Central Apnea in Heart Failure: Physiological Mechanisms to Inform Treatment
VA Office of Research and Development
Summary
Central sleep apnea (CSA) is common in patients with heart failure and those using opioid analgesics. Unfortunately, effective treatment of central apnea remains elusive, pressure therapy given the modest efficiency of positive airway pressure therapy. The focus of this proposal is to identify mechanistic pathways to guide future therapeutic interventions for central sleep apnea based on the strong premise that multi-modality therapy will normalize respiration and hence mitigate adverse long-term consequences of CSA. The investigators' proposed studies will test combination therapies, including positive airway pressure (PAP) plus a pharmacological agent who have heart failure or are using opioid analgesics. The investigators anticipate that findings will inform future clinical trials to improve care and quality of life among Veterans suffering from central sleep apnea, which remains difficult to treat using existing approaches.
Description
The objective in this project is to test mechanistic pathways to inform future clinical studies investigating the potential treatment of central sleep apnea (CSA) in Veterans with heart failure and reduced ejection fraction (HF). The long-term goal is to transform the care of Veterans living with these two conditions. The investigators will test two key determinants of recurrent CSA in Veterans with HF: augmented peripheral chemoreceptor activity and respiratory arousals. Specifically, the project will utilize a novel PAP plus approach, combining PAP therapy to alleviate upper airway obstructi…
Eligibility
- Age range
- 18+ years
- Sex
- All
- Healthy volunteers
- Yes
Inclusion Criteria: * Men and Women Veterans with central sleep apnea, defined as Apnea Hypopnea Index (AHI)\>15/hour with CAHI\>5/hour, will be included with the experiments. * Those with chronic, stable heart failure with reduced ejection fraction, receiving stable optimized guideline-based therapy and no hospitalizations or change in the medical regimen for the past 90 days before enrollment. Exclusion Criteria: * less than 18 years old * pregnant or breastfeeding females * moderate or severe obstructive or restrictive lung disease, including supplemental o2 use * current treatment for C…
Interventions
- DrugTrazodone + PAP therapy
The central apnea index and the apneic threshold will be compared under two conditions: trazodone or placebo. In addition, participants will get PAP therapy during both the conditions.
- DrugOxygen + PAP therapy
The central apnea index and the apneic threshold will be compared under two conditions: oxygen or room air. In addition, participants will get PAP therapy during both the conditions.
Location
- John D. Dingell VA Medical Center, Detroit, MIDetroit, Michigan