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Central sleep apnea is common among patients who have heart failure and increases the risk of death in this setting. In the Canadian Continuous Positive Airway Pressure trial, continuous positive airway pressure (CPAP) therapy administered to patients with heart failure was found to reduce the severity of central sleep apnea and increase the left ventricular ejection fraction, but did not improve survival. Continuous positive airway pressure therapy administered to patients with heart failure was found to reduce the severity of central sleep apnea and increase the left ventricular ejection fraction but did not improve survival. Central sleep apnea, which is present in approximately 25 to 40 percent of patients with chronic heart failure, 1 – 3 results from cyclic hyperventilation and falls in the partial pressure of arterial carbon dioxide below the apnea threshold. 4 The condition affects cardiovascular function adversely by causing tissue hypoxia, arousals from sleep, and activation of the sympathetic nervous system, and it independently increases the risk of death. 1 , 5 , 6 In short-term, single-center randomized trials lasting one to three months involving small numbers of patients who had central sleep apnea and chronic heart failure, continuous positive airway pressure (CPAP) attenuated the central sleep . . .

Because patients with chronic heart failure (CHF) can benefit from specific treatment for coexisting obstructive and central sleep apnea (CSA), there is a need to develop accurate screening tools to identify or exclude these sleep-related breathing disturbances (SRBDs) in patients with CHF. To evaluate, prospectively, the diagnostic value of nocturnal home oximetry in identifying SRBD in CHF patients and in distinguishing central events from obstructive events. Blinded comparison of hospital and home oximetry, and polysomnographic nocturnal recordings Cardiac heart failure and sleep clinics in three tertiary referral centers. Fifty consecutive patients who were investigated for participation in the Canadian Continuous Positive Airway Pressure Trial for Congestive Heart Failure with Central Sleep Apnea and were recruited from three different centers. Patients underwent two oximetry recordings, one at home and one during a polysomnographic study. The criterion for an SRBD was the presence of > 15 apneas and hypopneas per hour of sleep during polysomnography or an oxygen desaturation index of > 10 events per hour during oximetry. The pattern of desaturation/resaturation during oximetry was also examined to distinguish obstructive events from central events. Using a 2% fall in pulse oximetric saturation as the criterion for oxygen desaturation, home oximetry had a 85% sensitivity and a 93% specificity (p < 0.001) for detecting an SRBD. However, the desaturation/resaturation pattern did not accurately distinguish between obstructive events and central events (eg, 100% sensitivity, 17% specificity for identifying CSA). The interpretation of the oximetry recording was highly consistent between scorers (p < 0.001). Overnight home oximetry is a sensitive and specific tool for identifying SRBDs in patients with CHF, but not for distinguishing between obstructive and central events in such patients.