This article is more than 5 years old. Information may no longer be current.
Sleep-disordered breathing common in patients with chronic HF
Click Here to Manage Email Alerts
Patients with chronic HF have a high prevalence of moderate-to-severe sleep-disordered breathing, particularly men and older adults.
Researchers evaluated 6,876 patients from the German SchlaHF registry to investigate the prevalence and predictors of sleep-disordered breathing in patients with HF. All patients had stable, symptomatic, chronic HF, with NYHA functional class of II or higher and left ventricular ejection fraction of 45% or lower. Sleep-disordered breathing was measured using a two-channel screening device (ApneaLink, ResMed).
Overall, the prevalence of moderate-to-severe sleep-disordered breathing (apnea-hypopnea index 15/hour) in patients with HF was 46%. The prevalence was higher among men compared with women (49% vs. 36%). In addition, prevalence rose with increasing age: 31% among those aged 50 years and younger; 39% among those aged 50 to 60 years; 45% among those aged 60 to 70 years; 52% among those aged 70 to 80 years; and 59% among those aged older than 80 years.
Clinical predictors of sleep-disordered breathing included BMI (per 5 units; OR = 1.29; 95% CI, 1.22-1.36), LVEF (per 5% decrement from 45%; OR = 1.1; 95% CI, 1.06-1.14), age (per 10-year difference to 60 years; OR = 1.41; 95% CI, 1.34-1.49), atrial fibrillation (OR = 1.19; 95% CI, 1.06-1.34) and male sex (OR = 1.9; 95% CI, 1.67-2.17).
Identifying predictors of sleep-disordered breathing in the HF population may help with risk stratification and the reduction of symptoms and morbidity, Michael Arzt, MD, from the Center for Sleep Medicine, department of internal medicine II, University Hospital Regensburg, Germany, and colleagues wrote in the study.
“Perhaps [one] of the most interesting results [of this study] was that there were no sex differences in the significant predictors of [sleep-disordered breathing] and [apnea-hypopnea index], despite analyses designed to detect such differences,” the researchers wrote. “This suggests that although the prevalence of [sleep-disordered breathing] differs in men and women, the underlying disease mechanisms are the same.”
One limitation of this study is the lack of differentiation between obstructive sleep apnea and central sleep apnea with the screening device used, according to the researchers. – by Tracey Romero
Disclosure: Arzt reports receiving grant support from the German Foundation for Cardiac Research, Philips Home Healthcare Solutions and ResMed; holding an endowed professorship from the Free State of Bavaria at the University of Regensburg that was donated by Phillips Home Healthcare Solutions and ResMed; and previously receiving lecture fees from AstraZeneca, Philips Home Healthcare Solutions and ResMed. Please see the full study for a list of all other researchers’ relevant financial disclosures.
Perspective
Back to Top
Ajay V. Srivastava , MD, FACC
It is known from prior studies that the prevalence of sleep-disordered breathing in patients with HF is high. This study analyzed a large real-world sample of patients with chronic HF and studied the prevalence of sleep-disordered breathing in this patient cohort. While sleep-disordered breathing in patients with HF was known previously, the SchlaHF registry unequivocally demonstrates that almost one in two patients with stable chronic HF receiving optimized medical treatment have moderate-to severe sleep-disordered breathing. The study further indicates that male sex, older age, higher BMI, more severe impairment of systolic cardiac function (i.e., lower LVEF), higher NYHA functional class, and AF were significant clinical predictors for at least moderate sleep-disordered breathing.
By elucidating significant demographic and clinical predictors for SDB that can be easily acquired during a clinic visit, the study can have vast implications for clinical practice. Healthcare providers can use the above predictors of sleep-disordered breathing in a clinic visit questionnaire to screen patients for sleep-disordered breathing and thereby identify at-risk patients and refer them for testing and management of sleep-disordered breathing.
I would like to see multi-center studies/data pooling from research centers studying this disease, so we have a larger patient sample size to better understand sleep-disordered breathing as well as the effects of intervention in specific patient cohorts.
The results of the recent SERVE-HF study (Cowie MR, et al. N Engl J Med. 2015;doi:10.1056/NEJMoa1506459) examining the effect of adaptive servo-ventilation using a noninvasive ventilator to treat central sleep apnea should serve as a distinct reminder that results of an intervention are not always in accordance with what we predict based on our prior knowledge, hence it is crucial that more studies continue to be carried to help us better understand this medical disorder.
Click Here to Manage Email Alerts