Prevalence and Predictors of Sleep-Disordered Breathing in Patients With Stable Chronic Heart Failure

Arzt, Michael; Woehrle, Holger; Oldenburg, Olaf; Graml, Andrea; Suling, Anna; Erdmann, Erland; Teschler, Helmut; Wegscheider, Karl; Investigators, SchlaHF

doi:10.1016/j.jchf.2015.09.014

Cited by 172 publications

(137 citation statements)

References 43 publications

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“…As described previously in the German SchlaHF registry, assessment of SDB using a 2‐channel respiratory monitor (ApneaLink, ResMed, Australia, Sydney) was being performed in 256 centers (NCT01500759) with sufficient infrastructure to participate 9, 23. Between February 2008 and January 2011, type of SDB (OSA, CSA or coexisting OSA and CSA [OSA‐CSA]) and the occurrence of periodic breathing (proportion of CSR ≥20%) were determined in 1557 HFrEF patients using in‐lab polysomnography (Figure 1).…”

Section: Methodsmentioning

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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Section: Methodsmentioning

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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“…From a total of 90 patients with HF who were initially screened to the study, 49 patients were excluded: peak V ⋅ O 2 >20 mL kg −1 per min (23), LVEF >40% (8), body mass index >30 kg/ m 2 (4), atrial fibrillation (2), pulmonary disease (1), complex arrhythmia (1), under anxiolytic (1), technical problems during polysomnography study (1), refused to participate (1), and did not conclude all the evaluations (7). Forty-one patients who fulfilled all the inclusion criteria were enrolled in the study: NoSDB (n=13, 46 [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53] years) and SDB (n=28, 57 [54-61] years).…”

Section: Baseline Measuresmentioning

confidence: 99%

Sleep-Disordered Breathing Exacerbates Muscle Vasoconstriction and Sympathetic Neural Activation in Patients with Systolic Heart Failure

Lobo

Trevizan

Toschi‐Dias

et al. 2016

Circ: Heart Failure

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Background— Sleep-disordered breathing (SDB) is common in patients with heart failure (HF), and hypoxia and hypercapnia episodes activate chemoreceptors stimulating autonomic reflex responses. We tested the hypothesis that muscle vasoconstriction and muscle sympathetic nerve activity (MSNA) in response to hypoxia and hypercapnia would be more pronounced in patients with HF and SDB than in patients with HF without SDB (NoSBD). Methods and Results— Ninety consecutive patients with HF, New York Heart Association functional class II–III, and left ventricular ejection fraction ≤40% were screened for the study. Forty-one patients were enrolled: NoSDB (n=13, 46 [39–53] years) and SDB (n=28, 57 [54–61] years). SDB was characterized by apnea–hypopnea index ≥15 events per hour (polysomnography). Peripheral (10% O 2 and 90% N 2 , with CO 2 titrated) and central (7% CO 2 and 93% O 2 ) chemoreceptors were stimulated for 3 minutes. Forearm and calf blood flow were evaluated by venous occlusion plethysmography, MSNA by microneurography, and blood pressure by beat-to-beat noninvasive technique. Baseline forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance were similar between groups. MSNA was higher in the SDB group. During hypoxia, the vascular responses (forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance) were significantly lower in the SDB group compared with the NoSDB group ( P <0.01 to all comparisons). Similarly, during hypercapnia, the vascular responses (forearm blood flow, forearm vascular conductance, calf blood flow, and calf vascular conductance) were significantly lower in the SDB group compared with the NoSDB group ( P <0.001 to all comparisons). MSNA were higher in response to hypoxia ( P =0.024) and tended to be higher to hypercapnia ( P =0.066) in the SDB group. Conclusions— Patients with HF and SDB have more severe muscle vasoconstriction during hypoxia and hypercapnia than HF patients without SDB, which seems to be associated with endothelial dysfunction and, in part, increased MSNA response.

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“…However, you have considered 4 patients who died of ventricular tachycardia (2) and ventricular fibrillation (2) …”

Section: To the Editormentioning

confidence: 99%

Respiratory Therapy in Chronic Heart Failure Patients Complicated With Sleep-Disordered Breathing: Potential Study Bias

Felix-Moscoso

Denegri-Galvan

Ortega-Loayza

et al. 2016

Circ J

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Prevalence and Predictors of Sleep-Disordered Breathing in Patients With Stable Chronic Heart Failure

Cited by 172 publications

References 43 publications

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

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

Sleep-Disordered Breathing Exacerbates Muscle Vasoconstriction and Sympathetic Neural Activation in Patients with Systolic Heart Failure

Respiratory Therapy in Chronic Heart Failure Patients Complicated With Sleep-Disordered Breathing: Potential Study Bias

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