Influence of Obstructive Sleep Apnea on Mortality in Patients With Heart Failure

Wang, Hanqiao; Parker, John D.; Newton, Gary E.; Floras, John S.; Mak, Susanna; Chiu, Kuo-Liang; Ruttanaumpawan, Pimon; Tomlinson, George; Bradley, T. Douglas

doi:10.1016/j.jacc.2006.12.046

Cited by 541 publications

(371 citation statements)

References 39 publications

(66 reference statements)

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“…Thus the prevalence of CSA and OSA in the AMI patients of our study is comparable with that reported in samples of patients with chronic HF and with a similar degree of cardiac impairment [1,3]. In such samples of chronic HF, CSA, as well as OSA, is associated with impaired prognosis [8,9].…”

Section: Sleep-related Disorders S Buchner Et Alsupporting

confidence: 85%

“…For example, in a previous observational study the presence of sleep apnoea early after AMI was linked to impaired recovery of cardiac function [6]. Ultimately, both OSA and CSA confer an increased mortality risk in patients with chronic HF [7][8][9]. 2) Conversely, there is epidemiological [10] and clinical evidence [11][12][13][14][15] that cardiovascular disease and especially HF can contribute to the development or worsening of sleep apnoea.…”

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confidence: 99%

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Natural course of sleep-disordered breathing after acute myocardial infarction

et al. 2012

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The aim of this study was to test whether an improvement of left ventricular ejection fraction (EF) in the early phase after acute myocardial infarction is associated with a reduction of the severity of central and obstructive sleep apnoea.40 consecutive patients with acute myocardial infarction underwent polysomnography and cardiovascular magnetic resonance imaging within 5 days and 12 weeks after the event to assess sleep apnoea and cardiac function. We stratified the sample in patients who improved their left ventricular EF within 12 weeks by o5% (improved EF group, DEF 9¡1%, n516) and in those who did not (unchanged EF group, DEF -1¡1%, n524).Prevalence of sleep apnoea (o15 apnoea and hypopnoea events?h -1 ) within f5 days after myocardial infarction was 55%. Apnoea and hypopnoea events?h -1 were significantly more reduced in the improved EF group compared with the unchanged EF group (-10¡3 versus 1¡3 events?h -1 ; p50.036). This reduction was based on a significant alleviation of obstructive events (-7¡2 versus 4¡3 events?h -1 ; p50.009), while the reduction of central events was similar between groups (p50.906).An improvement of cardiac function early after myocardial infarction is associated with an alleviation of sleep apnoea. This finding suggests that re-evaluation of treatment indication for sleep apnoea is needed when a change in cardiac function occurs.

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Section: Sleep-related Disorders S Buchner Et Alsupporting

confidence: 85%

mentioning

confidence: 99%

Natural course of sleep-disordered breathing after acute myocardial infarction

et al. 2012

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“…191 On the other hand, more recent data suggest that the presence of untreated OSA (AHI Ͼ15) in patients with heart failure is associated with an increased risk of death compared with patients with an AHI Ͻ15 independently of confounding factors. 171 Treatment of OSA: Effects on Heart Failure OSA patients are advised to reduce weight and to abstain from alcohol and sedatives that predispose to pharyngeal collapse during sleep; these general measures may reduce the severity of heart failure and the severity of OSA. 192,193 There have been no controlled studies of mandibular advancement devices or upper airway surgery involving OSA patients with heart failure.…”

Section: Osa and The Origin And Progression Of Heart Failurementioning

confidence: 99%

Sleep Apnea and Cardiovascular Disease

et al. 2008

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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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Influence of Obstructive Sleep Apnea on Mortality in Patients With Heart Failure

Abstract: In patients with HF, untreated OSA is associated with an increased risk of death independently of confounding factors.

Cited by 541 publications

References 39 publications

Natural course of sleep-disordered breathing after acute myocardial infarction

Natural course of sleep-disordered breathing after acute myocardial infarction

Sleep Apnea and Cardiovascular Disease

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

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