Cardiac valve replacement improves sleep quality in patients with rheumatic valvular heart disease and central sleep apnea_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

QI Daoda ¹ , DING Ning ² , ZHANG Xilong ² ,  ZONG Feng ¹

1. Geriatric Department of Respiration, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P. R. China;
2. Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, P. R. China;

Corresponding author：

ZONG Feng, Email: arthurjulia@126.com

Keywords：

Sleep quality; Rheumatic valvular heart disease; Central sleep apnea; Cardiac valve replacement

DOI：

10.7507/1671-6205.201804034

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To observes the postoperative transformation of subjective and objective sleep quality and related influencing factors in patients with rheumatic valvular heart disease (RVHD) who were found with central sleep apnea (CSA) after cardiac valve replacement.Methods A total of 262 patients undergoing cardiac valve replacement were screened for CSA by overnight polysomnography and 21 patients with CSA were enrolled and followed up successfully in the 3^th, 6^th and 12^th month of postoperation from April 2010 to January 2013. The Pittsburgh Sleep Quality Index, Epworth Sleepiness, polysomnography and cardiac function were evaluated in preoperation and postoperation (in the 3^th, 6^th and 12^th month).Results New York Heart Association class ［preoperation and postoperation: (3.7±0.5), (2.3±0.6), (1.7±0.6), (1.6±0.7), F=81.124, P<0.05］ continuously decreased, left ventricular ejection fraction ［preoperation and postoperation: (58.5±6.8)%, (60.0±7.4)%, (60.9±5.6)%, (64.4±4.0)%, F=7.182, P<0.05］ steadily increased, six-minute walk distance ［preoperation and postoperation: (271.5±76.6), (422.1±71.9), (445.1±56.2), (454.5± 63.5) m, F=67.134, P<0.05］ constantly increased. During postoperative follow-up, sleep apnea-hypopnea index ［preoperation and postoperation: (26.2±13.4), (12.0±11.5), (8.6±7.5), (7.4±5.5)/h, F=20.548, P<0.05, central sleep apnea index ［preoperation and postoperation: (19.6±10.3), (0.5±1.5), (0.3±1.3), (0.2±0.7)/h, F=72.926, P<0.05］ and oxygen desaturation index ［preoperation and postoperation: (20.1±16.6), (10.8±9.5), (8.5±7.2), (6.1±5.1)/h, F=9.646, P<0.05］ sustained improved. Aroual index ［preoperation and postoperation: (23.1±12.1), (2.7±3.8), (3.5±4.8), (2.2±2.1)/h, F=58.370, P<0.05］ presented overall downward trend. Pittsburgh Sleep Quality Index scale ［preoperation and postoperation: (11.1±3.2), (8.2±3.3), (6.0±3.8), (4.4±2.5), F=27.670, P<0.05］ were constantly improved. Epworth Sleepiness scale ［preoperation and postoperation: (13.3±5.7), (6.9±4.5), (8.2±4.8), (6.1±3.7), F=15.994, P<0.05］ showed overall reduction.Conclusion The sleep quality of patients with RVHD and CSA is improved after cardiac valve replacement, of which the trend is in keep with postoperative recovery of cardiac function.

Citation： QI Daoda, DING Ning, ZHANG Xilong, ZONG Feng. Cardiac valve replacement improves sleep quality in patients with rheumatic valvular heart disease and central sleep apnea. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(2): 144-149. doi: 10.7507/1671-6205.201804034 Copy

