Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case report
Abstract Background Adaptive support ventilation (ASV) is a proposed treatment option for central sleep apnea (CSA). Although the effectiveness of ASV remains unclear, some studies have reported promising results regarding the use of ASV in patients with heart failure with preserved ejection fractio...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-01-01
|
| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-021-02743-4 |
| _version_ | 1819008455920320512 |
|---|---|
| author | Yuriko Hajika Yuji Kawaguchi Kenji Hamazaki Yasuro Kumeda |
| author_facet | Yuriko Hajika Yuji Kawaguchi Kenji Hamazaki Yasuro Kumeda |
| author_sort | Yuriko Hajika |
| collection | DOAJ |
| description | Abstract Background Adaptive support ventilation (ASV) is a proposed treatment option for central sleep apnea (CSA). Although the effectiveness of ASV remains unclear, some studies have reported promising results regarding the use of ASV in patients with heart failure with preserved ejection fraction (HfpEF). To illustrate the importance of suspecting and diagnosing sleep-disordered breathing (SDB) in older adults unable to recognize symptoms, we discuss a case in which ASV was effective in a patient with CSA and HfpEF, based on changes in the Holter electrocardiogram (ECG). Case presentation. An 82-year-old man presented to our hospital with vomiting on April 19, 2021. Approximately 10 years before admission, he was diagnosed with type 1 diabetes mellitus and recently required full support from his wife for daily activities due to cognitive dysfunction. Two days before admission, his wife was unable to administer insulin due to excessively high glucose levels, which were displayed as “high” on the patient’s glucose meter; therefore, we diagnosed the patient with diabetic ketoacidosis. After recovery, we initiated intensive insulin therapy for glycemic control. However, the patient exhibited excessive daytime sleepiness, and numerous premature ventricular contractions were observed on his ECG monitor despite the absence of hypoglycemia. As we suspected sleep-disordered breathing (SDB), we performed portable polysomnography (PSG), which revealed CSA. PSG revealed a central type of apnea and hypopnea due to an apnea–hypopnea index of 37.6, which was > 5. Moreover, the patient had daytime sleepiness; thus, we diagnosed him with CSA. We performed ASV and observed its effect using portable PSG and Holter ECG. His episodes of apnea and hypopnea were resolved, and an apparent improvement was confirmed through Holter ECG. Conclusion Medical staff should carefully monitor adult adults for signs of or risk factors for SDB to prevent serious complications. Future studies on ASV should focus on older patients with arrhythmia, as the prevalence of CSA may be underreported in this population and determine the effectiveness of ASV in patients with HfpEF, especially in older adults. |
| first_indexed | 2024-12-21T00:40:45Z |
| format | Article |
| id | doaj.art-2d0df26b982e4adfb6614686d7b88635 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-12-21T00:40:45Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-2d0df26b982e4adfb6614686d7b886352022-12-21T19:21:40ZengBMCBMC Geriatrics1471-23182022-01-012211510.1186/s12877-021-02743-4Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case reportYuriko Hajika0Yuji Kawaguchi1Kenji Hamazaki2Yasuro Kumeda3Department of Internal Medicine, Minami Osaka HospitalDepartment of Internal Medicine, Minami Osaka HospitalDepartment of Internal Medicine, Minami Osaka HospitalDepartment of Internal Medicine, Minami Osaka HospitalAbstract Background Adaptive support ventilation (ASV) is a proposed treatment option for central sleep apnea (CSA). Although the effectiveness of ASV remains unclear, some studies have reported promising results regarding the use of ASV in patients with heart failure with preserved ejection fraction (HfpEF). To illustrate the importance of suspecting and diagnosing sleep-disordered breathing (SDB) in older adults unable to recognize symptoms, we discuss a case in which ASV was effective in a patient with CSA and HfpEF, based on changes in the Holter electrocardiogram (ECG). Case presentation. An 82-year-old man presented to our hospital with vomiting on April 19, 2021. Approximately 10 years before admission, he was diagnosed with type 1 diabetes mellitus and recently required full support from his wife for daily activities due to cognitive dysfunction. Two days before admission, his wife was unable to administer insulin due to excessively high glucose levels, which were displayed as “high” on the patient’s glucose meter; therefore, we diagnosed the patient with diabetic ketoacidosis. After recovery, we initiated intensive insulin therapy for glycemic control. However, the patient exhibited excessive daytime sleepiness, and numerous premature ventricular contractions were observed on his ECG monitor despite the absence of hypoglycemia. As we suspected sleep-disordered breathing (SDB), we performed portable polysomnography (PSG), which revealed CSA. PSG revealed a central type of apnea and hypopnea due to an apnea–hypopnea index of 37.6, which was > 5. Moreover, the patient had daytime sleepiness; thus, we diagnosed him with CSA. We performed ASV and observed its effect using portable PSG and Holter ECG. His episodes of apnea and hypopnea were resolved, and an apparent improvement was confirmed through Holter ECG. Conclusion Medical staff should carefully monitor adult adults for signs of or risk factors for SDB to prevent serious complications. Future studies on ASV should focus on older patients with arrhythmia, as the prevalence of CSA may be underreported in this population and determine the effectiveness of ASV in patients with HfpEF, especially in older adults.https://doi.org/10.1186/s12877-021-02743-4Sleep-disordered breathingCentral sleep apneaElectrocardiographyPremature ventricular contractionAdaptive support ventilationHeart failure with preserved ejection fraction |
| spellingShingle | Yuriko Hajika Yuji Kawaguchi Kenji Hamazaki Yasuro Kumeda Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case report BMC Geriatrics Sleep-disordered breathing Central sleep apnea Electrocardiography Premature ventricular contraction Adaptive support ventilation Heart failure with preserved ejection fraction |
| title | Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case report |
| title_full | Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case report |
| title_fullStr | Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case report |
| title_full_unstemmed | Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case report |
| title_short | Adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction: a case report |
| title_sort | adaptive support ventilation as an effective treatment option for central sleep apnea in an older adult with heart failure with preserved ejection fraction a case report |
| topic | Sleep-disordered breathing Central sleep apnea Electrocardiography Premature ventricular contraction Adaptive support ventilation Heart failure with preserved ejection fraction |
| url | https://doi.org/10.1186/s12877-021-02743-4 |
| work_keys_str_mv | AT yurikohajika adaptivesupportventilationasaneffectivetreatmentoptionforcentralsleepapneainanolderadultwithheartfailurewithpreservedejectionfractionacasereport AT yujikawaguchi adaptivesupportventilationasaneffectivetreatmentoptionforcentralsleepapneainanolderadultwithheartfailurewithpreservedejectionfractionacasereport AT kenjihamazaki adaptivesupportventilationasaneffectivetreatmentoptionforcentralsleepapneainanolderadultwithheartfailurewithpreservedejectionfractionacasereport AT yasurokumeda adaptivesupportventilationasaneffectivetreatmentoptionforcentralsleepapneainanolderadultwithheartfailurewithpreservedejectionfractionacasereport |