Keeping a finger on the pulse of a good night’s rest with a device for sleep apnea

Patients with heart failure and sleep apnea may benefit from a smart machine that regulates air pressure.

Sleep apnea affects millions of people worldwide, and while airway support machines can effectively help treat many with the condition, more research is needed to determine the best intervention for individuals with both sleep apnea and heart failure.

“Heart failure can cause sleep apnea or sleep apnea can lead to high blood pressure, heart attack and stroke,” explains Vancouver Coastal Health Research Institute researcher Dr. John Fleetham. 

"Sleep apnea is as common and as detrimental to one’s health as high blood pressure or diabetes," says Fleetham.

Fleetham is the principal investigator of a multi-centre randomized clinical trial studying an airway support machine for patients with sleep apnea and heart failure. This research examines the impact of Adaptive Servo Ventilation (ASV) technology on pauses in breathing. 

“Our research will determine if ASV improves breathing and reduces hospitalizations and mortality among patients with both conditions.”

Similar to other airway support machines, ASV machines produce positive airway pressure to improve patients’ breathing. However, ASV is also embedded with smart technology that regulates air pressure, depending on a patient’s breathing pattern. 

The adaptive air pressure of ASV is critical for heart patients, who often have what is called Cheyne-Stokes breathing, which is characterized by increases and decreases in breathing rate, and periods of stopping breathing throughout a person’s sleep. 

This condition differs from obstructive sleep apnea—the most common type of sleep apnea—when the muscles at the back of the throat collapse and obstruct a person’s airway. Obstructive sleep apnea can often be resolved with Continuous Positive Airway Pressure (CPAP) machines that retain a constant level of air pressure.

A growing problem with widespread consequences

Sleep apnea can have a profound impact on everything from sleep quality to job performance, memory, overall health and longevity. It is also a risk factor for cancer, perioperative mortality and car accidents, notes Fleetham.

The end point of combined sleep apnea and heart failure is often a heart transplant or premature death, he adds.

“Sleep apnea is similar to having a pillow placed over your face more than 30 times per hour throughout your sleep.” 

With self-reported rates of sleep apnea on the rise in Canada—increasing from three per cent of Canadians ages 18 and older in 2009 to 6.4 per cent in 2016/2017, more research is needed to fill in knowledge gaps and validate treatment interventions.

“If our hypothesis is correct, people with heart failure who use ASV will live longer,” says Fleetham. “This will likely be because the machine will help relieve the stress on the body caused by interrupted breathing and oxygen deprivation.” 

Dr. John Fleetham is head of the VCH Sleep Disorder Programs and a professor of medicine at the University of British Columbia.

ASV machines can cost almost three times more than other types of airway support machines, making it crucial to have clear evidence to back up claims of its effectiveness for people with sleep apnea and heart failure. 

“Research into sleep apnea really only began developing 30 years ago,” states Fleetham. “Now, because of the size of the problem and thanks to advances in medical technology, there is greater urgency and potential for research and new treatment interventions.”

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