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Respir Physiol Neurobiol. 2018 Jan;247:181-187. doi: 10.1016/j.resp.2017.10.010. Epub 2017 Nov 2.

Microstructural cerebral lesions are associated with the severity of central sleep apnea with Cheyne-Stokes-respiration in heart failure and are modified by PAP-therapy.

Author information

1
Department of Neurology, University Hospital of Muenster, Muenster, Germany; Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany.
2
Department of Neurology, University Hospital of Muenster, Muenster, Germany; Department of Sleep Medicine and Neuromuscular Disorders, University Hospital Muenster, Germany; Department of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Duesseldorf, Duesseldorf, Germany. Electronic address: jens.spiesshoefer@gmail.com.
3
Department of Cardiovascular Medicine, Division of Cardiology, University Hospital Muenster, Germany.
4
Department of Neurology, University Hospital of Muenster, Muenster, Germany.

Abstract

This study investigated the association of microstructural cerebral lesions with central sleep apnea with Cheyne-Stokes-respiration (CSA-CSR) in heart failure (HF) patients and the effect of positive airway pressure therapy (PAP) of CSA-CSR on these lesions. PAP-therapy was initiated in patients with HF with midrange and with reduced ejection fraction (NYHA≥II; left ventricular ejection fraction <50%) and proven CSA-CSR. Cerebral magnetic resonance imaging (MRI) scans at 3T including diffusion tensor imaging were obtained before and after 4 months of PAP-therapy. Cerebral MRI scans revealed microstructural lesions in all 11 patients with HF with midrange or reduced ejection fraction and CSA-CSR (64±8years, 82% male, left ventricular ejection fraction 37±11%) that were focussed on the brainstem and frontal cerebral regions. This microstructural damage correlated with the severity of CSA-CSR and 4 months of PAP-therapy lead to voxel clusters of altered fiber integrity in these lesions. Microstructural cerebral lesions might contribute to the pathophysiology of CSA-CSR in HF. In these patients PAP-therapy induces neuronal plasticity.

KEYWORDS:

Brainstem lesions; Cheyne-Stokes respiration; Heart failure; Positive airway pressure therapy; Respiratory control

PMID:
29102807
DOI:
10.1016/j.resp.2017.10.010
[Indexed for MEDLINE]

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