The reduction of central sleep apnoea severity in the left lateral position is not due to an improvement in cardiac haemodynamics in patients with chronic heart failure

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Abstract

Objective The severity of central sleep apnoea (CSA), a common comorbidity in patients with chronic heart failure (CHF) and reduced ejection fraction, markedly decreases from the supine to the lateral sleeping position, with no difference between the left and right positions. The mechanisms responsible for this beneficial effect have not yet been elucidated. Methods We tested the hypothesis that CSA attenuation in the left lateral position is due, at least in part, to an improvement in cardiac haemodynamics. Sixteen CHF patients (male, aged 60 ± 7 years, New York Heart Association class 2.6 ± 0.5, left ventricular ejection fraction [LVEF] 30% ± 5%) with moderate-to-severe CSA underwent two consecutive tissue Doppler echocardiography examinations in random order, one in the left lateral position (90°) and the other in the supine position (0°). The following parameters were obtained: left ventricular end-diastolic volume (LVEDV) and LVEF, left atrial volume (LAV) and right atrial volume (RAV), mitral regurgitation (MR), cardiac output (CO), transmitral protodiastolic (E) wave deceleration time (DT), E/e′ ratio, tricuspid annular plane systolic excursion (TAPSE), and right ventricular−atrial gradient (RVAG). Results The LAV, MR, E/e′, RAV, and RVAG significantly increased, whereas the LVEF and TAPSE significantly decreased in the left lateral position. All changes, however, were of negligible clinical significance. No significant changes were observed in CO, DT, and LVEDV. Conclusions This study shows that the reduction of CSA severity from the supine to the left lateral position in patients with CHF is not due to an improvement in cardiac haemodynamics. Other, noncardiac factors are likely to represent the main cause.

Original languageEnglish
Pages (from-to)30-32
Number of pages3
JournalSleep Medicine
Volume34
DOIs
Publication statusPublished - Jun 1 2017

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Central Sleep Apnea
Stroke Volume
Inpatients
Heart Failure
Hemodynamics
Deceleration
Mitral Valve Insufficiency
Cardiac Output
Doppler Echocardiography
Supine Position
Comorbidity

Keywords

  • Central sleep apnoea
  • Echocardiography
  • Haemodynamics
  • Left lateral sleeping position

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{d9c59aaf4d5b401b830a88193362eee4,
title = "The reduction of central sleep apnoea severity in the left lateral position is not due to an improvement in cardiac haemodynamics in patients with chronic heart failure",
abstract = "Objective The severity of central sleep apnoea (CSA), a common comorbidity in patients with chronic heart failure (CHF) and reduced ejection fraction, markedly decreases from the supine to the lateral sleeping position, with no difference between the left and right positions. The mechanisms responsible for this beneficial effect have not yet been elucidated. Methods We tested the hypothesis that CSA attenuation in the left lateral position is due, at least in part, to an improvement in cardiac haemodynamics. Sixteen CHF patients (male, aged 60 ± 7 years, New York Heart Association class 2.6 ± 0.5, left ventricular ejection fraction [LVEF] 30{\%} ± 5{\%}) with moderate-to-severe CSA underwent two consecutive tissue Doppler echocardiography examinations in random order, one in the left lateral position (90°) and the other in the supine position (0°). The following parameters were obtained: left ventricular end-diastolic volume (LVEDV) and LVEF, left atrial volume (LAV) and right atrial volume (RAV), mitral regurgitation (MR), cardiac output (CO), transmitral protodiastolic (E) wave deceleration time (DT), E/e′ ratio, tricuspid annular plane systolic excursion (TAPSE), and right ventricular−atrial gradient (RVAG). Results The LAV, MR, E/e′, RAV, and RVAG significantly increased, whereas the LVEF and TAPSE significantly decreased in the left lateral position. All changes, however, were of negligible clinical significance. No significant changes were observed in CO, DT, and LVEDV. Conclusions This study shows that the reduction of CSA severity from the supine to the left lateral position in patients with CHF is not due to an improvement in cardiac haemodynamics. Other, noncardiac factors are likely to represent the main cause.",
keywords = "Central sleep apnoea, Echocardiography, Haemodynamics, Left lateral sleeping position",
author = "Egidio Traversi and Davide Rossi and Roberto Maestri and Francesca Olmetti and {La Rovere}, {Maria Teresa} and Giandomenico Pinna",
year = "2017",
month = "6",
day = "1",
doi = "10.1016/j.sleep.2017.02.023",
language = "English",
volume = "34",
pages = "30--32",
journal = "Sleep Medicine",
issn = "1389-9457",
publisher = "Elsevier",

