Predictor factors of sleep-disordered breathing in heart failure (original) (raw)
Related papers
Respiratory Medicine, 2008
Background: Over 50% of patients with chronic heart failure (CHF) have sleep-disordered breathing (SDB). Any variation in the type of SDB in CHF will have implications for patient management. Currently there is good evidence for treatment of obstructive sleep apnea (OSA) in CHF with continuous positive airway pressure; however, for central sleep apnea (CSA) the treatment is less clear. Aims: The aim of this study was to investigate the variation in the severity and type of SDB (OSA vs. CSA) throughout 4 consecutive nights in CHF patients with SDB. Methods: Nineteen male CHF patients (mean7sd: age 6179 years; left ventricular ejection fraction: 34710% and percent predicted peak VO 2 : 67719%) underwent cardiorespiratory monitoring in their own home throughout 4 consecutive nights. Results: There was minimal variation in apnea-hypopnea index (AHI) throughout 4 nights in CHF patients with SDB [intraclass correlation coefficient (95% confidence interval ): 0.97 (95% CI 0.76 and 0.97)]. Eight patients [42% (95% CI 20% and 64%)] demonstrated a shift in the type of their SDB, from CSA to OSA or vice versa; these patients had significantly smaller neck circumference (group mean7sd) 4272 vs. 4472 cm; p ¼ 0.04), and had significant variation in the central AHI [intraclass correlation coefficient: 0.51 (95% CI 0.16 and 0.85)]. Conclusions: A single night of cardiorespiratory monitoring is representative of moderateto-severe SDB in patients with CHF. However, a high proportion of patients shift their type ARTICLE IN PRESS 0954-6111/$ -see front matter & (A. Vazir). Respiratory Medicine (2008) 102, 831-839
Prevalence and profile of sleep disordered breathing amongst patients with congestive heart failure
Indian Journal of Sleep Medicine, 2010
Introduction: It has been observed that since heart failure is highly prevalent and central sleep apnea (CSA) is common in patients with a failing heart, heart failure is the commonest cause of CSA in the general population. Aims & Objectives: The present study was undertaken with the purpose of finding prevalence of sleep disordered breathing (SDB) in patients of heart failure and also to find the association of severity of SDB with severity of heart failure. Material & Methods: Forty patients suffering from systolic heart failure were selected on random basis. All these patients underwent complete evaluation of history, physical examination and overnight polysomnography. The patients were divided into two groups, namely group 1 and group 2, on the basis of polysomnography. Group 1 consisted of 17 patients who did not have sleep disordered breathing i.e. AHI (central or obstructive) < 5. Group 2 consisted of 23 patients who had sleep disordered breathing i.e. AHI (central or obstructive) > 5. Comparison of biochemical profile and sleep parameters was made between group 1 and group 2 and results analyzed. Observations: Aetiology of heart failure was ischemic heart disease in 34 patients, viral myocarditis in 3 patients and postpartum cardiomyopathy in 3 patients. Total prevalence of CSA in heart failure was 57.5%.Prevelance in males and females was 47.6% and 68.42% respectively. There was a significant difference in O2 desaturation index, minimum O2, arousal index, total sleep time, AHI (central), sleep efficiency and wake O2 amongst the two groups. A negative correlation was observed between ejection fraction and O2 desaturation index, AHI (central), and arousal index. A positive correlation was found between ejection fraction and wake O2. Conclusions: A fairly high prevalence of sleep-disordered breathing (57.5%) was found in patients of heart failure in the present study. With increasing severity of HF a significant worsening of CSA-CSR was observed. The treatment of CSA-CSR may prevent the worsening status of HF. Hence long term randomized and controlled interventions are required to further substantiate these fact.
BMC Cardiovascular Disorders, 2014
Background The objective of the SCHLA-HF registry is to investigate the prevalence of sleep-disordered breathing (SDB) in patients with chronic heart failure with reduced left ventricular systolic function (HF-REF) and to determine predictors of SDB in such patients. Methods Cardiologists in private practices and in hospitals in Germany are asked to document patients with HF-REF into the prospective SCHLA-HF registry if they meet predefined inclusion and exclusion criteria. Screening was started in October 2007 and enrolment was completed at the end of May 2013. After enrolment in the registry, patients are screened for SDB. SDB screening is mainly undertaken using the validated 2-channel ApneaLink™ device (nasal flow and pulse oximetry; ResMed Ltd., Sydney, Australia). Patients with a significant number of apneas and hypopneas per hour recording time (AHI ≥15/h) and/or clinical symptoms suspicious of SDB will be referred to a cooperating sleep clinic for an attended in-lab polysomn...
