Journal of Cardiac Failure
Volume 13, Issue 5 , Pages 395-400 , June 2007

Autonomic Abnormalities in Congestive Heart Failure Patients With Sleep-Disordered Breathing

  • Austin Chin Chwan Ng, MBBS, Bsc(Med)
    • ,
  • Saul Benedict Freedman, MBBS, PhD, FACC
    • ,
  • Andrew Paul Sindone, B.Med(Hons), MD, FRACP

      Affiliations

    • Corresponding Author InformationReprint requests: Prof. Andrew Paul Sindone, B.Med(Hons), MD, FRACP, Cardiologist, Director of Heart Failure Clinic, Concord Hospital, Concord RG Hospital, Hospital Road, Concord, NSW 2139, Australia.

Received 13 November 2006 ,Revised 6 February 2007 ,Accepted 12 February 2007.

References 

  1. Floras JS. Sympathetic activation in human heart failure: diverse mechanism, therapeutic opportunities. Acta Physiol Scand. 2003;177:391–398
  2. Brum PC, Kosek J, Patterson A, Bernstein D, Kobilka B. Abnormal cardiac function associated with sympathetic nervous system hyperactivity in mice. Am J Physiol Heart Circ Physiol. 2002;283:H1838–H1845
  3. Narkiewicz K, Somers VK. Sympathetic nerve activity in obstructive sleep apnea. Acta Physiol Scand. 2003;177:385–390
  4. Javaheri S. Central sleep apnea in congestive heart failure: prevalence, mechanisms, impact, and therapeutic options. Semin Respir Crit Care Med. 2005;26:44–55
  5. Mansfield D, Kaye DM, Brunner La Rocca H, Solin P, Esler MD, Naughton MT. Raised sympathetic nerve activity in heart failure and central sleep apnea is due to heart failure severity. Circulation. 2003;107:1396–1400
  6. Grassi G, Esler M. How to assess sympathetic activity in humans. J Hypertens. 1999;17:719–734
  7. Esler M, Jennings G, Korner P, Willett I, Dudley F, Hasking G, et al. Assessment of human sympathetic nervous system activity from measurements of norepinephrine turnover. Hypertension. 1988;11:3–20
  8. Hasking GJ, Esler MD, Jennings GL, Burton D, Johns JA, Korner PI. Norepinephrine spillover to plasma in patients with congestive heart failure: evidence of increased overall and cardiorenal sympathetic nervous activity. Circulation. 1986;73:615–621
  9. Cohn JN, Levine TB, Olivari MT, Garberg V, Lura D, Francis GS, et al. Plasma norepinephrine as a guide to prognosis in patients with chronic congestive heart failure. N Engl J Med. 1984;311:819–823
  10. Kaye DM, Lefkovits J, Jennings GL, Bergin P, Broughton A, Esler MD. Adverse consequences of high sympathetic nervous activity in the failing human heart. J Am Coll Cardiol. 1995;26:1257–1263
  11. Dimsdale JE, Coy T, Ziegler MG, Ancoli-Israel S, Clausen J. The effect of sleep apnea on plasma and urinary catecholamines. Sleep. 1995;18:377–381
  12. Solin P, Kaye DM, Little PJ, Bergin P, Richardson M, Naughton MT. Impact of sleep apnea on sympathetic nervous system activity in heart failure. Chest. 2003;123:1119–1126
  13. Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, Naughton MT. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. Am J Respir Crit Care Med. 2004;169:361–366
  14. Vallbo AB, Hagbarth KE, Wallin BG. Microneurography: how the technique developed and its role in the investigation of the sympathetic nervous system. J Appl Physiol. 2004;96:1262–1269
  15. Kimmerly DS, O'Leary DD, Shoemaker JK. Test-retest repeatability of muscle sympathetic nerve activity: influence of data analysis and head-up tilt. Auton Neurosci. 2004;114:61–71
  16. Leimbach WN, Wallin BG, Victor RG, Aylward PE, Sundlof G, Mark AL. Direct evidence from intraneural recordings for increased central sympathetic outflow in patients with heart failure. Circulation. 1986;73:913–919
  17. Roveda F, Middlekauff HR, Rondon MU, Reis SF, Souza M, Nastari L, et al. The effects of exercise training on sympathetic neural activation in advanced heart failure: a randomized controlled trial. J Am Coll Cardiol. 2003;42:854–860
