Prevalence and risk factors of sleep apnea in adult patients with congenital heart disease

Abstract

Background:Although sleep apnea is an important disorder associated with cardiac events, data regarding its prevalence and risk factors in adult patients with congenital heart disease are limited.Methods:In this study, patients underwent a sleep study in the hospital. Indications for admission were classified as heart failure, diagnostic catheterisation, interventional catheterisation, or arrhythmia. The prevalence, characteristics, and risk factors of sleep apnea using a type-3 portable overnight polygraph in adult patients with congenital heart disease were evaluated.Results:There were 104 patients [median age: 36 (interquartile range: 28–48) years] who were admitted for heart failure 34% (n = 36), diagnostic catheterisation 26% (n = 27), interventional catheterisation 18% (n = 19), or arrhythmia 22% (n = 23). The prevalence of sleep apnea, defined as a respiratory disturbance index ≥5, was 63% (n = 63), with a distribution of 37%, 16%, and 10% for mild (5≤ respiratory disturbance index <15), moderate (15≤ respiratory disturbance index <30), and severe (respiratory disturbance index ≥30) sleep apnea, respectively. A large majority of the sleep apnea cases were categorised as obstructive sleep apnea (92%, n = 58). The respiratory disturbance index ≥15 group had a significantly higher proportion of male patients and higher body mass index, noradrenaline level, and aortic blood pressure than the group without sleep apnea (respiratory disturbance index <5). Multivariable analysis showed that New York Heart Association class ≥II (OR, 4.36; 95% CI, 1.09–20.87) and body mass index ≥25 (OR, 4.29; 95% CI, 1.32–15.23) were independent risk factors for a respiratory disturbance index ≥15.Conclusion:Our results showed a high prevalence of sleep apnea in adult patients with congenital heart disease. Its unique haemodynamics may be associated with a high prevalence of sleep apnea. Congestive heart failure and being overweight are important risk factors for sleep apnea. Management of heart failure and general lifestyle improvements will be important for controlling sleep apnea symptoms in these patients.

Sleep-disordered breathing and lung function abnormalities in adults with congenital heart disease

“…They identified a proportion of 31% of patients with ACHD at high risk of OSA that diverges from our results, mainly due to the employed screening tool. A likewise wider range of defects was evaluated by Harada and colleagues [ 21 ]. Patients with ACHD who required hospitalization and underwent in-hospital overnight polygraphy were retrospectively analysed.…”

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

“…It has been reported that sleep-disordered breathing (SDB) is often associated with CHD. 238 In patients with obstructive sleep apnea syndrome (OSAS), continuous positive airway pressure has been established. 239 Its clinical relevance remains unknown in terms of prognosis in patients with HF and OSAS.…”

“…Blood pressure should be measured or monitored annually in the clinic or at home (Class I). 398 When secondary hypertension is suspected on medical interview, physical examination, and general laboratory examinations, it is important to investigate specific risk factors in ACHD; sleep apnea syndrome, 238 repaired coarctation of the aorta (CoA) and recurrent hypertension, 399 and use of nonsteroidal antiinflammatory drugs. In patients with cyanotic malformations, it may be worth screening for renal impairment, pheochromocytoma, and paraganglioma.…”

“…According to the current guidelines for treating heart failure, target systolic blood pressure is 110-130 mmHg for patients with heart failure with reduced ejection fraction and <130 mmHg for patients with heart failure with preserved ejection fraction. 238,397 Lifestyle should be modified; controlled sodium intake, food restriction, healthy body mass index (BMI), and smoking cessation. Management for cardioprotection is reasonable using angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers in combination with mineralocorticoid receptor blockers.…”

Successful Total Management of Multi-Causative Sleep-Disordered Breathing Complicated with Patient with Adult Congenital Heart Disease

“…leep-disordered breathing is one of the common complications in patients with adult congenital heart disease (ACHD). 1,2) It is caused by a reduced forced vital capacity (VC) due to the complexity of underlying cardiac defects, cardiomegaly, previous thoracotomies, obesity, scoliosis, and paralysis of the diaphragm in these patients. 3) Multiple causes are responsible for this complication and thus therapeutic strategies need to be multi-targeted.…”