Abstract
Introduction
Advances in cardiac diagnosis, medical therapy, and surgery have resulted in greater survival for patients with congenital heart disease (CHD). As a result, increasing numbers of CHD patients are surviving to adulthood with little knowledge regarding the consequences of comorbid medical conditions. Obstructive sleep apnea (OSA) is common and associated with hypertension, heart failure, and arrhythmias. Adults with certain types of CHD are at a higher risk for these and other cardiovascular complications than the general population. Therefore, OSA in adults with CHD may have a greater adverse impact on cardiovascular health than in the general population.
Materials and methods
We report four patients with CHD and OSA. All had conditions resulting in a hypoplastic right ventricle causing a single ventricle physiology, and all were treated surgically with a Fontan repair.
Results and discussion
Because of their unique cardiac physiology, our cases were at risk for a further decrease in cardiac output and systemic perfusion with the application of continuous positive airway pressure (CPAP) therapy for OSA. We describe a method of identifying safe CPAP thresholds in the cardiac catheterization laboratory prior to titration of CPAP in the sleep laboratory in these patients.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Scal P, Evans T, Blozis S, Okinow N, Blum R (1999) Trends in transition from pediatric to adult health care services for young adults with chronic conditions. J Adol Health 24:259–264
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235
Peppard PE, Young T, Palta M, Skatrud J (2000) Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 342:1378–1384
Shahar E, Whitney CW, Redline S, Lee ET, Newman AB, Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM (2001) Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the sleep heart health study. Am J Respir Crit Care Med 163:19–25
Mehra R, Benjamin EJ, Shahar E, Gottlieb DJ, Nawabit R, Kirchner HL, Sahadevan J, Redline S (2006) Association of nocturnal arrhythmias with sleep-disordered breathing: The Sleep Heart Health Study. Am J Respir Crit Care Med 173:910–6
Fishberger SB, Wernovsky G, Gentles TL, Gauvreau K, Burnett J, Mayer JE Jr, Walsh EP (1997) Factors that influence the development of atrial flutter after the Fontan operation. J Thorac Cardiovasc Surg 113:80–86
Williams DB, Kiernan PD, Metke MP, Marsh HM, Danielson GK (1984) Hemodynamic response to positive end-expiratory pressure following right atrium-pulmonary artery bypass (Fontan procedure). J Thorac Cardiovasc Surg 87:856–861
Chesson AL Jr, Ferber RA, Fry JM, Grigg-Damberger M, Hartse KM, Hurwitz TD, Johnson S, Kader GA, Littner M, Rosen G, Sangal RB, Schmidt-Nowara W, Sher A (1997) The indications for polysomnography and related procedures. Sleep 20:423–487
Ehlers KC, Mylrea KC, Waterson CK, Calkins JM (1986) Cardiac output measurements. A review of current techniques and research. Ann Biomed Eng 14:219–239
Author information
Authors and Affiliations
Corresponding author
Additional information
This work was performed at the University of Washington Medical Center and Harborview Medical Center, Seattle, Washington.
Grant support: None.
Disclosure: The authors have reported no conflicts of interest.
Rights and permissions
About this article
Cite this article
Watson, N.F., Bushnell, T., Jones, T.K. et al. A novel method for the evaluation and treatment of obstructive sleep apnea in four adults with complex congenital heart disease and Fontan repairs. Sleep Breath 13, 421–424 (2009). https://doi.org/10.1007/s11325-009-0260-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-009-0260-8