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Cycle length identifies obstructive sleep apnea and central sleep apnea in heart failure with reduced ejection fraction

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Aim

To clarify whether unmasking of central sleep apnea during continuous positive airway pressure (CPAP) initiation can be identified from initial diagnostic polysomnography (PSG) in patients with heart failure with reduced ejection fraction (HFREF) and obstructive sleep apnea (OSA)

Materials and methods

Forty-three consecutive patients with obstructive sleep apnea and central sleep apnea (OSA/CSA) in HFREF were matched with 43 HFREF patients with OSA and successful CPAP initiation. Obstructive apneas during diagnostic PSG were then analyzed for cycle length (CL), ventilation length (VL), apnea length (AL), time to peak ventilation (TTPV), and circulatory delay (CD). We calculated duty ratio (DR) as the ratio of VL/CL and mathematic loop gain (LG).

Results

While AL was similar, CL, VL, TTPV, CD, and DR was significantly longer in patients with OSA/CSA compared to those with OSA, and LG was significantly higher. Receiver operator curves identified optimal cutoff values of 50.2 s for CL (area under the curve (AUC) 0.85, 29.2 s for VL (AUC 0.92), 11.5 s for TTPV (AUC 0.82), 26.4 s for CD (AUC 0.79), and 3.96 (AUC 0.78)) respectively for LG to identify OSA/CSA.

Conclusion

OSA/CSA in HFREF can be identified by longer CL, VL, TTPV, and CD from obstructive events in initial diagnostic PSG. The underlying mechanisms seem to be the presence of an increased LG.

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Author notes

  1. Thomas Bitter and Burak Özdemir contributed equally to this work.

Authors and Affiliations

  1. Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany

    Thomas Bitter, Burak Özdemir, Henrik Fox, Dieter Horstkotte & Olaf Oldenburg

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  1. Thomas Bitter
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  2. Burak Özdemir
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  3. Henrik Fox
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  4. Dieter Horstkotte
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  5. Olaf Oldenburg
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Correspondence to Thomas Bitter.

Ethics declarations

The study was approved by the Ethical Review Board of the Ruhr University, Bochum, and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Conflict of interest

Olaf Oldenburg reports personal fees from ResMed, personal fees from LivaNova, personal fees from Novartis, and personal fees from Bayer, outside the submitted work. The other authors declare that they have no conflicts of interest.

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Bitter, T., Özdemir, B., Fox, H. et al. Cycle length identifies obstructive sleep apnea and central sleep apnea in heart failure with reduced ejection fraction. Sleep Breath 22, 1093–1100 (2018). https://doi.org/10.1007/s11325-018-1652-4

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  • DOI: https://doi.org/10.1007/s11325-018-1652-4

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