Prognostic Impact of Central Sleep Apnea in Patients With Heart Failure

Grimm, Wolfram; Sosnovskaya, A.V.; Timmesfeld, Nina; Hildebrandt, Olaf; Koehler, Ulrich

doi:10.1016/j.cardfail.2014.10.017

Cited by 23 publications

(21 citation statements)

References 35 publications

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“…However, several studies also reported conflicting results (17, 18). Unlike OSA, there are limited changes in the intrathoracic pressure during CSA and mild desaturations and hyperpnea.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Importance of Novel Oxygen Desaturation Metrics in Patients With Heart Failure and Central Sleep Apnea

Watanabe

Kiyono

Matsui

et al. 2017

Journal of Cardiac Failure

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Background Sleep-disordered breathing, particularly central sleep apnea (CSA), is highly prevalent in heart failure (HF) and an independent prognostic marker. We assessed the hypothesis that an increased hypoxemic burden during sleep may have greater prognostic value than the frequency of apneic and hypopneic episodes. Methods and Results We prospectively conducted overnight cardiorespiratory polygraphy on consecutive HF patients referred to our hospital between 2008 and 2011. We studied CSA defined by an apnea-hypopnea index (AHI) of ≥5 events/h, whereby >75% of all events were central in origin. We determined the AHI, proportion of the sleep time with an SpO2<90% (T90%), and percent of the recording time that 4% desaturation events occurred (4%POD). We studied 112 HF patients with either systolic or diastolic dysfunction. During a follow-up period of 37±25 months, 32 patients (29%) died. Non-survivors had a higher 4%POD compared to survivors (11±6.4 vs. 19±13%, p=0.001), but did not differ significantly regarding the AHI and T90% compared to survivors. An adjusted logistic regression analysis revealed that the 4%POD was the best independent predictor of mortality. Conclusion The 4%POD, a novel metric for the nocturnal hypoxemic burden, is an independent prognostic marker in HF patients affected by CSA.

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“…However, several studies also reported conflicting results (17, 18). Unlike OSA, there are limited changes in the intrathoracic pressure during CSA and mild desaturations and hyperpnea.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Importance of Novel Oxygen Desaturation Metrics in Patients With Heart Failure and Central Sleep Apnea

Watanabe

Kiyono

Matsui

et al. 2017

Journal of Cardiac Failure

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“…92 In contrast, a study of 267 patients with stable HF demonstrated no difference in transplant-free survival over a 5-year period between those with no/mild CSA, moderate CSA, or severe CSA. 93 …”

Section: Clinical Featuresmentioning

confidence: 99%

Heart Failure and Sleep Apnea

Lyons

Bradley

2015

Canadian Journal of Cardiology

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“…It has been reported that sleep apnea, generally scored by the apnea‐hypopnea index (AHI), might be an independent risk factor of adverse outcomes in heart failure . However, AHI has been questioned as a prognostic predictor of heart failure in some studies . AHI is only a metric reflecting the frequency of apneas and hypopneas during sleep and does not take the lengths of apneas and hypopneas into consideration on its own definition.…”

Section: Introductionmentioning

confidence: 99%

“…1,2,11 However, AHI has been questioned as a prognostic predictor of heart failure in some studies. 12,13 AHI is only a metric reflecting the frequency of apneas and hypopneas during sleep and does not take the lengths of apneas and hypopneas into consideration on its own definition. Therefore, more importance should be attached to detailed characteristics of sleep apnea.…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of sleep apnea and nocturnal hypoxemia in patients with decompensated heart failure

Huang

Wang

Huang

et al. 2020

Clinical Cardiology

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Background Nocturnal hypoxemia is an important factor underlying the impact of sleep apnea on heart failure. It remains unclear whether nocturnal hypoxemia has a greater prognostic value in acute decompensated heart failure (ADHF) compared with the frequency of sleep apnea. Hypothesis Nocturnal hypoxemia might be better than the frequency of sleep apnea in predicting the outcomes in ADHF. Methods Sleep studies were prospectively performed during an ADHF hospitalization from January 2015 to December 2017. Sleep apnea was defined as the apnea‐hypopnea index (AHI) ≥15/h. The severity of nocturnal hypoxemia was determined by the percentage of time with saturation below 90% (T90%). The endpoint was the first event of all‐cause death, heart transplantation, implantation of left ventricular assist device, unplanned hospitalization for worsening heart failure, acute coronary syndrome, significant arrhythmias, or stroke. Results Of 382 patients, 189 (49.5%) had sleep apnea. The endpoint incidence did not differ between AHI categories (≥15/h vs <15/h: 52.4% vs 44.6%, log rank P = .353), but did between T90% categories (≥3.6% vs <3.6%: 54.5% vs 42.4%, log rank P = .023). Multivariate Cox regression analysis showed that T90% was independently associated with the endpoint (hazard ratio [HR] 1.008, 95% confidence interval [CI] 1.001‐1.016, P = .033), whereas AHI was not; the risk of the endpoint increased by 40.8% in patients with T90% ≥3.6% (HR 1.408, 95%CI 1.030‐1.925, P = .032). Conclusion Nocturnal hypoxemia had a greater prognostic value in ADHF than the frequency of sleep apnea.

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Prognostic Impact of Central Sleep Apnea in Patients With Heart Failure

Cited by 23 publications

References 35 publications

Prognostic Importance of Novel Oxygen Desaturation Metrics in Patients With Heart Failure and Central Sleep Apnea

Prognostic Importance of Novel Oxygen Desaturation Metrics in Patients With Heart Failure and Central Sleep Apnea

Heart Failure and Sleep Apnea

Prognostic value of sleep apnea and nocturnal hypoxemia in patients with decompensated heart failure

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