Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure

Bitter, Thomas; Westerheide, Nina; Prinz, Christian; Hossain, M. Sajid; Vogt, Juergen; Langer, C.; Horstkotte, Dieter; Oldenburg, Olaf

doi:10.1093/eurheartj/ehq327

Cited by 256 publications

(166 citation statements)

References 49 publications

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“…After a 48 month follow-up period, sleep disordered breathing was found to be independently associated with an increased risk for ventricular arrhythmias [94]. Moreover, OSA patients treated with catheter ablation for ventricular dysrhythmias seem to have a higher relapse rate compared to those without OSA (45% versus 6%) [95].…”

Section: Ventricular Arrhythmias Observational Studiesmentioning

confidence: 98%

Effects of obstructive sleep apnoea on heart rhythm

2012

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Symptomatic obstructive sleep apnoea (OSA) has been proven to be a risk factor for hypertension and vascular dysfunction, and has been proposed to be causally related with cardiac arrhythmias and sudden cardiac death.Searches of bibliographical databases revealed that several mechanisms seem to underpin the association between OSA and cardiac arrhythmias: intermittent hypoxia associated with autonomic nervous system activation and increased oxidative stress, which may lead to cardiac cellular damage and alteration in myocardial excitability; recurrent arousals, resulting in sympathetic activation and coronary vasoconstriction; and increased negative intrathoracic pressure which may mechanically stretch the myocardial walls and, thus, promote acute changes in myocardial excitability as well as structural remodelling of the myocardium.Findings from cross-sectional studies suggest a high prevalence of cardiac arrhythmias in patients with OSA and a high prevalence of OSA in those with cardiac arrhythmias. Preliminary evidence from uncontrolled interventional studies suggests that treatment of OSA may prevent cardiac arrhythmias.In conclusion, there is preliminary evidence that OSA is associated with the development of cardiac arrhythmias. Data from randomised controlled studies are needed to definitively clarify the role of OSA in arrhythmogenesis.

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Section: Ventricular Arrhythmias Observational Studiesmentioning

confidence: 98%

Effects of obstructive sleep apnoea on heart rhythm

2012

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“…Many patients show a combination of different types of SDB breathing patterns that may change over the course of a night as well as over time 10. Although both OSA and CSA/CSR have been shown to be independent predictors of worse outcome in HF patients,11, 12, 13, 14, 15, 16 the different forms of SDB are likely to have different effects on the cardiovascular system 17. The findings of a post hoc analysis of the SERVE‐HF study provided some evidence that the impact of SDB and its treatment might be different in CSA and OSA, showing effect modification when the proportion of CSR at baseline was <20% 18.…”

Section: Introductionmentioning

confidence: 99%

Phenotyping of Sleep‐Disordered Breathing in Patients With Chronic Heart Failure With Reduced Ejection Fraction—the SchlaHF Registry

Arzt

Oldenburg

Graml

et al. 2017

JAHA

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BackgroundDifferent 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.Methods and ResultsThe 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 groups and in those with versus without periodic breathing. There was a relationship between greater proportions of CSA and the presence of periodic breathing. Risk factors for having CSA rather than OSA were male sex, older age, presence of atrial fibrillation, lower ejection fraction, and lower awake carbon dioxide pressure (pco 2). Periodic breathing was more likely in men, patients with atrial fibrillation, older patients, and as left ventricular ejection fraction and awake pco 2 decreased, and less likely as body mass index increased and minimum oxygen saturation decreased.ConclusionsSchlaHF data show that there is wide interindividual variability in the SDB phenotype of HFrEF patients, suggesting that individualized management is appropriate.Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01500759.

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“…When multivariate analyses were performed to control for potential confounders involved in determining outcome in patients with HF, CSA was an independent factor for death or cardiac transplantation in these patients 4,22,23) . Some large -scale studies have demonstrated that SDB is associated with occurrence of ventricular arrhythmias 20,24) and adverse prognosis in HF patients 25,26) .…”

Section: Impact Of Sdb In Hf Patientsmentioning

confidence: 99%