Interrelated atrial fibrillation and leaks triggering and maintaining central sleep apnoea and periodic breathing in a CPAP-treated patient.
Arnaud PrigentAnne-Laure SerandourRégis LuraineJean Sébastien PoineufChristian BosseauJean-Louis PépinPublished in: Respirology case reports (2020)
We report the case of a 71-year-old obese continuous positive airway pressure (CPAP)-treated man who developed an acute cardiac failure (ACF) triggered by atrial fibrillation. CPAP data downloaded from the CPAP software (Rescan®) retrospectively demonstrated the progressive development of a high residual central apnoea-hypopnoea index (AHI) with Cheyne-Stokes respiration (CSR). The AHI decreased after cardioversion allowing normalization of cardiac rhythm and function. Raw data extracted from CPAP software showed a gradual decrease in the periodic breathing cycle length related to a simultaneous improvement in left ventricular ejection fraction (LVEF) after cardioversion. During this clinical period of respiratory instability in the presence of cardiac failure, CSR episodes were exacerbated by ventilation overshoots followed by micro-arousals induced by leaks. This might explain the high night to night variability of CSR occurrence in susceptible patients with impaired cardiac function. Beyond attempts to improve cardiac function, leak reduction might represent an important target for CSR management.
Keyphrases
- positive airway pressure
- atrial fibrillation
- obstructive sleep apnea
- sleep apnea
- left ventricular
- ejection fraction
- left atrial
- aortic stenosis
- catheter ablation
- oral anticoagulants
- heart failure
- left atrial appendage
- direct oral anticoagulants
- electronic health record
- data analysis
- type diabetes
- respiratory failure
- sleep quality
- percutaneous coronary intervention
- risk assessment
- big data
- multiple sclerosis
- mitral valve
- cardiac resynchronization therapy
- liver failure
- acute myocardial infarction
- adipose tissue
- heart rate
- fluorescent probe
- deep learning
- bariatric surgery
- acute respiratory distress syndrome
- mechanical ventilation
- intensive care unit
- weight loss
- drug induced
- obese patients
- coronary artery disease
- machine learning
- extracorporeal membrane oxygenation
- artificial intelligence