1.	Ding N, Ni BQ, Zhang XL, et al. Prevalence and risk factors of sleep disordered breathing in patients with rheumatic valvular heart disease. J Clin Sleep Med, 2013, 9(8): 781-787.
2.	Asker M, Asker S. Sleep apnea in patients with rheumatic mitral stenosis. J Heart Valve Dis, 2015, 24(3): 325-330.
3.	Ding N, Ni BQ, Zhang XL, et al. Elimination of central sleep apnea by cardiac valve replacement: a continuous follow-up study in patients with rheumatic valvular heart disease. Sleep Med, 2014, 15(8): 880-886.
4.	Sinha AM, Skobel EC, Breithardt OA, et al. Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure. J Am Coll Cardiol, 2004, 44(1): 68-71.
5.	Skobel EC, Sinha AM, Norra C, et al. Effect of cardiac resynchronization therapy on sleep quality, quality of life, and symptomatic depression in patients with chronic heart failure and Cheyne-Stokes respiration. Sleep Breath, 2005, 9(4): 159-166.
6.	Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA, 1992, 268(15): 2069-2073.
7.	Bonow R, Carablello B, Chatterjee K. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2008, 52(13): e1-e142.
8.	Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med, 2012, 8(5): 597-619.
9.	Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep, 1999, 22(5): 667-689.
10.	Ueno LM, Drager LF, Rodrigues AC, et al. Effects of exercise training in patients with chronic heart failure and sleep apnea. Sleep, 2009, 32(5): 637-647.
11.	Ferrier K, Campbell A, Yee B, et al. Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure. Chest, 2005, 128(4): 2116-2122.
12.	Schulz R, Blau A, Borgel J, et al. Sleep apnoea in heart failure. Eur Respir J, 2007, 29(6): 1201-1205.
13.	Atalla A, Carlisle TW, Simonds AK, et al. Sleepiness and activity in heart failure patients with reduced ejection fraction and central sleep-disordered breathing. Sleep Med, 2017, 34: 217-223.
14.	Buysse DJ, Reynolds CR, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res, 1989, 28(2): 193-213.
15.	ATS statement: guidelines for the six-minute walk test. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
16.	Bekfani T, Abraham WT. Current and future developments in the field of central sleep apnoea. Europace, 2016, 18(8): 1123-1134.
17.	Hanly P, Zuberi-Khokhar N. Daytime sleepiness in patients with congestive heart failure and Cheyne-Stokes respiration. Chest, 1995, 107(4): 952-958.
18.	Sin DD, Fitzgerald F, Parker J D, et al. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med, 1999, 160(4): 1101-1106.
19.	胡盛寿, 孙晓刚, 郭加强, 等. 2261 例二尖瓣及主动脉瓣联合瓣膜置换术临床结果与随访. 中华胸心血管外科杂志, 2002, 18(1): 11-13.
20.	Naughton MT. Loop gain in apnea: gaining control or controlling the gain?. Am J Respir Crit Care Med, 2010, 181(2): 103-105.
21.	Zuurbier LA, Luik AI, Leening MJ, et al. Associations of heart failure with sleep quality: the Rotterdam Study. J Clin Sleep Med, 2015, 11(2): 117-121.
22.	Edell-Gustafsson UM, Hetta JE, Aren CB. Sleep and quality of life assessment in patients undergoing coronary artery bypass grafting. J Adv Nurs, 1999, 29(5): 1213-1220.
23.	Suna JM, Mudge A, Stewart I, et al. The effect of a supervised exercise training programme on sleep quality in recently discharged heart failure patients. Eur J Cardiovasc Nurs, 2015, 14(3): 198-205.
24.	Cooper DC, Ziegler MG, Milic MS, et al. Endothelial function and sleep: associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep. J Sleep Res, 2014, 23(1): 84-93.
25.	Levy D, Larson MG, Vasan RS. The progression from hypertension to congestive heart failure. JAMA, 1996, 275(20): 1557-1562.