Journal of Clinical Respiratory Diseases and Care, 2017
Central sleep apnea (CSA) rather than obstructive sleep apnea (OSA) is widely believed to be the dominant form of sleep apnea (SA) in patients with heart failure (HF). Hitherto, no study has characterized sleep disordered breathing (SDB) in Indian subjects with heart failure and evaluated its impact on severity of HF, which this study attempts to do. A retrospective data-analysis was done in 65 consecutive patients with stable mild-to-moderate HF referred for evaluation on the basis of fatigue and excessive daytime somnolence (EDS) regarded by the institute's cardiologists. Patients with ejection fraction (EF) <55% or LV fractional shortening of 28% were included in the study. PSG was scored according to current AASM recommendations. Based on the Apnea-Hypopnea Index (AHI), OSA was classified as mild (AHI:5-15), moderate (AHI: 15-30) and severe (AHI: >30). HF was arbitrarily classified as mild (EF:<35%) moderate (EF:35-45%) and severe (EF:45-55%). OSA emerged as the exclusive form of SA (95.4%; n=65) and was more severe in males. Patients with more severe HF tended to be less obese, and interestingly to have less severe OSA. In contrast to Western literature, OSA seems to be by far the most prevalent form of sleep apnea in Indian subjects with HF. HF mortality is known to be high in underweight individuals yet, persons with severe HF are often less obese and partly by reason of a lower BMI, appear to be relatively protected against severe OSA and severe nocturnal hypoxemia. This study thus raises important and intriguing questions which merit further enquiry.
Clinical predictors of sleep apnoea in heart failure outpatients
International Journal of Clinical Practice, 2014
Background: Sleep-disordered breathing (SDB) is common in heart failure patients. Many of them still remain undiagnosed. The aim of this study was to detect clinical predictors of sleep apnoea which may help to identify patients with SDB at a heart failure clinic. Methods: We performed an in-home sleep study on 115 consecutive patients from our heart failure clinic. Clinical characteristics, blood samples, daytime sleepiness and quality of life were registered. Results: Among 115 patients, 52% had moderate to severe SDB. Body Mass Index (BMI) ≥ 30 kg/ m² was the only independent predictor of moderate to severe SDB [Odds ratio (OR) = 3.62, 95% Confidence interval (CI) 1.40-9.36, p = 0.008]. Quality of life and level of sleepiness were not significantly associated with SDB. Patients with mild to moderate chronic obstructive pulmonary disease (COPD) were unlikely to have SDB compared with patients without COPD (OR = 0.10, 95% CI 0.02-0.43, p = 0.002).Hypertension was a predictor of having obstructive sleep apnoea (OR = 2.78, 95% CI 1.15-6.75, p = 0.02), while haemoglobin ≥ 15 g/dl was associated with central sleep apnoea (OR = 6.71, 95% CI 1.96-22.99, p = 0.002). Conclusion: BMI ≥ 30 kg/m 2 is associated with moderate to severe SDB, both obstructive and central sleep apnoea. Thus, BMI may be used as one of the selection criteria for referral of heart failure patients to a sleep specialist. What's known Sleep-disordered breathing is highly prevalent in patients with heart failure and associated with a higher morbidity and mortality. So far, the ESC heart failure guidelines still lack clear recommendations for sleep apnoea screening. We need more knowledge on how to select these patients before referring them to a sleep specialist. What's new BMI 30 kg/m 2 significantly predicts sleep-disordered breathing, both obstructive and central sleep apnoea in heart failure patients. Thus, BMI may be used as one of the selection criteria for referral of heart failure patients to a sleep specialist.
