Breathing disorders in congestive heart failure: gender, etiology and mortality

Abstract

We investigated the relationship between sleep-disordered breathing (SDB) and Cheyne-Stokes respiration (CSR) while awake as well as mortality. Eighty-nine consecutive outpatients (29 females) with congestive heart failure (CHF; left ventricular ejection fraction, LVEF <45%) were prospectively evaluated. The presence of SDB and of CSR while awake before sleep onset was investigated by polysomnography. SDB prevalence was 81 and 56%, using apnea-hypopnea index cutoffs >5 and >15, respectively. CHF etiologies were similar according to the prevalence of SDB and sleep pattern. Males and females were similar in age, body mass index, and LVEF. Males presented more SDB (P = 0.01), higher apnea-hypopnea index (P = 0.04), more light sleep (stages 1 and 2; P < 0.05), and less deep sleep (P < 0.001) than females. During follow-up (25 ± 10 months), 27% of the population died. Non-survivors had lower LVEF (P = 0.01), worse New York Heart Association (NYHA) functional classification (P = 0.03), and higher CSR while awake (P < 0.001) than survivors. As determined by Cox proportional model, NYHA class IV (RR = 3.95, 95%CI = 1.37-11.38, P = 0.011) and CSR while awake with a marginal significance (RR = 2.96, 95%CI = 0.94-9.33, P = 0.064) were associated with mortality. In conclusion, the prevalence of SDB and sleep pattern of patients with Chagas' disease were similar to that of patients with CHF due to other etiologies. Males presented more frequent and more severe SDB and worse sleep quality than females. The presence of CSR while awake, but not during sleep, may be associated with a poor prognosis in patients with CHF.

Impact of untreated sleep apnea on prognosis of patients with congestive heart failure

“…However, after adjusting confounding factors such as age and NYHA functional class, untreated SA (OSA or CSA) has no significant impact on mortality in CHF. These observations were consistent with some previous studies [3][4][5], but conflict with others [6][7][8][9]. After further analyzing these studies, we found that the sample size, study population, end points, statistical tests, etc.…”

Day–night pattern of autonomic nervous system modulation in patients with heart failure with and without sleep apnea

“…It is now recognized that sleep apnea (SA) is very common among patients with congestive heart failure (CHF) [1][2][3][4]. Obstructive and central SA occur in approximately 25% to 37% and 27% to 38% of the CHF patients, respectively [1][2][3][4].…”

“…Obstructive and central SA occur in approximately 25% to 37% and 27% to 38% of the CHF patients, respectively [1][2][3][4]. There is also evidence that SA is associated with increased risk of cardiovascular morbidity and mortality in patients with CHF [5,6].…”

Altered Breathing Syndrome in Heart Failure: Newer Insights and Treatment Options

“…Some recent studies also suggest that daytime PB is associated with a poor prognosis, whereas other studies showed conflicting results [41,44]. Such conflicting results may be explained by the differences of situation and tools used to detect daytime PB across the studies (Table 1).…”

“…One report showed a circadian variation of frequency of PB with three peaks (at 4:00 am, 2:00 pm, and 6:00 pm). PB was less frequently observed in the daytime (approximately one fourth of that in the nighttime) [ [44].…”