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TY - JOUR

T1 - The reduction of central sleep apnoea severity in the left lateral position is not due to an improvement in cardiac haemodynamics in patients with chronic heart failure

AU - Traversi, Egidio

AU - Rossi, Davide

AU - Maestri, Roberto

AU - Olmetti, Francesca

AU - La Rovere, Maria Teresa

AU - Pinna, Giandomenico

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objective The severity of central sleep apnoea (CSA), a common comorbidity in patients with chronic heart failure (CHF) and reduced ejection fraction, markedly decreases from the supine to the lateral sleeping position, with no difference between the left and right positions. The mechanisms responsible for this beneficial effect have not yet been elucidated. Methods We tested the hypothesis that CSA attenuation in the left lateral position is due, at least in part, to an improvement in cardiac haemodynamics. Sixteen CHF patients (male, aged 60 ± 7 years, New York Heart Association class 2.6 ± 0.5, left ventricular ejection fraction [LVEF] 30% ± 5%) with moderate-to-severe CSA underwent two consecutive tissue Doppler echocardiography examinations in random order, one in the left lateral position (90°) and the other in the supine position (0°). The following parameters were obtained: left ventricular end-diastolic volume (LVEDV) and LVEF, left atrial volume (LAV) and right atrial volume (RAV), mitral regurgitation (MR), cardiac output (CO), transmitral protodiastolic (E) wave deceleration time (DT), E/e′ ratio, tricuspid annular plane systolic excursion (TAPSE), and right ventricular−atrial gradient (RVAG). Results The LAV, MR, E/e′, RAV, and RVAG significantly increased, whereas the LVEF and TAPSE significantly decreased in the left lateral position. All changes, however, were of negligible clinical significance. No significant changes were observed in CO, DT, and LVEDV. Conclusions This study shows that the reduction of CSA severity from the supine to the left lateral position in patients with CHF is not due to an improvement in cardiac haemodynamics. Other, noncardiac factors are likely to represent the main cause.

AB - Objective The severity of central sleep apnoea (CSA), a common comorbidity in patients with chronic heart failure (CHF) and reduced ejection fraction, markedly decreases from the supine to the lateral sleeping position, with no difference between the left and right positions. The mechanisms responsible for this beneficial effect have not yet been elucidated. Methods We tested the hypothesis that CSA attenuation in the left lateral position is due, at least in part, to an improvement in cardiac haemodynamics. Sixteen CHF patients (male, aged 60 ± 7 years, New York Heart Association class 2.6 ± 0.5, left ventricular ejection fraction [LVEF] 30% ± 5%) with moderate-to-severe CSA underwent two consecutive tissue Doppler echocardiography examinations in random order, one in the left lateral position (90°) and the other in the supine position (0°). The following parameters were obtained: left ventricular end-diastolic volume (LVEDV) and LVEF, left atrial volume (LAV) and right atrial volume (RAV), mitral regurgitation (MR), cardiac output (CO), transmitral protodiastolic (E) wave deceleration time (DT), E/e′ ratio, tricuspid annular plane systolic excursion (TAPSE), and right ventricular−atrial gradient (RVAG). Results The LAV, MR, E/e′, RAV, and RVAG significantly increased, whereas the LVEF and TAPSE significantly decreased in the left lateral position. All changes, however, were of negligible clinical significance. No significant changes were observed in CO, DT, and LVEDV. Conclusions This study shows that the reduction of CSA severity from the supine to the left lateral position in patients with CHF is not due to an improvement in cardiac haemodynamics. Other, noncardiac factors are likely to represent the main cause.

KW - Central sleep apnoea

KW - Echocardiography

KW - Haemodynamics

KW - Left lateral sleeping position

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U2 - 10.1016/j.sleep.2017.02.023

DO - 10.1016/j.sleep.2017.02.023

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SN - 1389-9457

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