Abstract | BACKGROUND: METHODS: Full polysomnograms were performed on CHF patients who were scheduled for CRT, and those patients with an apnea-hypopnea index (AHI) of > 5 events per hour were approached about study enrollment. Patients had a pre-CRT implant baseline echocardiogram and an echocardiogram a mean (+/- SEM) duration of 6.6 +/- 1.4 months post-CRT implant; polysomnography; and responded to the Minnesota Living with Heart Failure questionnaire, the Epworth sleepiness scale, and the Functional Outcomes of Sleep Questionnaire. An additional third polysomnography was performed combining CRT with a pacing rate of 15 beats/min above the baseline sleeping heart rate within 1 week of the second polysomnography. Assessments for the change in cardiac output during the polysomnography were performed using circulation time to pulse oximeter as a surrogate. RESULTS: Twenty-four patients were screened, and 13 patients (mean age, 68.6 years; body mass index, 28.7 kg/m(2)) had evidence of OSA. The mean AHI decreased from 40.9 +/- 6.4 to 29.5 +/- 5.9 events per hour with CRT (p = 0.04). The mean baseline ejection fraction was 22 +/- 1.7% and increased post-CRT to 33.6 +/- 2.0% (p < 0.05). The reduction in AHI with CRT closely correlated with a decrease in circulation time (r = 0.89; p < 0.001) with CRT. Increased rate pacing made no additional impact on the AHI or circulation time. CRT had a limited impact on sleep architecture or daytime symptom scores. CONCLUSIONS: CRT improved cardiac function and reduced the AHI. Reduced circulatory delay likely stabilized ventilatory control systems and may represent a new therapeutic target in OSA.
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Authors | Michael L Stanchina, Kristin Ellison, Atul Malhotra, Maria Anderson, Malcolm Kirk, Michael E Benser, Christine Tosi, Carol Carlisle, Richard P Millman, Alfred Buxton |
Journal | Chest
(Chest)
Vol. 132
Issue 2
Pg. 433-9
(Aug 2007)
ISSN: 0012-3692 [Print] United States |
PMID | 17573498
(Publication Type: Journal Article)
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Topics |
- Aged
- Cardiac Pacing, Artificial
- Echocardiography
- Female
- Follow-Up Studies
- Heart Failure
(complications, physiopathology, therapy)
- Humans
- Male
- Microcirculation
(physiology)
- Oximetry
- Pilot Projects
- Polysomnography
- Prognosis
- Retrospective Studies
- Severity of Illness Index
- Sleep Apnea, Obstructive
(blood, complications, physiopathology)
- Stroke Volume
(physiology)
- Surveys and Questionnaires
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