes DG, et al: The effect of oxygen on respiration and sleep in patients with congestive heart failure. Ann Intern Med 111:777-782, 1989

12. Franklin K, Eriksson P Sahlin, C, Lundgren R. Reversal of central sleep apnea with oxygen. Chest 1997; 111:163-169

13. Lorenzi-Filho G, Rankin F, Bies I, Bradley T. Effects of inhaled carbon dioxide and oxygen on Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med 1999;159:1490-1498.

14. Andreas, S, Clemens, C, Sandholzer H, Figulla H, Kreuzer H. Improvement of exercise capacity with treatment of Cheyne-Stokes respiration in patients with congestive heart failure. J Am Coll Cardiol 1996; 27:1486-90.

15. Javaheri S, Parker, TJ, Wexler MD, et al. Effect of theophylline on sleep-disordered breathing in heart failure. N Engl J Med 1996; 335:562

16. Granton J, Naughton M, Benard D. et al. CPAP improves inspiratory muscle strength in patients with hear failure and central sleep apnea. Am J Respir Crit Care Med 1996; 153:277-82.

17. Naughton M, Liu, P, Benard 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.

18. Takasaki, Y, Orr, D, Popkin, J, et al. Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure. Am Rev Respir Dis 1989; 140:1578

19. Naughton MT, Benard DC, Rutherford, R, Bradley TD. Effect of continuous positive airway pressure on central sleep apnea and nocturnal PCO2 in heart failure. Am J Respir Crit Care Med 1995; 151:92-97

20. Sin D Logan A, Fitzgerald F et al Effects of CPAP on Cardiovascular Outcomes in Congestive Heart Failure Patients with and without Cheyne-Stokes Respiration. Circulation 2000; 102;61-66

21. Cohn JN, Levine B, Olivari MT, et al: Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med 311:1984; 819-823

22. Kay DM, Lefkovits J, Jennings GL, et al: Adverse consequences of high sympathetic nervous activity in the failing human heart. J Am Coll Cardiol 26:1257-1263, 1995.

23. Van de Borne, P, Oren, R, Abouassaly, C, Anderson, E, Somers, VK. Effect of Cheyne-Stokes Respiration on Muscle Sympathetic Nerve Activity in Severe CHF Secondary to Ischemic or Idiopathic Dilated Cardiomyopathy. Am J Cardiol 1998; 81:432-436.

24. Waravdekar N, Sinoway,L, Zwillich C, Leuenberger UA. Influence of treatment on muscle sympathetic nerve activity in sleep apnea. Am J Respir Crit Care Med 1996; 153:1333-8.

25. 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 152:473-479, 1995.

26. Tkacova R, Liu PP, Naughton MT, Bradley TD. Effect of CPAP on Mitral Regurgitant Fraction and Atrial Natriuretic Peptide in Patients with Heart Failure. J Am Coll Cardiol 1997; 30:739-45.