phenylephrine-hydrochloride and Sleep-Apnea--Central

Sleep disordered breathing (SDB) is a common condition and could be a risk factor for cardiovascular morbidity and mortality. However, the pathogenesis of SDB remains to be elucidated. In general, SDB is divided into two forms, obstructive and central sleep apnea (OSA and CSA, respectively). OSA results from the sleep-related collapse of the upper airway (UA) in association with multiple factors like race, gender, obesity and UA dimensions. CSA primarily results from a fall in PaCO2 to a level below the apnea threshold during sleep through the reflex inhibition of central respiratory drive. It has been reported that UA alterations (i.e., collapse or dilation) can be observed in CSA. This review highlights the roles of the UA in the pathogenesis and pathophysiology of SDB.

Topics: Airway Obstruction; Cardiovascular Diseases; Female; Humans; Male; Nasal Obstruction; Nose; Obesity; Palatal Muscles; Pharyngeal Muscles; Pharynx; Respiratory Mechanics; Risk Factors; Sex Factors; Sleep; Sleep Apnea, Central; Sleep Apnea, Obstructive; Wakefulness

Cheyne - Stokes respiration with central sleep apnea (CSR-CSA) contributes to the poor prognosis in patients with congestive heart failure (CHF). Bi-level positive airway pressure (bi-level PAP) may be an effective alternative for treating CSR-CSA and CHF.. Fourteen patients with CSR-CSA were divided into 2 groups, a control group that included 7 patients who decided to receive only conventional medications and a group of 7 patients that received bi-level PAP. Left ventricular ejection fraction (LVEF), mitral regurgitation (MR) area, plasma brain natriuretic peptide (BNP) concentration and the New York Heart Association (NYHA) functional class were evaluated initially (baseline) and 3 months later. In the control group, there were no significant changes in cardiac function during the study period. In contrast, in the group that received bi-level PAP, there were significant improvements in LVEF (from 36.3+/-2.9% to 46.0+/-4.0%, p = 0.02), MR area (from 30.4+/-7.6% to 20.0+/-5.1%, p = 0.02), BNP (from 993.6+/-332.0 pg/ml to 474.0+/-257.6 pg/ml, p = 0.02) and NYHA functional class (from 3.1+/-0.1 to 2.1+/-0.1, p = 0.03).. Treatment with bi-level PAP improved cardiac functions in CHF patients with CSR-CSA.

Topics: Aged; Aged, 80 and over; Cheyne-Stokes Respiration; Female; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Nose; Positive-Pressure Respiration; Sleep Apnea, Central; Ventricular Function, Left