1. Ding N, Ni BQ, Zhang XL, et al. Prevalence and risk factors of sleep disordered breathing in patients with rheumatic valvular heart disease. J Clin Sleep Med, 2013, 9(8): 781-787.
2. Asker M, Asker S. Sleep apnea in patients with rheumatic mitral stenosis. J Heart Valve Dis, 2015, 24(3): 325-330.
3. Ding N, Ni BQ, Zhang XL, et al. Elimination of central sleep apnea by cardiac valve replacement: a continuous follow-up study in patients with rheumatic valvular heart disease. Sleep Med, 2014, 15(8): 880-886.
4. Sinha AM, Skobel EC, Breithardt OA, et al. Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure. J Am Coll Cardiol, 2004, 44(1): 68-71.
5. Skobel EC, Sinha AM, Norra C, et al. Effect of cardiac resynchronization therapy on sleep quality, quality of life, and symptomatic depression in patients with chronic heart failure and Cheyne-Stokes respiration. Sleep Breath, 2005, 9(4): 159-166.
6. Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA, 1992, 268(15): 2069-2073.
7. Bonow R, Carablello B, Chatterjee K. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol, 2008, 52(13): e1-e142.
8. Berry RB, Budhiraja R, Gottlieb DJ, et al. Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med, 2012, 8(5): 597-619.
9. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep, 1999, 22(5): 667-689.
10. Ueno LM, Drager LF, Rodrigues AC, et al. Effects of exercise training in patients with chronic heart failure and sleep apnea. Sleep, 2009, 32(5): 637-647.
11. Ferrier K, Campbell A, Yee B, et al. Sleep-disordered breathing occurs frequently in stable outpatients with congestive heart failure. Chest, 2005, 128(4): 2116-2122.
12. Schulz R, Blau A, Borgel J, et al. Sleep apnoea in heart failure. Eur Respir J, 2007, 29(6): 1201-1205.
13. Atalla A, Carlisle TW, Simonds AK, et al. Sleepiness and activity in heart failure patients with reduced ejection fraction and central sleep-disordered breathing. Sleep Med, 2017, 34: 217-223.
14. Buysse DJ, Reynolds CR, Monk TH, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res, 1989, 28(2): 193-213.
15. ATS statement: guidelines for the six-minute walk test. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002, 166(1): 111-117.
16. Bekfani T, Abraham WT. Current and future developments in the field of central sleep apnoea. Europace, 2016, 18(8): 1123-1134.
17. Hanly P, Zuberi-Khokhar N. Daytime sleepiness in patients with congestive heart failure and Cheyne-Stokes respiration. Chest, 1995, 107(4): 952-958.
18. Sin DD, Fitzgerald F, Parker J D, et al. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med, 1999, 160(4): 1101-1106.
19. 胡盛寿, 孙晓刚, 郭加强, 等. 2261 例二尖瓣及主动脉瓣联合瓣膜置换术临床结果与随访. 中华胸心血管外科杂志, 2002, 18(1): 11-13.
20. Naughton MT. Loop gain in apnea: gaining control or controlling the gain?. Am J Respir Crit Care Med, 2010, 181(2): 103-105.
21. Zuurbier LA, Luik AI, Leening MJ, et al. Associations of heart failure with sleep quality: the Rotterdam Study. J Clin Sleep Med, 2015, 11(2): 117-121.
22. Edell-Gustafsson UM, Hetta JE, Aren CB. Sleep and quality of life assessment in patients undergoing coronary artery bypass grafting. J Adv Nurs, 1999, 29(5): 1213-1220.
23. Suna JM, Mudge A, Stewart I, et al. The effect of a supervised exercise training programme on sleep quality in recently discharged heart failure patients. Eur J Cardiovasc Nurs, 2015, 14(3): 198-205.
24. Cooper DC, Ziegler MG, Milic MS, et al. Endothelial function and sleep: associations of flow-mediated dilation with perceived sleep quality and rapid eye movement (REM) sleep. J Sleep Res, 2014, 23(1): 84-93.
25. Levy D, Larson MG, Vasan RS. The progression from hypertension to congestive heart failure. JAMA, 1996, 275(20): 1557-1562.

Chinese Journal of Respiratory and Critical Care Medicine

Cardiac valve replacement improves sleep quality in patients with rheumatic valvular heart disease and central sleep apnea

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content