Penn Researchers to Lead Study on Sleep Apnea's Effects
on Heart Physiology
(Philadelphia,
PA) - Many people feel beat without a good night's sleep,
but for some folks, it may be their heart that's taking
a beating. Researchers at the University of Pennsylvania
Medical Center are leading a comprehensive multi-center
clinical trial in the treatment of central sleep apnea
and exploring its relationship with congestive heart
failure (CHF). The trial is not only a test of an innovative
new continuous positive airway pressure (CPAP) device
but it is also the examination of heart physiology during
episodes of sleep apnea.
"In this study, we are looking how to treat CHF
patients with a unique CPAP device designed to automatically
respond to their breathing patterns," Lee Goldberg,
MD, MPH, assistant professor of medicine in the Penn
Heart Failure and Cardiac Transplant Program. "Since
heart failure patients often develop central sleep apnea,
we also want to learn more about the physiology of the
disorder and how it can exacerbate their condition "
The term congestive heart failure describes the state
of a person with a weakened heart - whether it is due
to age, a heart attack, coronary disease, or a number
of other conditions. As a result, the heart is not strong
enough to pump enough blood throughout the body, leading
to shortness of breath and fatigue. Sufferers also retain
fluids in their limbs due to the lack of blood flow,
hence the term 'congestive.' It is the decreased blood
flow, in fact, that can lead to developing central sleep
apnea.
There are two forms of sleep apnea, obstructive and
central. Just as it sounds, obstructive sleep apnea
is caused when the muscles of the throat relax, obstructing
the airway. Central sleep apnea, however, is caused
as chemical sensors in the brain confuse a rise in carbon
dioxide in the blood (due to low blood volume) with
hyperventilation. In response, the brain sends a signal
to the lungs, which tells them to slow breathing.
"This often jolts the patient awake, ruining a
good night's sleep and delivering a shot of adrenaline
to an already-weakened heart," explained Goldberg.
"The lack of sleep also makes simple tasks difficult
- balancing a checkbook suddenly becomes more difficult
than plotting a moon landing."
One of the most useful treatments of central sleep apnea
involves CPAP systems, which deliver air through a small
mask that covers the nose. The constant pressure keeps
the airway open, which prevents both snoring and episodes
of apnea. ResMed Inc.'s AutoSetÓ CS, which the
researchers are studying in this trial, is different
from similar devices in that it monitors the patient's
breathing on a breath-by-breath basis and automatically
adjusts the pressure as required. Therefore, the user
receives the minimum amount of pressure they need for
effective therapy.
"Since CPAPs must stay on all night, patients find
them to be uncomfortable - like heavy breath being blown
into their face all night - and find reasons not to
use CPAP therapy," said Allan Pack, MD, PhD co-lead
investigator and director of Penn's Center for Sleep
and Respiratory Neurobiology. "According to the
manufacturers, the advantage of the AutoSet CS device
is that it only turns on when you need it, which we
hope will lead to better compliance with the therapy."
Pack and Goldberg are looking to enlist 200 CHF patients
nationwide, coordinating efforts with colleagues at
five other locations throughout the United States. While
they can use the CPAP at home, the patients would be
required to spend the night at the Center for Sleep
and Respiratory Neurobiology on four separate occasions
throughout the study. In addition to receiving the treatment
at no cost, patients will also be compensated for travel
expenses.
Volunteers or referring physicians can call (215) 615-0800
to receive more information.
Funding for this study is provided by the National Institutes
on Health and ResMed, Inc.
"Speaking as a cardiologist, we find this type
of work especially rewarding," said Goldberg. "Not
only do we have a way to easily increase a patient's
quality of life, but we also get to delve into a new
way of looking at the physiology of the heart and its
relationship with the other organs."
# # #
Editor's Note: Neither Dr. Pack nor Dr. Goldberg have
any financial interest in ResMed, Inc.
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