Changes in the Objective Measures of Sleep in Association with Menses Among Female Athletes with Poor Subjective Sleep Quality: Female Athletes with Poor Subjective Sleep Quality Have More Sleep Arousals During Menses.

Purpose: Female athletes with menstrual abnormalities have poor sleep quality. However, whether female athletes with poor sleep quality based on subjective assessment have distinctive changes in objective measures of sleep in association with menses remains unclear. This study aimed to compare changes in objective sleep measurements during and following menses between collegiate female athletes with and without poor subjective sleep quality. Patients and Methods: Female collegiate athletes (age range/mean ± standard deviation: 18-22/ 22.2±1.1) with regular menstrual cycles were recruited. The participants underwent home electroencephalogram monitoring during the first and second nights after the onset of menses and one night between the seventh and 10th nights after menses onset (mid-follicular phase). The Pittsburgh Sleep Quality Index (PSQI) was used to assess the subjective sleep quality. Interactions between the presence of poor subjective sleep quality (ie, PSQI ≥6) and changes in objective measures of sleep in association with menses were analyzed. Results: Data of 45 athletes, including 13 with poor subjective sleep quality, showed that changes in arousal index in athletes with poor subjective sleep quality were distinctive from those in athletes without poor subjective sleep quality (p = 0.036 for interaction). In athletes with poor subjective sleep quality, the arousal index was significantly increased in menses (p for analysis of variance, 0.015), especially on the first night after the onset of menses compared with during the mid-follicular phase (p = 0.016). Conclusion: Collegiate female athletes with regular menstrual cycles are likely to have poor subjective sleep quality in association with more frequent arousal during the first night after the onset of menses than during the mid-follicular phase.

Impact of sleep-disordered breathing on overnight changes in arterial stiffness in patients with acute heart failure.

Overnight increases in arterial stiffness associated with sleep-disordered breathing may adversely affect patients with acute heart failure. Thus, we investigated overnight changes in arterial stiffness and their association with sleep-disordered breathing in patients hospitalized for acute heart failure. Consecutive patients with acute heart failure were enrolled. All participants underwent overnight full polysomnography following the initial improvement of acute signs and symptoms of acute heart failure. The arterial stiffness parameter, cardio-ankle vascular index (CAVI), was assessed before and after polysomnography. Overall, 60 patients (86.7% men) were analyzed. CAVI significantly increased overnight (from 8.4 ± 1.6 at night to 9.1 ± 1.7 in the morning, P < 0.001) in addition to systolic and diastolic blood pressure (from 114.1 mmHg to 121.6 mmHg, P < 0.001; and from 70.1 mmHg to 78.2 mmHg, P < 0.001, respectively). Overnight increase in CAVI (ΔCAVI ≥ 0) was observed in 42 patients (70%). The ΔCAVI ≥ 0 group was likely to have moderate-to-severe sleep-disordered breathing (i.e., apnea-hypopnea index ≥15, 55.6% vs 80.9%, P = 0.047) and greater obstructive respiratory events (29.4% vs 58.5%, P = 0.041). In multivariable analysis, moderate-to-severe sleep-disordered breathing and greater obstructive respiratory events were independently correlated with an overnight increase in CAVI (P = 0.033 and P = 0.042, respectively). In patients hospitalized for acute heart failure, arterial stiffness, as assessed by CAVI, significantly increased overnight. Moderate-to-severe sleep-disordered breathing and obstructive respiratory events may play an important role in the overnight increase in cardio-ankle vascular index.

Impact of radiotherapy for head and neck cancer on obstructive sleep apnea: a prospective study.

