Heart Failure and Sleep-related Breathing Disorders (original) (raw)
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International Journal of Cardiology, 2018
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.
Predictor factors of sleep-disordered breathing in heart failure
Egyptian Journal of Bronchology, 2017
Background Heart failure (HF) is characterized by its high mortality, frequent hospitalizations, and reduced quality of life. Sleep-disordered breathing (SDB), one of the common comorbidities, accelerates the progression of HF. Objectives The objectives of the study were (a) to investigate the prevalence and type of SDB in HF patients and (b) to determine the predictors of SDB. Materials and methods In a cross-sectional analytic study, all eligible patients of Assiut Chest and Cardiology Department admitted (100 patients) during the period from August 2015 to March 2016 were included in this study. Clinical assessment, full-night attended polysomnography, and echocardiography were recorded and compared between patients with (SDB) (85 patients) and those without SDB (15 patients). Results SDB was found in 85% of patients [53% had obstructive sleep apnea (OSA) and 32% had central sleep apnea (CSA)]. OSA patients are characterized by higher BMI and neck and waist circumference. There was a higher prevalence of hypertension, as well as mean blood pressure, systolic blood pressure, diastolic blood pressure, in OSA patients. Loud snoring was the only clinical symptom associated with OSA as compared with CSA. CSA patients had a significant reduction in PaCO 2. OSA patients showed a significant increase in desaturation index and time spent with oxygen saturation less than 90%. Maximum heart rate and brady/tachy index were significantly increased in OSA. Cycle length was significantly increased in CSA. Conclusion The prevalence of sleep apnea was high in patients with stable HF (85%). OSA was the predominant type (53%). The predictors of SDB were BMI (≥30), systemic hypertension, neck circumference more than 40 cm, waist circumference more than 110 cm, and ejection fraction (left ventricular ejection fraction) (≤45%).
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.
Archives of Cardiovascular Diseases, 2009
Sleep apnoea syndromes;Prevalence; Congestive heart failure Summary Background. -Heart failure with systolic dysfunction occurs frequently. Studies in North America and Germany have shown a high prevalence of sleep-disordered breathing in patients with heart failure. Aims. -To assess the prevalence of sleep-disordered breathing and its associated risk factors in French patients with heart failure.
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...
Sleep disordered breathing in coronary heart disease patients with mild and moderate heart failure
Health, 2013
The purpose of the study was to investigate the relationship between sleep disordered breathing (SDB) and degree of heart failure (HF) in patients with coronary heart disease (CHD). A total of 3017 patients (77.4% men and 22.6% women) were included in the study. Clinical examination and echocardiography for evaluation of HF using NYHA functional classification and sleep polysomnography were performed. The study demonstrated that SDB is more common in CHD patients with higher NYHA functional class. The prevalence of central sleep apneas against obstructive apneas was observed in patients with mild and moderate HF. The number of central apneas was strongly related to the severity of heart failure. More frequent appearance of central sleep apneas is predominantly due to instability of ventilatory control systems during sleep because of impaired cardiac function in HF patients. Sleep architecture was more disturbed in CHD patients with higher NYHA functional class. A gradual increase of stage 1 and wakefulness after sleep onset and a decrease of sleep stages 3-4 and REM sleep as well as a diminution of sleep efficiency with worsening of NYHA functional class were observed. We suggest that both SDB and disturbed sleep variables independently significantly correlate with manifestation of HF.
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 ...
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
Sleep Disordered Breathing and Heart Failure
Journal of Cardiac Failure, 2010
Most patients with heart failure (HF) have sleep-disordered breathing (SDB), with central (rather than obstructive) sleep apnea becoming the predominant form in patients with more severe disease. Cyclical apnea and hypopneas are associated with sleep disturbance, hypoxemia, hemodynamic changes, and sympathetic activation. These patients have a worse prognosis than those without SDB. Mask-based therapies of positive airway pressure targeted at SDB can improve measures of sleep quality and can partially normalize the sleep and respiratory physiology. However, recent randomized trials of cardiovascular outcomes in central sleep apnea in chronic HF with reduced ejection fraction have had neutral findings or suggested the possibility of harm, likely from an increased rate of sudden death. Further randomized outcome studies are required to determine whether mask-based treatment is appropriate for patients with chronic HF with reduced ejection fraction and obstructive sleep apnea, for patients with heart failure with preserved ejection fraction, and for patients with decompensated heart failure. New therapies for sleep apnea (e.g., implantable phrenic nerve stimulators) also require robust assessment. No longer can the surrogate endpoints of improvement in respiratory and sleep metrics be taken as adequate therapeutic outcome measures in patients with HF and sleep apnea.