  18. Somers VK, Dyken ME, Clary MP, Abboud FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest. 1995;96:1897–1904
  19. Usui K, Bradley TD, Spaak J, Ryan CM, Kubo T, Kaneko Y, et al. Inhibition of awake sympathetic nerve activity of heart failure patients with obstructive sleep apnea by nocturnal continuous positive airway pressure. J Am Coll Cardiol. 2005;45:2008–2011
  20. Bradley TD, Tkacova R, Hall MJ, Ando S, Floras JS. Augmented sympathetic neural response to simulated obstructive apnea in human heart failure. Clin Sci (Lond). 2003;104:231–238
  21. Stauss HM. Heart rate variability. Am J Physiol Regul Integr Comp Physiol. 2003;285:R927–R931
  22. Lombardi F. Clinical implications of present physiological understanding of HRV components. Card Electrophysiol Rev. 2002;6:245–249
  23. La Rovere MT, Bigger JT, Marcus FI, Mortara A, Schwartz PJ. Baroreflex sensitivity and heart-rate variability in prediction of total cardiac mortality after myocardial infarction. ATRAMI (Autonomic Tone and Reflexes After Myocardial Infarction) Investigators. Lancet. 1998;351:478–484
  24. Kleiger RE, Miller JP, Bigger JT, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987;59:256–262
  25. Nolan J, Batin PD, Andrews R, Lindsay SJ, Brooksby P, Mullen M, et al. Prospective study of heart rate variability and mortality in chronic heart failure: results of the United Kingdom Heart Failure Evaluation and Assessment of Risk trial (UK-heart). Circulation. 1998;98:1510–1516
  26. Fauchier L, Babuty D, Cosnay P, Autret ML, Fauchier JP. Heart rate variability in idiopathic dilated cardiomyopathy: characteristics and prognostic value. J Am Coll Cardiol. 1997;30:1009–1014
  27. Ponikowski P, Anker SD, Chua TP, Szelemej R, Piepoli M, Adamopoulos S, et al. Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 1997;79:1645–1650
  28. Kleiger RE, Stein PK, Bigger JT. Heart rate variability: measurement and clinical utility. Ann Noninvasive Electrocardiol. 2005;10:88–101
  29. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17:354–381
  30. Malliani A, Pagani M, Lombardi F, Cerutti S. Cardiovascular neural regulation explored in the frequency domain. Circulation. 1991;84:482–492
  31. Malik M, Camm AJ. Components of heart rate variability—what they really mean and what we really measure. Am J Cardiol. 1993;72:821–822
  32. Saul JP, Arai Y, Berger RD, Lilly LS, Colucci WS, Cohen RJ. Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. Am J Cardiol. 1988;61:1292–1299
  33. Casolo G, Balli E, Taddei T, Amuhasi J, Gori C. Decreased spontaneous heart rate variability in congestive heart failure. Am J Cardiol. 1989;64:1162–1167
  34. La Rovere MT, Pinna GD, Maestri R, Mortara A, Capomolla S, Febo O, et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation. 2003;107:565–570
  35. Guzzetti S, La Rovere MT, Pinna GD, Maestri R, Borroni E, Porta A, et al. Different spectral components of 24 h heart rate variability are related to different modes of death in chronic heart failure. Eur Heart J. 2005;26:357–362
  36. Guilleminault C, Connolly S, Winkle R, Melvin K, Tilkian A. Cyclical variation of the heart rate in sleep apnea syndrome. Mechanisms, and usefulness of 24 h electrocardiography as a screening technique. Lancet. 1984;1:126–131
  37. Roche F, Pichot V, Sforza E, Court-Fortune I, Duverney D, Costes F, et al. Predicting sleep apnea syndrome from heart period: a time-frequency wavelet analysis. Eur Respir J. 2003;22:937–942
  38. Narkiewicz K, Montano N, Cogliati C, van de Borne PJ, Dyken ME, Somers VK. Altered cardiovascular variability in obstructive sleep apnea. Circulation. 1998;98:1071–1077
  39. Roche F, Xuong AN, Court-Fortune I, Costes F, Pichot V, Duverney D, et al. Relationship among the severity of sleep apnea syndrome, cardiac arrhythmias, and autonomic imbalance. Pacing Clin Electrophysiol. 2003;26:669–677