BACKGROUND: In recent years, a relatively high prevalence of obstructive sleep apnea (OSA) in patients following radiotherapy (RT) for head and neck cancer (HNC) has been reported; however, little is known regarding the impact of RT on sleep disorders and the underlying mechanisms. This aim of this study was to elucidate the pathogenesis of OSA by comparing the clinical and sleep test parameters and magnetic resonance imaging (MRI) findings before and after HNC treatment with radiation. METHODS: This prospective study included patients scheduled for RT with or without chemotherapy or bioradiotherapy for HNC. Patients diagnosed with HNC between May 2017 and August 2020 were consecutively recruited. The results of the sleep tests were analyzed both before and after treatment. The clinical characteristics of the patients and cephalometric and MRI parameters were also measured. RESULTS: First, a total of 32 patients (64.8±11.8 years old; BMI, 22.7±3.6 kg/m2) underwent pre-treatment sleep tests. The prevalence of OSA [apnea hypopnea index (AHI) ≥5] in these patients was 81.3% (26 patients) before treatment, and the mean AHI was 20.8±19.0 events/hr. Next, 21 patients performed a sleep test both before and after treatment. Regarding subjective symptoms, there were no significant differences in the Epworth Sleepiness Scale (ESS) (P=0.142) or Pittsburgh Sleep Quality Index (PSQI) (P=0.935) after treatment; however, the BMI and neck circumference significantly decreased after treatment (P<0.0001 and P=0.0001, respectively). The incidence of OSA in these patients was 81.0% (17 patients) before treatment and 85.7% (19 patients) after treatment (P=1.0). Overall, the AHI was not significantly different, changing only from 14.5 to 14.9 after treatment (P=0.147). The MRI parameters showed that the retroglossal pharyngeal area increased significantly after treatment (P=0.007). CONCLUSIONS: This study found that the prevalence of OSA before and after RT for HNC was higher than that in the normal population, despite a significant decrease in BMI and increase in the retroglossal pharyngeal area after treatment. We suggest that physicians who manage patients with HNC should consider the occurrence of OSA before and after treatment.

Evaluation of Sleep Parameters and Sleep Staging (Slow Wave Sleep) in Athletes by Fitbit Alta HR, a Consumer Sleep Tracking Device.

Purpose: Sleep is an essential factor for athletes, and it is important to intervene in sleep to manage it. We need a device that can evaluate sleep easily and constantly. Consumer wearable devices can be useful tools for athletes. In order to use consumer wearable devices in clinical research, it is essential to conduct a validation study. Thus, we conducted a validation study to assess the Fitbit Alta HRTM (FBA)- a consumer wearable device with an accelerometer and a heart rate monitor to detect sleep stages and quality against electroencephalographic (EEG) studies in athletes. Patients and Methods: Forty college athletes participated in the study. EEG was applied to participants simultaneously while wearing FBA. Results: Regarding sleep parameters, there was a strong correlation between the total sleep time (TST)-EEG and the TST-Fitbit (r = 0.83; p < 0.001). Regarding the sleep stages, there was a modest correlation between the N3 sleep-EEG and the N3 sleep-Fitbit (r = 0.68; p < 0.001). In addition, there was a strong correlation between the percentage of N3 sleep in between sleep onset and initial rapid eye movement sleep-EEG and those on Fitbit (r = 0.73; p < 0.001). Conclusion: These results demonstrate that FBA facilitates sleep monitoring and exhibits acceptable agreement with EEG. Therefore, FBA is a useful tool in athletes' sleep management.

Severe obstructive sleep apnea after concurrent chemoradiotherapy for laryngeal and hypopharyngeal cancer managed by CPAP.

Concurrent chemoradiotherapy (CCRT) is one of the most promising treatments for advanced head and neck cancer (HNC). On the other hand, CCRT may induce severe edema in laryngo-pharyngeal structures in association with radiation. This is a report of a 66-year-old man with severe obstructive sleep apnea (OSA) associated with edema in laryngo-hypopharynx after CCRT for advanced laryngeal and hypopharyngeal cancer. Tracheostomy was avoided and OSA was controlled by continuous positive airway pressure (CPAP). Subjective symptoms of sleepiness were improved. Though laryngeal edema appeared during the course of CCRT in this case, OSA was not evaluated until snoring had been pointed out and he complained of sleepiness. CCRT for laryngeal and hypopharyngeal cancer have a risk of occurrence of OSA due to irreversible mucous edema in the upper airway. Patients for whom CCRT is planned should be informed about the occurrence of OSA before the treatment because symptoms associated with OSA can negatively impact not only the daytime quality of life but also increase the risk of cardiovascular events. The OSA treatment for post CCRT would be expected to have a positive impact on not only cardiovascular and metabolic systems but also on the cancer treatment survival rate.

The relationship between body composition and sleep architecture in athletes.

Sleep is essential for athletes to recover physical fitness. It has been suggested that sleep is affected by muscle volume. Compared to female athletes, male athletes with greater muscle volume may have inferior objective sleep quality. This study aimed to assess the relationship between body composition and objective sleep parameters in male and female athletes. The body composition of 17 male and 19 female collegiate athletes were measured, and they underwent overnight home sleep monitoring. Compared with female athletes, male athletes had more muscle mass and less fat mass. Moreover, male athletes had lower sleep efficiency, longer sleep onset latency, higher arousal index, less rapid eye movement (REM) sleep, and lower percentage of slow-wave (N3) sleep in the initial non-REM sleep. Furthermore, the percentage of muscle mass was inversely related, whereas fat mass or percentage of fat mass was directly related to the percentage of N3 sleep in the initial non-REM sleep. Overall, there were no significant association between sex and sleep parameters. However, a significant correlation was found within both subgroups. Objective sleep quality was suggested to be worse in male athletes than in female athletes, implying that sleep architecture may be related to the muscle volume.