Canadian Journal of Cardiology, 2015
Background: Sleep-disordered breathing (SDB) is highly prevalent in patients with chronic heart failure (CHF) and is associated with a poor prognosis. Data on SDB-related symptoms and vigilance impairment in patients with CHF and SDB are rare. Thus, the objective of the present study was to assess a wide spectrum of SDB-related symptoms and objective vigilance testing in patients with CHF with and without SDB. Methods: Patients with CHF (n ¼ 222; average age, 62 years; left ventricular ejection fraction [LVEF], 34%) underwent polysomnography regardless of the presence or absence of SDB-related symptoms. Patients were stratified into those with no SDB (apnea-hypopnea index [AHI] < 15 episodes/h), moderate SDB (AHI ! 15 to < 30 episodes/ h), and severe SDB (AHI ! 30 episodes/h). A standardized institutional questionnaire assessing a wide spectrum of SDB-related symptoms was applied. A subset of patients underwent objective vigilance testing (Quatember Maly, 100 stimuli within 25 minutes). Results: Daytime fatigue (no SDB, moderate SDB, and severe SDB: 53%, 69%, and 80%, respectively; P ¼ 0.005), unintentional sleep (9%, 15%, and 32%, respectively; P ¼ 0.004), and xerostomia (52%, 49%, and 70%, respectively; P ¼ 0.018), as well as an impaired objective vigilance test result (mean reaction time, 0.516, 0.497, and 0.579 ms, respectively; P < 0.001) occurred more frequently with R ESUM E enhanced negative intrathoracic pressure, 5 and thus increased cardiac workload. The long-term effects include the development of hypertension, 6 myocardial hypertrophy, atherosclerosis, and coronary artery disease, 7,8 contributing to the progression of heart failure and increased mortality rates. 9-11 Despite advances in medical and device therapy for CHF within the past 2 decades, SDB remains highly prevalent in patients with CHF. 12-15 Observational studies suggest that treatment of severe SDB with positive airway pressure (PAP) improves survival of patients with CHF. 10,11 In addition, PAP therapy improves quality of life and sleepiness, especially in those patients with CHF who present with SDB-related symptoms. 16-18
Journal of the American Heart Association, 2017
Different sleep-disordered breathing (SDB) phenotypes, including coexisting obstructive and central sleep apnea (OSA-CSA), have not yet been characterized in a large sample of patients with heart failure and reduced ejection fraction (HFrEF) receiving guideline-based therapies. Therefore, the aim of the present study was to determine the proportion of OSA, CSA, and OSA-CSA, as well as periodic breathing, in HFrEF patients with SDB. The German SchlaHF registry enrolled patients with HFrEF receiving guideline-based therapies, who underwent portable SDB monitoring. Polysomnography (n=2365) was performed in patients with suspected SDB. Type of SDB (OSA, CSA, or OSA-CSA), the occurrence of periodic breathing (proportion of Cheyne-Stokes respiration ≥20%), and blood gases were determined in 1557 HFrEF patients with confirmed SDB. OSA, OSA-CSA, and CSA were found in 29%, 40%, and 31% of patients, respectively; 41% showed periodic breathing. Characteristics differed significantly among SDB ...
European Journal of Heart Failure, 2007
Aim: Evaluation of the prevalence and nature of sleep-disordered breathing (SDB) in patients with symptomatic chronic heart failure (CHF) receiving therapy according to current guidelines. Methods and results: We prospectively screened 700 patients with CHF (NYHA class ≥ II, LV-EF ≤ 40%) for SDB using cardiorespiratory polygraphy (Embletta™). Furthermore, echocardiography, cardiopulmonary exercise and 6-min walk testing were performed. Medication included ACE-inhibitors and/or AT1-receptor blockers in at least 94%, diuretics in 87%, β-blockers in 85%, digitalis in 61% and spironolactone in 62% of patients.
Heart Failure and Sleep-related Breathing Disorders
Cardiology in Review, 2000
Background: In heart failure (HF) sleep problems and sleep-related breathing disorders are frequently reported and are associated with poor prognosis. However, only few large clinical studies have investigated this issue in heart failure through breathing pattern analysis by polysomnography. Methods and results: 370 HF patients, with either moderate-severe reduced ejection fraction or with clinical decompensation, consecutively referred to 10 participating cardiology centers, have been enrolled in the PROMISES Study, an Italian project aimed at generating a large, multidisciplinary database of anthropometric, clinical, echocardiographic and sleep data, the last derived from overnight unattended cardio-respiratory polysomnography in HF patients. Obstructive sleep apnea was the most frequent form of sleep related breathing disorders observed in our cohort (35.4% with an AHI cutoff of 15). The possible determinants of sleep related breathing disorders were analyzed through stepwise logistic regression analysis and two multivariate models showing that a markedly reduced left ventricular ejection fraction was the most important factor associated with central sleep apneas (OR = 7.7 for AHI cutoff = 15 and LVEF ≤ 35%) together with male gender and increasing age. Conventional risk factors for obstructive sleep apnea did not identify HF patients affected by this condition. Conversely, a greater neck circumference was associated with an increased risk for central apneas. Conclusions: Our paper offers a deeper insight into the features of SRBD and its determinants in HF patients, leading in turn to a better clinical management of these comorbid patients.