o desafio da apneia central do sono elizabeth rosa e silva hospital santa lúcia

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O Desafio da Apneia Central do Sono

Elizabeth Rosa e Silva

Hospital Santa Lcia

Apneia Central do SonoConceitoFisiopatologiaRespirao de Cheyne StokesCasos clnicosTratamentoConclusesApneia Central do SonoConceitoFisiopatologiaRespirao de Cheyne StokesCasos clnicosTratamentoConclusesFigure 1. Polysomnographic recordings of central and obstructive hypopneas from patients with heart failure with use of respiratory inductance plethysmography (RIP). The upper panel shows a central hypopnea during stage 2 sleep in a patient who has Cheyne-Stokes respiration with central sleep apnea. Note in-phase gradual waxing and waning of tidal volume during hyperpnea, and only minimal O2 desaturation during hypopnea. Arousal occurs several breaths after termination of the hypopnea. The lower panel shows an obstructive hypopnea in a patient with obstructive sleep apnea. Note that in contrast to central hypopnea, rib cage and abdominal motion are out-of-phase and O2 desaturation is greater during hypopnea, the rise in ventilation following its termination is more abrupt and hyperpneas are shorter. In addition, arousals occur earlier at hypopnea termination. EEG = electroencephalogram; EKG = electrocardiogram; EMGsm = submental electromyogram; EMGat = anterior tibial EMG; EOG = electrooculogram. Arrows () indicate arousals.Proc Am Thorac Soc, Published in: Dai Yumino; T. Douglas Bradley; Proc Am Thorac Soc 2008, 5, 226-236. 2008 The American Thoracic Society

APNEIA CENTRAL4Apneia Central do SonoConceitoFisiopatologiaRespirao de Cheyne StokesCasos clnicosTratamentoConclusesFigure 2. Polysomnographic recordings demonstrating differences in periodic breathing patterns between a patient with and without heart failure (HF). The upper panel shows a recording from a patient with idiopathic central sleep apnea (ICSA) during stage 2 sleep. Apnea length (AB) is 18 seconds, hyperpnea length (BD) is 7 seconds, and cycle length (AD) is 25 seconds. C represents the nadir of SaO2 (arterial oxygen saturation), detected by an oximeter placed on the ear in close proximity to the carotid body chemoreceptors. From the end of apnea (B) to the nadir in SaO2 (C) is the lung-to-ear circulation time (BC), which is 8 seconds and approximates lung-to-carotid body circulation time. The lower panel is a recording from a patient with HF and Cheyne-Stokes respiration with central sleep apnea (CSR-CSA) during stage 2 sleep. Compared with the patient with ICSA, lung-to-ear circulation time (BC = 26 s), hyperpnea (BD = 46 s), and cycle lengths (AD = 65 s) are substantially longer. However, apnea length (AB = 21 s) is similar. Abbreviations are the same as for Figure 1. Adapted by permission from Reference 28.

Proc Am Thorac Soc, Published in: Dai Yumino; T. Douglas Bradley; Proc Am Thorac Soc 2008, 5, 226-236. 2008 The American Thoracic Society

6Figure 3. Pathophysiologic scheme of CSR-CSA in heart failure. BP = blood pressure; HR = heart rate; SNA = sympathetic nervous system activity. Modified by permission from Reference 93.

Proc Am Thorac Soc, Published in: Dai Yumino; T. Douglas Bradley; Proc Am Thorac Soc 2008, 5, 226-236. 2008 The American Thoracic Society

Fisiopatologia AC-CSPAO2 = PiO2-PaCO2

PaO27Apneia Central do SonoCheyne Stokes

Apneia Central Cheyne-Stokes Comum em IVE (Instabilidade sistema respiratrio) Congesto Pulmonar Sensibilidade - receptor perifrico e central Fluxo sanguneo cerebral Outros fatores?