Lung-to-finger circulation time can be measured stably with high reproducibility by simple breath holding method in cardiac patients.

Lung to finger circulation time (LFCT) has been used to estimate cardiac function. We developed a new LFCT measurement device using a laser sensor at fingertip. We measured LFCT by measuring time from re-breathing after 20 s of breath hold to the nadir of the difference of transmitted red light and infrared light, which corresponds to percutaneous oxygen saturation. Fifty patients with heart failure were enrolled. The intrasubject stability of the measurement was assessed by the intraclass correlation coefficient (ICC). The ICC calculated from 44 cases was 0.85 (95% confidence interval: 0.77-0.91), which means to have "Excellent reliability." By measuring twice, at least one clear LFCT value was obtained in 89.1% of patients and the overall measurability was 95.7%. We conducted all LFCT measurements safely. High ICCs were obtained even after dividing patients according to age, cardiac index (CI); 0.85 and 0.84 (≥ 75 or < 75 years group, respectively), 0.81 and 0.84 (N = 26, ≥ or < 2.2 L/min/M2). These results show that our new method to measure LFCT is highly stable and feasible for any type of heart failure patients.

Utility of cyclic variation of heart rate score as a screening tool for sleep-disordered breathing in patients with heart failure.

STUDY OBJECTIVES: Patients with sleep-disordered breathing have cyclic variation of heart rate (CVHR) in response to respiratory events. However, limited data are available regarding the utility of CVHR as a screening tool for sleep-disordered breathing in patients with mixed heart failure (HF) and those without HF. METHODS: We enrolled consecutive patients with and without HF who underwent full polysomnographies with simultaneous Holter electrocardiogram monitoring. We determined the temporal position of the individual dips comprising the CVHR score using time-domain methods. RESULTS: The data of 101 patients, including 70 with and 31 without HF, were analyzed. The CVHR score was significantly correlated with the apnea-hypopnea index (r = .667, P < .001) and limits of agreement between the apnea-hypopnea index and CVHR score were -21.8 to 35.2. The receiver operating characteristic analysis demonstrated that the CVHR score (best cut-off of 23.5 events/h) identified severe sleep-disordered breathing with a sensitivity of 83.3%, specificity of 79.5%, and the area under the curve of 0.856. In addition, there was no interaction between the presence or absence of HF and the apnea-hypopnea index-CVHR score relationship (P = .323). CONCLUSIONS: The CVHR score, determined by Holter electrocardiogram monitoring, is a useful tool for evaluating sleep-disordered breathing even in patients with mixed HF and patients without HF. CITATION: Yatsu S, Kasai T, Naito R, et al. Utility of cyclic variation of heart rate score as a screening tool for sleep-disordered breathing in patients with heart failure. J Clin Sleep Med. 2021;17(11):2187-2196.

Clinical, polysomnographic, and cephalometric features of obstructive sleep apnea with AHI over 100.

PURPOSE: Obstructive sleep apnea (OSA) is induced by a sleep-related collapse of the upper airway in association with multiple factors. The severity of OSA is determined by the apnea-hypopnea index (AHI). Although obesity and sex differences are common factors in OSA, the level of the AHI varies to the same degree according to the age and sex and degree of obesity. However, only a few studies have evaluated AHI over 100/h, those reports did not describe why they set the AHI cutoff at 100/h. The purpose of this study was to elucidate the pathogenesis of "very" severe OSA, defined as having an AHI > 100/h. METHODS: AHI > 100/h was set as very severe OSA (VS-OSA) in this study. As controls, moderate to severe OSA patients, matched with VS-OSA for age, sex, and body mass index (BMI), were enrolled. The findings of polysomnography and cephalography between VS-OSA and controls were compared. RESULTS: Eleven patients in the VS-OSA group (mean AHI 110.2/h) and 22 patients in the control group (mean AHI 41.6/h) were compared (mean age 50.2 vs 50.6, male:female 5:6 vs 10:12, mean BMI 35.4 kg/m2 vs 34.5 kg/m2). There were no significant differences in the clinical characteristics. In the polysomnographic parameters, the VS-OSA group showed apnea predominance, the mean percutaneous oxygen saturation (SO2) was significantly lower in all sleep stages, and the minimum SO2 was significantly lower (49.0% vs 77.5%, p = 0.002). A similar apnea duration and rather shorter hypopnea duration were shown. The time of apnea-to-arousal was significantly earlier (- 0.1 s vs 0.9 s, p = 0.003). Lung-to-finger circulation time showed no differences. The cephalometric findings showed no significant differences. CONCLUSIONS: VS-OSA patients were more likely to have apnea predominance, desaturation when sleeping despite a similar apnea duration, and rather shorter hypopnea duration, and arousals were evoked significantly earlier.

Changes in the objective measures of sleep between the initial nights of menses and the nights during the midfollicular phase of the menstrual cycle in collegiate female athletes.

STUDY OBJECTIVES: Sleep is an important recovery period for athletes. Women, including athletes, have reported sleep disturbances around menses. Thus, the aim of this study was to assess the changes in objective sleep parameters in the nights during menses and in the midfollicular phase of the menstrual cycle of young female athletes. METHODS: Female collegiate athletes with regular menstrual cycles were recruited. The participants underwent home electroencephalogram monitoring during the first and second nights after the onset of menses (M1 and M2, respectively) and during one night between the 7th and the 10th night after menses onset (midfollicular phase). RESULTS: Data from 45 athletes were analyzed. The total sleep time was significantly reduced, and sleep onset latency was significantly prolonged in M2 compared with those in the night during the midfollicular phase. Sleep efficiency was significantly reduced in M1 compared with that in the night during the midfollicular phase. Changes in the percentage of deep sleep across menstrual cycles differed among the participants with and without menstrual symptoms or concerns for sanitary products; moreover, such participants spent a lower percentage of time in deep sleep in M1 compared with the other nights. CONCLUSIONS: Collegiate female athletes with regular menstrual cycles are likely to have trouble falling asleep, tend to sleep less, and when concerned about sanitary products, have less deep sleep during menses. Even in young female athletes with regular menstrual cycles, sleep can be disturbed during menses. Interventions to restore or improve sleep should be considered.

Prevalence of Restless Legs Syndrome and Its Effects on Sleep and Health-Related Quality of Life in Patients With Heart Failure.

BACKGROUND: Restless legs syndrome (RLS) is a neurological disorder characterized by leg restlessness and dysesthesia. Although the relationship between RLS and heart failure (HF) has been reported, the prevalence and clinical significance of RLS in patients with HF remain to be elucidated. METHODS AND RESULTS: We enrolled consecutive patients with HF who were admitted to our institutions. RLS was diagnosed using the International Restless Legs Syndrome Study Group criteria. Subjective sleepiness, sleep quality, and quality of life (QoL) were assessed using the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and 8-item Short Form (SF-8), respectively. Among the 133 patients, 18 (13.6%) had RLS and were younger than those without RLS (62.4±13.4 vs 70.0±12.2, P = .017). The RLS group had significantly disrupted sleep quality and QoL, with greater PSQI score (8.0±3.2 vs 5.9±3.3, P = .015) and lower SF-8 physical component summary (PCS) score (35.6±6.5 vs 40.7±9.5, P = .031), despite similar ESS and SF-8 mental component summary scores. In the multivariable regression analysis, RLS was associated with greater PSQI (ß=0.211; P = .014) and lower PCS score (ß=-0.177; P = .045). CONCLUSION: In the patients with HF, RLS was prevalent, and sleep quality and QoL may be disrupted by RLS.

Prevalence and Significance of Restless Legs Syndrome in Patients With Coronary Artery Disease.

Restless legs syndrome (RLS), characterized by leg restlessness and dysesthesia predominantly at night and at rest, disrupts sleep and quality of life. The reported prevalence of RLS is 2% to 5%. Although a relation between RLS and coronary artery disease has been suggested, the prevalence and clinical significance of RLS in coronary artery disease patients remain unknown. We enrolled coronary artery disease patients who underwent percutaneous coronary intervention. Patients with RLS were identified according to international criteria. Subjective sleepiness, sleep quality, and health-related quality of life were assessed using the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, and Short Form-8, respectively. Among 326 patients with coronary artery disease, 26 (8.0%) had RLS. There were no significant differences in characteristics between patients with and without RLS. Sleep quality and quality of life were more disrupted in patients with RLS (Pittsburgh Sleep Quality Index score, 7.4 ± 2.4 vs 5.6 ± 2.5, p <0.001; physical component summary and mental component summary scores of Short Form-8, 39.6 ± 1.8 vs 43.5 ± 0.5, p = 0.042 and 45.2 ± 8.4 vs 48.4 ± 7.4, p = 0.037, respectively), despite no significant difference in Epworth Sleepiness Scale score (8.2 ± 5.1 vs 7.1 ± 4.8, p = 0.293). In multiple linear regression analyses, RLS was independently associated with Pittsburgh Sleep Quality Index (ß = 0.174, p <0.001), physical component summary (ß = -0.127, p = 0.029), and mental component summary (ß = -0.113, p = 0.042) scores. In conclusion, in patients with coronary artery disease, the prevalence of RLS was relatively high compared to that reported in the general population. The presence of RLS was associated with disrupted sleep quality and health-related quality of life in coronary artery disease patients.

Prevalence and Clinical Correlates of Sleep-Disordered Breathing in Patients Hospitalized With Acute Decompensated Heart Failure.

BACKGROUND: Limited data are available regarding the presence of sleep-disordered breathing (SDB) assessed using polysomnography in patients hospitalized with left ventricular (LV) systolic dysfunction after acute decompensated heart failure (ADHF). We investigated the prevalence and clinical correlates of SDB in patients hospitalized with ADHF and LV systolic dysfunction. METHODS: Prospectively collected data from 105 consecutive patients with an LV ejection fraction < 50% who were hospitalized with ADHF from May 2012 to July 2014 were retrospectively assessed. Polysomnography was performed during the initial hospitalization after the initial improvement in ADHF acute signs and symptoms. The apnea-hypopnea index (AHI), including obstructive or central AHI, was computed as a severity of obstructive or central sleep apnea. Echocardiography and blood sampling for various parameters, such as B-type natriuretic peptide level, were performed systematically. RESULTS: The proportions of patients with an AHI ≥ 5 events per hour and those with an AHI ≥ 15 events per hour were 93% and 69%, respectively, and central sleep apnea was predominant (66% and 44%, respectively). In the multivariate analysis, only body mass index (BMI) was independently correlated with AHI, whereas age, BMI, and E/e' level were independently correlated with obstructive AHI. In addition, use of loop diuretics and E/e' level were independently correlated with central AHI. CONCLUSIONS: SDB determined using polysomnography was common in hospitalized patients with ADHF and LV systolic dysfunction. Age, BMI, and E/e' levels were significantly correlated with obstructive sleep apnea severity, whereas E/e' levels and use of loop diuretics were significantly correlated with central sleep apnea severity.

Age-stratified sex differences in polysomnographic findings and pharyngeal morphology among children with obstructive sleep apnea.

BACKGROUND: Childhood obstructive sleep apnea (OSA) has important implications for growth, learning, behavior, cognition and cardiovascular health as well as snoring and OSA in adulthood. In this study, we elucidated the sex differences in polysomnographic (PSG) findings and pharyngeal radiographic data in pediatric OSA patients. METHODS: Sixty three children (age between 3 and 15 years old) with OSA [defined as apnea-hypopnea index (AHI) ≥1/h by polysomnography] were enrolled. Lateral neck radiographs were obtained from the patients. All subjects were separated by age: pre-adolescent group (3-8 years old) and adolescent group (9-15 years old). RESULTS: Overall, 45 patients in the pre-adolescent group (33 boys and 12 girls) and 18 patients in the adolescent group (10 boys and 8 girls) were enrolled, and sex differences were compared in each group. We found sex differences in craniofacial features and severity of OSA in the adolescent group, in which girls with OSA had more upper airway space, in addition to lower AHI, lower 3% oxygen desaturation index (ODI), higher minimum SO2 and better sleep efficiency than the boys. CONCLUSIONS: The present study found revealed sex differences in pediatric OSA patients in the adolescent group. Girls in the adolescent group had more upper airway space in addition to lower AHI, lower 3% ODI, higher minimum SO2 and better sleep efficiency than boys.

Acute Effects of Positive Airway Pressure on Functional Mitral Regurgitation in Patients with Systolic Heart Failure.

