title: Identifying Predictors of Central Sleep Apnea/Cheyne-Stokes Breathing in Chronic Heart Failure: a Pathophysiological Approach.
abstract: Chronic heart failure (CHF) is a major health problem associated with increased mortality, despite modern treatment options. Central sleep apnea (CSA)/Cheyne-Stokes breathing (CSB) is a common and yet largely under-diagnosed co-morbidity, adding significantly to the poor prognosis in CHF because of a number of acute and chronic effects, including intermittent hypoxia, sympathetic overactivation, disturbed sleep architecture and impaired physical tolerance. It is characterized by repetitive periods of crescendo-decrescendo ventilatory pattern, alternating with central apneas and hypopneas. The pathogenesis of CSA/CSB is based on the concept of loop gain, comprising three major components: controller gain, plant gain and feedback gain. Laboratory polysomnography, being the golden standard for diagnosing sleep-disordered breathing (SDB) at present, is a costly and highly specialized procedure unable to meet the vast diagnostic demand. Unlike obstructive sleep apnea, CSA/CSB has a low clinical profile. Therefore, a reliable predictive system is needed for identifying CHF patients who are most likely to suffer from CSA/CSB, optimizing polysomnography use. The candidate predictors should be standardized, easily accessible and low-priced in order to be applied in daily medical routine. The present review focuses on a pathophysiological approach to the selection of some predictors based on parameters reflecting the etiology, the pathogenesis and the consequences of CSA/CSB in CHF.
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
authors.forename: Aneliya I
authors.initials: AI
authors.lastname: Draganova
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
authors.forename: Kiril V
authors.initials: KV
authors.lastname: Terziyski
authors.affiliation: Department of Pathophysiology, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
authors.forename: Stefan S
authors.initials: SS
authors.lastname: Kostianev
mesh_terms: D001784:Blood Gas Analysis; D002303:Cardiac Output, Low / Q000503:physiopathology; D002639:Cheyne-Stokes Respiration / Q000453:epidemiology* / Q000503:physiopathology; D002908:Chronic Disease; D019560:Echocardiography, Three-Dimensional; D005080:Exercise Test; D005652:Functional Residual Capacity; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D000860:Hypoxia; D011669:Pulmonary Wedge Pressure; D012129:Respiratory Function Tests; D018570:Risk Assessment; D020182:Sleep Apnea, Central / Q000453:epidemiology* / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology