Impact of sleep‐related breathing disorders on health‐related quality of life in patients with chronic heart failure

Abstract

Background: Quality of life in patients with chronic heart failure (HF) is often severely compromised. Sleep-related breathing disorders (SRBD) like Cheyne-Stokes Respiration (CSR) or obstructive sleep apnea (OSAS) are often observed in patients with severe HF resulting in fragmentation of sleep, excessive daytime sleepiness and an increased mortality. While an apnea/hypopnea-index (AHI) N30/h represents an independent predictor of poor prognosis, clinical relevance of even minor SRBD with an AHI b30/h remains unclear with respect to quality of life, exercise capacity or depression rate. Methods: Sixty-nine consecutive ambulatory patients with stable HF (NYHA II-III, EF 25%) underwent two night polygraphies with a sixchannel ambulatory recording. Spiroergometry was performed, and patients were examined for sleep quality (PSQI), depressed mood (BDI) and health-related quality of life (SF-36). The data were compared to 10 age-matched healthy controls and 11 patients with OSAS (AHI 14-29/h) not suffering from HF. Results: Fifty-one patients completed follow up. 52% were positively diagnosed for SRBD (AHI 16-30/h: 12 patients CSR, 5 patients OSAS, 9 patients mixed); 25 patients (48%) showed no relevant SRBD. Patients with HF and SRBD had lower quality of life than patients without SRBD and HF. The severity of SRBD as indicated by the AHI significantly correlated with quality of life measures: Bodily pain, physical functioning and social functioning showed largest impairment in patients with HF and SRBD. Furthermore, elevated depression rates in correlation to the AHI were only observed in patients with SRBD similar to patients with OSAS without HF. Conclusion: Even minor SRBD in patients with HF independently influence quality of life and correlate with estimation of depression and sleep disturbances.

Sleep and psychological well-being

“…There is ample evidence of correlation between many illnesses such as chronic pain conditions and sleep disruption (Ohayon and Roth, 2002). Furthermore, it is possible that our ''long sleeping'' participants may have also suffered from sleep apnea, a disorder associated with hypersomnolence, diminished well-being, and symptoms of psychopathology (Parish and Somers, 2004;Skobel et al, 2005). Despite these alternative explanations, this study is a first investigation of the relationship of sleep to dimensions of eudaimonic well-being.…”

Health Related Quality of Life in Patients Awaiting Heart Transplantation

“…Although pulmonary functions of HF patients show restrictive or obstructive characteristics most of HF patients have normal pulmonary function test results (Kindman et al 1994;Clark 2000). In addition, inspiratory muscle training has been shown to reduce dyspnea and increase the quality of life and functional status of HF patients due to increase in strength and endurance of respiratory muscles (McConnell et al 2003;Skobel et al 2005). Russell et al (1998) pointed out an association between pulmonary function tests and exercise capacity of HF patients, but Ingle et al (2005) failed to demonstrate this association.…”

Die Bedeutung von Schlafstörungen für die Prävention von Suizidalität

“…Angenommen wird, dass vermehrte Tagesmüdig-keit und Hypersomnie mit Depressivität auch in Suizidalität münden könnten [20]. Für die Tagesmüdigkeit als Leitsymptom einer obstruktiven Schlafapnoe [103] konnten bislang nur Bezüge zwischen schlafbezogenen Atemstörungen (SBAS) und Depressivität, nicht aber Suizidalität, festgestellt werden [62]. Allerdings liegt eine Kasuistik eines 74-jährigen Mannes mit SBAS aus einer Schlafambulanz vor [58], dessen depressiv-suizidales Syndrom unter alleiniger nasaler Überdruck-(nCPAP-)Beatmung vollständig remittierte.…”