Background: Acute effects of positive airway pressure (PAP) [including continuous PAP (CPAP) and adaptive servo-ventilation, an advanced form of bi-level PAP] on functional mitral regurgitation (fMR) in patients with heart failure (HF) with left ventricular (LV) systolic dysfunction remain unclear. Thus, whether PAP therapy reduces fMR in such patients with HF was investigated. Methods and Results: Twenty patients with HF and LV systolic dysfunction defined as LV ejection fraction (LVEF) <50% (14 men; mean LVEF, 35.0 ± 11.5%) with fMR underwent echocardiography during 10-min CPAP (4 and 8 cm H2O) and adaptive servo-ventilation. For fMR assessment, MR jet area fraction, defined as the ratio of MR jet on color Doppler to the left atrial area, was measured. The forward stroke volume (SV) index (fSVI) was calculated from the time-velocity integral, cross-sectional area of the aortic annulus, and body surface area. fMR significantly reduced on CPAP at 8 cm H2O (0.30 ± 0.12) and adaptive servo-ventilation (0.29 ± 0.12), compared with the baseline phase (0.37 ± 0.12) and CPAP at 4 cm H2O (0.34 ± 0.12) (P < 0.001). The fSVI did not change in any of the PAP sessions (P = 0.888). However, significant differences in fSVI responses to PAP were found between sexes (P for interaction, 0.006), with a significant reduction in fSVI in women (P = 0.041) and between patients with baseline fSVI ≥ and < the median value (27.8 ml/m2, P for interaction, 0.018), with a significant fSVI reduction in patients with high baseline fSVI (P = 0.028). In addition, significant differences were found in fSVI responses to PAP between patients with LV end-systolic volume (LVESV) index ≥ and < the median value (62.0 ml/m2, P for interaction, 0.034), with a significant fSVI increase in patients with a high LVESV index (P = 0.023). Conclusion: In patients with HF, LV systolic dysfunction, and fMR, PAP can alleviate fMR without any overall changes in forward SV. However, MR alleviation due to PAP might be associated with a decrease in forward SV in women with high baseline SV, whereas MR alleviation due to PAP might be accompanied by increased forward SV in patients with a dilated LV.

Impact on Clinical Outcomes of Periodic Leg Movements During Sleep in Hospitalized Patients Following Acute Decompensated Heart Failure.

BACKGROUND: Periodic leg movements during sleep (PLM) are characterized by regularly recurring movement of the legs during sleep. Although PLM is common and a predictor of death in patients with chronic heart failure, the clinical significance of PLM in hospitalized patients with a reduced left ventricular ejection fraction (LVEF) following acute decompensated heart failure (ADHF) remains unknown.Methods and Results:After initial improvement of acute signs and symptoms of ADHF, 94 consecutive patients with reduced LVEF who underwent polysomnography were enrolled. They were divided into 2 groups based on the presence or absence of severe PLM defined as PLM index ≥30. The risks for clinical events, composite of all-cause death and rehospitalization, were assessed using a stepwise multivariable Cox proportional model including variables showing P<0.10 in univariate analyses. Severe PLM was observed in 21 patients (22%). At a median follow-up of 5.2 months, 30 patients experienced clinical events (32%). In the multivariable analysis, the presence of severe PLM was significantly associated with increasing clinical events (hazard ratio, 2.16; 95% confidence interval, 1.03-4.54; P=0.042) independent of hemoglobin level and the severity of sleep-disordered breathing. CONCLUSIONS: In hospitalized patients with systolic dysfunction following ADHF, severe PLM was prevalent and significantly associated with increased risk of death and/or rehospitalization.

Change in type of sleep-disordered breathing from predominant central to obstructive sleep apnea following coronary artery bypass grafting.

We report the case of a 67-year-old overweight man with reduced left ventricular ejection fraction (LVEF) due to myocardial infarction. He had an implantable cardioverter defibrillator (ICD) for frequent episodes of ventricular tachyarrhythmia and was initiated into adaptive-servo ventilation therapy for severe central sleep apnea (CSA), which was not suppressed by continuous positive airway pressure (CPAP). Since he still had several episodes of appropriate ICD therapies, coronary angiogram was performed, and severe three-vessel disease was found. He then underwent coronary artery bypass grafting (CABG). After CABG, his LVEF did not improve (from 29 to 25%); however, the B-type natriuretic peptide level decreased (from 560 to 330 pg/mL). Although the apnea-hypopnea index did not change (49.4 before and 55.1/h after CABG), his CSA converted to predominant obstructive sleep apnea accompanied by a shortening of the lung-to-finger circulation time (from 43 to 29 s) 2 weeks after CABG, which was completely suppressed by CPAP. .