Different Loop Gain Phenotypes in Patients With Chronic Systolic Heart Failure and Periodic Breathing
NCT ID: NCT03532412
Last Updated: 2023-12-15
Study Results
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Basic Information
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COMPLETED
12 participants
OBSERVATIONAL
2016-06-28
2016-11-14
Brief Summary
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The pathogenesis of PB is characterized by an instability of ventilatory drive. The level of carbon dioxide (CO2) in blood and cerebrospinal fluid correlates linearly with minute ventilation. A high level of CO2 increases ventilation while hypocapnia dampens it. This control theory is based on the loop gain (LG), which represents the sensitivity and reactivity of the ventilatory system and comprises three components: The plant gain defines the capacity of the system to change PaCO2 in response to a change in ventilation (metabolic response). It is influenced by the lung volume as well as the anatomy of the thorax and the upper airways. The feedback gain is defined by the chemoreceptor responsiveness in reaction to blood gas changes. The controller gain is represented by the respiratory control center in the brain stem and defines the capacity of the system to change ventilation in response to a change in PaCO2 (ventilatory response).
Sands et al. proposed and validated a mathematical model based on the ventilatory cycle pattern that quantifies the feedback loop. The ratio of ventilatory and cycle duration within the PB pattern is defined as the duty ratio (DR), which is the basis to calculate the LG. Any temporary breathing disturbance causing a PB pattern with a LG \< 1 stabilizes within a few breathing cycles. A LG \> 1 represents an unstable ventilatory response and slight changes of CO2 are accompanied by overshooting and undershooting of the ventilation. In that case, the polysomnography shows the typical pattern of waxing and waning of the tidal volume and effort.
HF patients typically present with an increased LG due to an impaired left ventricular function and a hyperstimulation of pulmonary vagal receptors. Furthermore, Khoo showed an increased chemosensitivity (controller gain) as well as a decreased ventilatory capacity (plant gain) in this group of people.
Sands and colleagues characterized PB considering the mean LG derived from several ventilatory cycles during non-REM sleep. This retrospective study of PB in HFrEF patients addresses the following questions:
1. Is a single LG value appropriate to characterize the individual PB?
2. Does the LG depend on sleep stage and body position?
3. Does the intraindividual LG variability allow for the discrimination of different PB phenotypes and, if so, do these phenotypes differ in further characteristics?
Detailed Description
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Conditions
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Keywords
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Study Design
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COHORT
RETROSPECTIVE
Study Groups
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HF+CSA+PB
Systolic heart failure with predominant central sleep apnea and periodic breathing
No interventions assigned to this group
Eligibility Criteria
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Inclusion Criteria
* Apnea-Hypopnea index \>15 per hour as determined by diagnostic polysomnography
* Predominant central sleep apnea as defined by \>50% central respiratory events
Exclusion Criteria
ALL
No
Sponsors
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Wissenschaftliches Institut Bethanien e.V
OTHER
Responsible Party
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Principal Investigators
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Winfried J Randerath, Prof. Dr.
Role: PRINCIPAL_INVESTIGATOR
Director
Locations
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Wissenschaftliches Institut Bethanien für Pneumologie e.V.
Solingen, , Germany
Countries
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References
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Brack T, Randerath W, Bloch KE. Cheyne-Stokes respiration in patients with heart failure: prevalence, causes, consequences and treatments. Respiration. 2012;83(2):165-76. doi: 10.1159/000331457. Epub 2011 Oct 18.
Javaheri S, Shukla R, Zeigler H, Wexler L. Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure. J Am Coll Cardiol. 2007 May 22;49(20):2028-34. doi: 10.1016/j.jacc.2007.01.084. Epub 2007 May 4.
Naughton MT. Epidemiology of central sleep apnoea in heart failure. Int J Cardiol. 2016 Mar;206 Suppl:S4-7. doi: 10.1016/j.ijcard.2016.02.125. Epub 2016 Feb 26.
Randerath W, Verbraecken J, Andreas S, Arzt M, Bloch KE, Brack T, Buyse B, De Backer W, Eckert DJ, Grote L, Hagmeyer L, Hedner J, Jennum P, La Rovere MT, Miltz C, McNicholas WT, Montserrat J, Naughton M, Pepin JL, Pevernagie D, Sanner B, Testelmans D, Tonia T, Vrijsen B, Wijkstra P, Levy P. Definition, discrimination, diagnosis and treatment of central breathing disturbances during sleep. Eur Respir J. 2017 Jan 18;49(1):1600959. doi: 10.1183/13993003.00959-2016. Print 2017 Jan.
Yumino D, Bradley TD. Central sleep apnea and Cheyne-Stokes respiration. Proc Am Thorac Soc. 2008 Feb 15;5(2):226-36. doi: 10.1513/pats.200708-129MG.
Kasai T, Floras JS, Bradley TD. Sleep apnea and cardiovascular disease: a bidirectional relationship. Circulation. 2012 Sep 18;126(12):1495-510. doi: 10.1161/CIRCULATIONAHA.111.070813. No abstract available.
Rowley JA, Badr MS. Central Sleep Apnea in Patients with Congestive Heart Failure. Sleep Med Clin. 2017 Jun;12(2):221-227. doi: 10.1016/j.jsmc.2017.03.001.
Naughton MT. Loop gain in apnea: gaining control or controlling the gain? Am J Respir Crit Care Med. 2010 Jan 15;181(2):103-5. doi: 10.1164/rccm.200909-1449ED. No abstract available.
Wellman A, Malhotra A, Fogel RB, Edwards JK, Schory K, White DP. Respiratory system loop gain in normal men and women measured with proportional-assist ventilation. J Appl Physiol (1985). 2003 Jan;94(1):205-12. doi: 10.1152/japplphysiol.00585.2002. Epub 2002 Sep 20.
Sands SA, Edwards BA, Kee K, Turton A, Skuza EM, Roebuck T, O'Driscoll DM, Hamilton GS, Naughton MT, Berger PJ. Loop gain as a means to predict a positive airway pressure suppression of Cheyne-Stokes respiration in patients with heart failure. Am J Respir Crit Care Med. 2011 Nov 1;184(9):1067-75. doi: 10.1164/rccm.201103-0577OC.
Khoo VS. MRI--"magic radiotherapy imaging" for treatment planning? Br J Radiol. 2000 Mar;73(867):229-33. doi: 10.1259/bjr.73.867.10817036. No abstract available.
Other Identifiers
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WI_LoopGain
Identifier Type: -
Identifier Source: org_study_id