Dai YuminoandT. Douglas Bradley"Central Sleep Apnea and Cheyne-Stokes Respiration",Proceedings of the American Thoracic Society, Vol.5, No.2(2008), pp. 226-236.Apneia Central do SonoConceitoFisiopatologiaRespirao de Cheyne StokesCasos clnicosTratamentoConclusesPSG DATAIAHACAOREMDIAG20/06/201236/h19113...BIPAP13/07/201218/hAC-CS......CPAP16/10/201232/h10141%SV19/03/20130/h0027%JAR, 82 anosDPOC, Hipertenso, Aneurisma de Aorta

JAR, 82 anosDPOC, Hipertenso, Aneurisma de Aorta

IAH 32/h

16/10/12

CPAP


IAH 32/h

16/10/12

CPAP


CPAP IAH 32/h

16/10/12


CPAP - IAH 32/h

16/10/12


SV - IAH 0/h

19/03/13

JAR , 82 anosDPOC, Hipertenso, Aneurisma de Aorta

SV - IAH 0/h

19/03/13

IBF, 60 anosArritmia cardaca, Sndrome de resistncia insulina,Hipotiroidismo

PSG DATAIAHACAO-AM HIPOREMSpO2DIAG08/04/201548/h17814613%16%CPAP10/06/20153/h71730%1%

08/04/15IBF, 60 anosArritmia cardaca, Sndrome de resistncia insulina,Hipotiroidismo

DIAG


DIAG

08/04/15


08/04/15


08/04/15


PSG DATAIAHACAO-AM HIPOREMSpO2DIAG08/04/201548/h17814613%16%CPAP10/06/20153/h71730%1%


CPAP

10/06/15

PSG DATAIAHACAO-AM HIPOREMSpO2DIAG29/06/200729/h.........18%CPAP / BIPAP17/04/201456/h290911%1%SV03/07/20147/h29315%0%RBP, 59 anos (2014)Arritmia cardaca, Diabete, Dislipidemia

RBP, 59 anos (2014)Arritmia cardaca, Diabete, Dislipidemia

CPAP / BIPAP IAH 56/h

17/04/14

03/07/14RBP, 59 anos (2014)Arritmia cardaca, Diabete, Dislipidemia

SV IAH 7/h

Apneia Central do SonoConceitoFisiopatologiaRespirao de Cheyne StokesCasos clnicosTratamentoConcluses

n engl j med 353;19 www.nejm.org november 10, 2005The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure (CANPAP) 204 pacientes

The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure (CANPAP)

The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure (CANPAP) TratamentoCPAP

Reduz o IAH em ACAumenta a frao de ejeo ICC c/ AC-CSReduz a mortalidadeMelhora a oxigenao noturnaDiminui os nveis de norepinefrinaTeste de caminhadaTratamentoEspao morto (VD)400ml a 800ml VD Aumenta a reinalao de CO2 Acima do limiar de apneia

Precauo : VD e CO2 Piora da apneia obstrutiva PaCO2 de 1,5 a 2,0 mm Hg Estabilizar o padro respiratrioTratamentoSV (Servo Ventilator)Superior ao CPAPMelhora a arquitetura do sonoMelhora a sonolncia diurnaComo CPAP e corrige o IAHAumenta a SpO2Reduz a frequncia cardaca Melhora os nveis de BNP

TratamentoOXIGNIO Melhora FE Atenua a reposta hiperventilatria

MARCAPASSO IAH em 60% pacientes com bradicardia sinusal sintomtico Apneia Central do SonoConceitoFisiopatologiaRespirao de Cheyne StokesCasos clnicosTratamentoConclusesCONCLUSES

Apneia Central do Sono

causada por instabilidade do controle da respirao por tendncia hiperventilao. frequente em pacientes com insuficincia cardaca e quando associada CS, sugere pior prognstico.Os pacientes podem se beneficiar do tratamento com CPAP, SV, Aumento do VD, O2.

o desafio da apneia central do sono elizabeth rosa e silva hospital santa lúcia

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