title: Is Mixed Apnea Associated with Non-Rapid Eye Movement Sleep a Reversible Compensatory Sign of Heart Failure?
abstract: BACKGROUND
  Sleep-disordered breathing is common in heart failure (HF), and prolonged circulation time and diminished pulmonary volume are considered the main possible causes of sleep apnea in these patients. However, the impact and interrelation between sleep apnea and HF development are unclear. We report the case of a patient with complete elimination of non-rapid-eye-movement (NREM) sleep-associated mixed apnea in HF after heart transplantation.
  
  
  METHODS
  After unsuccessful 12-month conventional treatment with abrupt exacerbation of biventricular HF IV class (according to New York Heart Association Functional Classification), a 26-year-old man was admitted to the hospital. Based on a comprehensive examination including endomyocardial biopsy, dilated cardiomyopathy was diagnosed. Heart transplantation was considered the only possible treatment strategy. Polysomnography showed severe NREM sleep-associated mixed sleep apnea [apnea-hypopnea index 43/h, in rapid eye movement (REM) sleep 3.7/h, in NREM sleep 56.4/h, mean SatO2 93.9%], and periodic breathing. One-month post-transplantation polysomnography did not show sleep-disordered breathing (apnea-hypopnea index 1.0/h; in REM sleep - 2.8/h, in NREM sleep 0.5/h, mean SatO2 97.5%). The patient was discharged from the hospital in improved condition.
  
  
  CONCLUSIONS
  NREM sleep-associated mixed apnea occurring in severe systolic HF due to dilated cardiomyopathy might be reversible in case of successful HF treatment. We suggest that mixed sleep apnea strongly associated with NREM sleep occurs in HF, when the brain centers regulating ventilation are intact, and successful HF compensation might be highly effective regarding sleep-breathing disorders without non-invasive ventilation. This is important to know, especially with regard to the recently published data of potentially unfavorable effects of adaptive servoventilation in systolic HF, and the lack of other treatment options.
authors.affiliation: Somnology Group, Hypertension Research Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Lyudmila
authors.initials: L
authors.lastname: Korostovtseva
authors.affiliation: Cardiothoracic Surgery Research Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Sazonova
authors.affiliation: Hypertension Research Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Nadezhda
authors.initials: N
authors.lastname: Zvartau
authors.affiliation: Department of Cardiology #2, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Andrey
authors.initials: A
authors.lastname: Semenov
authors.affiliation: Somnology Group, Hypertension Research Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Viktoriya
authors.initials: V
authors.lastname: Nepran
authors.affiliation: Somnology Group, Hypertension Research Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Bochkarev
authors.affiliation: Cardiothoracic Surgery Research Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: German
authors.initials: G
authors.lastname: Nikolaev
authors.affiliation: Pathologic Laboratory, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Lyubov
authors.initials: L
authors.lastname: Mitrofanova
authors.affiliation: Somnology Group, Hypertension Research Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Yurii
authors.initials: Y
authors.lastname: Sviryaev
authors.affiliation: Surgery Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Gordeev
authors.affiliation: Hypertension Research Department, Almazov Federal North-West Medical Research Centre, St. Petersburg, Russian Federation.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Konradi
mesh_terms: D000328:Adult; D001706:Biopsy; D006328:Cardiac Catheterization; D004452:Echocardiography; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D017286:Polysomnography; D011669:Pulmonary Wedge Pressure; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D012895:Sleep, REM / Q000502:physiology*; D016278:Ventricular Function, Right / Q000502:physiology