  40. Aydin M, Altin R, Ozeren A, Kart L, Bilge M, Unalacak M. Cardiac autonomic activity in obstructive sleep apnea: time-dependent and spectral analysis of heart rate variability using 24-hour Holter electrocardiograms. Tex Heart Inst J. 2004;31:132–136
  41. Dingli K, Assimakopoulos T, Wraith PK, Fietze I, Witt C, Douglas NJ. Spectral oscillations of RR intervals in sleep apnea-hypopnea syndrome patients. Eur Respir J. 2003;22:943–950
  42. Roche F, Gaspoz JM, Court-Fortune I, Minini P, Pichot V, Duverney D, et al. Screening of obstructive sleep apnea syndrome by heart rate variability analysis. Circulation. 1999;100:1411–1415
  43. Lanfranchi PA, Braghiroli A, Bosimini E, Mazzuero G, Colombo R, Donner CF, et al. Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure. Circulation. 1999;99:1435–1440
  44. Lanfranchi PA, Somers VK, Braghiroli A, Corra U, Eleuteri E, Giannuzzi P. Central sleep apnea in left ventricular dysfunction: prevalence and implications for arrhythmic risk. Circulation. 2003;107:727–732
  45. Tateishi O, Shouda T, Azuma Y, Chin K, Nogimura T, Gotou Y, et al. Heart rate variability in congestive heart failure. Clin Exp Hypertens. 2002;24:75–81
  46. Tateishi O, Shouda T, Sakai T, Honda Y, Mochizuki S, Machida K. Apnea-related heart rate variability in congestive heart failure patients. Clin Exp Hypertens. 2003;25:183–189
  47. Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med. 1999;341:577–585
  48. Colucci WS, Braunwald E. Pathophysiology of heart failure. In:  Zipes DP,  Libby P,  Bonow RO,  Braunwald E editor. Braunwald's heart disease: a textbook of cardiovascular medicine. 7th ed.. Philadelphia: Elsevier Saunders; 2005;p. 509–538
  49. Floras JS. Sympathetic activation in human heart failure: diverse mechanisms, therapeutic opportunities. Acta Physiol Scand. 2003;177:391–398
  50. Aggarwal A, Esler MD, Lambert GW, Hastings J, Johnston L, Kaye DM. Norepinephrine turnover is increased in suprabulbar subcortical brain regions and is related to whole-body sympathetic activity in human heart failure. Circulation. 2002;105:1031–1033
  51. Altman JD, Trendelenburg AU, MacMillan L, Bernstein D, Limbird L, Starke K, et al. Abnormal regulation of the sympathetic nervous system in alpha2A-adrenergic receptor knockout mice. Mol Pharmacol. 1999;56:154–161
  52. Kaye DM, Jennings GL, Dart AM, Esler MD. Differential effect of acute baroreceptor unloading on cardiac and systemic sympathetic tone in congestive heart failure. J Am Coll Cardiol. 1998;31:583–587
  53. Kara T, Narkiewicz K, Somers VK. Chemoreflexes—physiology and clinical implications. Acta Physiol Scand. 2003;177:377–384
  54. Narkiewicz K, Pesek CA, van de Borne PJ, Kato M, Somers VK. Enhanced sympathetic and ventilatory responses to central chemoreflex activation in heart failure. Circulation. 1999;100:262–267
  55. Javaheri S. A mechanism of central sleep apnea in patients with heart failure. N Engl J Med. 1999;341:949–954
  56. Calhoun DA, Nishizaka MK, Zaman MA, Harding SM. Aldosterone excretion among subjects with resistant hypertension and symptoms of sleep apnea. Chest. 2004;125:112–117
  57. Struthers AD. Pathophysiology of heart failure following myocardial infarction. Heart. 2005;91(Suppl 2):ii14–ii16discussion ii31, ii43–8
  58. Oldenburg O, Lamp B, Faber L, Teschler H, Horstkotte D, Topfer V. Sleep-disordered breathing in patients with symptomatic heart failure A contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail. 2007;9:251–257
  59. Bradley TD, Logan AG, Kimoff RJ, Series F, Morrison D, Ferguson K, et al. Continuous Positive Airway Pressure for Central Sleep Apnea and Heart Failure. N Engl J Med. 2005;353:2025–2033

PII: S1071-9164(07)00031-0

doi: 10.1016/j.cardfail.2007.02.003

Journal of Cardiac Failure
Volume 13, Issue 5 , Pages 395-400 , June 2007

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