Heart failure and sleep‐disordered breathing: susceptibility to reduced muscle strength and preclinical congestion (SICA‐HF cohort)

Abstract

Aims Increased sympathetic activation in patients with heart failure (HF) and sleep-disordered breathing (SDB) provokes cardiac decompensation and protein degradation and could lead to muscle wasting and muscle weakness. The aim of this study was to investigate the differences in body composition, muscle function, and the susceptibility of preclinical congestion among patients with HF and SDB compared with those without SDB. Methods and results We studied 111 outpatients with stable HF who were enrolled into the Studies Investigating Co-morbidities Aggravating Heart Failure. Echocardiography, short physical performance battery (SPPB), cardiopulmonary exercise testing, dual-energy X-ray absorptiometry, bioelectrical impedance analysis (BIA), tests of muscle strength, and polygraphy were performed. SDB was defined as apnoea/hypopnoea index (AHI) >5 per hour of sleep. Central sleep apnoea (CSA) and obstructive sleep apnoea (OSA) were defined as AHI >50% of central or obstructive origin, respectively. A total of 74 patients (66.7%) had any form of SDB [CSA (24 patients, 32.4%), OSA (47 patients, 63.5%)]. Patients with SDB showed increased muscle weakness (chair stand), reduced muscle strength, and lower values of SPPB score (P < 0.05). Patients with SDB did not show overt clinical signs of cardiac decompensation compared with those without SDB (P > 0.05) but had increased amounts of water (total body water, intracellular, and extracellular) measured using BIA (P < 0.05). Increased amounts of total body water were associated with the severity of SDB and inversely with muscle strength and exercise capacity measured by anaerobic threshold (P < 0.05). Altogether, 17 patients had muscle wasting. Of these, 11 (65%) patients had SDB (statistically not significant). Conclusions SDB is highly prevalent in patients with HF. Patients with SDB have lower muscle strength and tend to be more susceptible to preclinical congestion.

Obstructive sleep apnea (OSA) is associated with increased risk of early-onset sarcopenia and sarcopenic obesity: Results from NHANES 2015-2018.

“…There were a limited number of studies that investigated the association between OSA and sarcopenia. Bekfani T et al found a positive correlation between sleep-disordered breathing and low muscle strength in patients with heart failure [14]. However, Fernandes et al indicated that OSA was not associated with sarcopenia in a population of patients with non-dialyzed chronic kidney disease [15].…”

The role of nutraceuticals in heart failure muscle wasting as a result of inflammatory activity. The International Lipid Expert Panel (ILEP) Position Paper.

“…The article on muscle wasting cited in the HF guidelines suggests cut-off points used to detect the presence of sarcopenia as the appendicular skeletal mass index values of 7.0 kg/m 2 for men and 5.5 kg/m 2 for women [ 7 ]. It has been shown that patients with sarcopenic HF have reduced exercise capacity [ 8 , 9 ], reduced quality of life, endothelial dysfunction [ 10 ], and reduced appetite [ 11 ] among other detrimental consequences [ 12 ]. Sarcopenia also has independent prognostic value in patients with HF [ 13 ].…”

Association between Obstructive Sleep Apnea and Heart Failure in Adults—A Systematic Review

“…Among patients with symptomatic or decompensated HF, the prevalence of sleep apnea ranges up to 80%. More than half of these individuals suffer from OSA [16,17]. Sleep apnea, whether in the presence or absence of HF, is associated with a higher risk of negative cardiovascular outcomes, including aggravation of HF-related symptoms, increased hospitalizations, and higher mortality rates.…”