Living With and Managing Sleep Apnea
JIM: I had this problem throughout my life. Driving was always a problem, and I tried to make sure that no place I ever had to go was very far away because I knew I'd fall asleep. Carol Lynn was complaining about snoring and, more specifically, snoring and then long periods of nothing,
and then a gasp when I would, you know, start breathing again. Obviously, I wanted to enjoy my life with my children more than I felt that I was enjoying it. It's Saturday morning, and the kids are at your bed ready to do something, and I'm just like, quot;I gotta sleep, guys. I'm sorry. I can't play with you. I can't do this.quot; And I look back and I'm like, quot;This just can't be right.quot;
I had been talking to my about possibly having depression symptoms. I remember the other thing that I said to the when I went was that I no longer had any dreams. If you're not getting into REM sleep, you have no dreams. And so she's the one who then said, quot;Okay, we're gonna send you for a sleep study.quot; I spent the night there.
The amount of times that I was technically waking, and as low as my blood oxygen levels were, it was extreme. I was diagnosed with severe obstructive sleep apnea. Surgery, as it turned out, really wasn't a good option for me. The next step was that my did prescribe a CPAP machine. CPAP stands for continuous positive airway pressure.
The idea is they have to get the air pressure to your nose or your mouth or both in order to keep your airway open while you sleep. Because it wasn't comfortable for me to use, I was not using it as well as I should have been, in some cases not at all for weeks at a time. And things got worse, other symptoms appeared. I felt confused and out of it and just not right.
And I realized that I really needed to figure out a way to learn to live with this contraption. Now I'm at the point where I am consistently using it and have been for a long period of time. I definitely feel better. I'm looking forward to feeling better yet. Certainly, I have more energy to do activities with the children than I did before, and we do more.
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