Obstructive Sleep Apnea versus Central Sleep Apnea
Obstructive sleep apnea is when the airwaybecomes narrowed or obstructed and you're making the effort to breathe but we do notsee any flow in air movement coming from your nose or mouth. Where central sleep apnea occurswhere your brain forgets to tell your body to breathe. If we're looking at it from avery simplistic term and so we do not see the drive to breathe. So the first step isto come into the and be seen by one of our physicians in the sleep medicine .We'll go through a questionnaire and try to determine what risk factors we think you havefor sleep apnea such as obesity, snoring, daytime sleepiness and then if we think thatyou have a high risk for meeting those criteria
then we would set you up for a sleep studyeither in your home to do an overnight sleep study or in our laboratory, depending on yoursituation. The CPAP can be used to treat both conditions and, in some patients, that isenough. However, there are some patients that have more complex types of central sleep apneathat require more complicated types of machines to treat that condition. Obstructive sleepapnea actually has been linked to a lot of other problems such as high blood pressureand then, you know, difficulty functioning during the day. If it goes untreated for along period of time there's an increased risk of early heart problems and those types ofthings.
ESC TV 2015 Congress by Topic Heart Failure
The study is called SchlaHF XT, which means sleep and heart failure We were able to rule out sleep apnea in only 25 % of the patients so that is meaning that 75 % of the patients will have sleeplessness or breathing of one or other type or severity and about half of them are, let us sayroughly 45 %, will present with moderate to severe obstructive or central sleep apnea we see that with including now HFPAF patients into the registry, we see much more obstructive sleep apnea compared tocentral sleep apnea before sleep breathing disorder is very prevalent in heart failure either HFRAFand HFPAF
it is, all the data out say that it has a prognostic impact, you can treat it and I think my key messages is, screen your patients for prevalence of sleep disorder breathing and look for data out there iftreatment changes anything in prognostic prognosis of them or quality of life, and we have to clearly differentiate I think at that point, from obstructive andcentral sleep apnea In SERVEHF, 1 325 systolic heart failure patients presenting with central sleep apnea were randomised to receive either adaptive servoventilation or medicalmanagement alone, median followup was 31 months
We found actually there was no difference in outcome at all and surprisingly, which has taken both respiratory physicians and cardiologists completely by surprise we found an increase inmortality, and if you look at cardiovascular mortality it was up 34 %,so not only does it not make any difference to the patients with systolicheart failure but it actually increases the risk of them dying, so this is a realgamechanger trial, really important All of the available patients who wererandomised in trials, we put those patients together from individual patient dataand so we were able to do something that
has not been done before which is to lookat age as a continuous variable and look at the benefits of betablockerscompared to placebo across all ages and gender and what we found was that patients who were older got exactly the same benefit from beta blockers as youngerpatients, if they were in sinus rhythm with an absolute risk reduction ofaround 4 % whether you are 50 or whether you are 75, looking at the results for gender, women had less mortality as you would expect but actually again they got exactly the same benefit that men got from beta blockers, so this suggestsvery importantly that the practice that
seems to be out there that women andolder patients get less beta blockers is something that we should not do, andreinforces the need for all of these patients to get guidelines' recommendedtreatments The ESC heart failure longterm registry is a general registry under the European observational research programme of the ESC, and the aim is to know theepidemiology and management of adult patients with heart failure in ESC countries orMediterranean countries
this registry has started in 2011, so far we have enrolled more than 24 000 patients from 31 ESC countries and 320 active centres participating, according to KaplanMeier survival curves the mortality at one year is 23.6 % for acute heart failure patients and around 6 % for chronic heart failure patients mortality for acute heart failure is still high while mortality for chronic heart failure is lower and this might reflect that there have been no new therapies in the last years for the
You have sleep apneawhat now
Typically what we will do after you're diagnosedwith sleep apnea is we'll bring you back for a titration study. And basically what thatdoes is those are done in the lab and our technicians or respiratory therapists willactually measure you to determine what size of mask that you need and what type of maskthat you are most comfortable with because there are multiple types. There's a type thatcovers the nose and the mouth and a and a type that covers just the nose. And withinthe types that cover the nose, there's ones that sits over the nose like a dome as wellas ones that go up in the nose almost like thick oxygen prongs. And so typically whenwe bring you back for your titration we determine
which feels most comfortable to you and thenwhat we do is we start with a low airway pressure through the machine and we continue to monitoryou to see if you have sleep apnea. If you're demonstrating sleep apnea through your studythen we continue to increase your pressure until we see those events go away and that'stypically then around the pressure that we'll prescribe for you to start using at home.But even after that you need to have regular followups with your sleep physician becauseadjustments are typically needed to optimize things. This is because sometimes people sleepa little bit differently at home then they do in the laboratory. It really depends onthe severity, in my experience, of their sleep
apnea. Typically what I see is the more severesomebody's sleep apnea, the more they notice a difference more quickly. And I've had patientsthat have said they've slept the best night of their life that they've slept in the lasttwenty years after just one night of using their CPAP. But as we know, sleep deprivationis not something that goes away overnight. And so if somebody has had significant sleepapnea and been sleep deprived from it for years, typically it can take weeks to monthsuntil somebody really starts feeling their optimum. It's important that if you're diagnosedwith obstructive sleep apnea or central sleep apnea that you do get treated because we knowthat patients that go for a long period of
time years to decades without being treateddo have an increased risk of early strokes, heart disease, those types of things. There'salso now been shown some linkages to difficulty in controlling things like blood sugar, yourblood pressure and those types of things in patients that have significant sleep apneaand aren't being treated.