Sleep apnoea in heart failure

Schulz, Richard; Blau, Alexander; Börgel, Jan; Duchna, Hans‐Werner; Fietze, Ingo; Koper, Iris; Prenzel, R; Schädlich, S.; Schmitt, Julian; Tasci, Selçuk; Andreas, Stefan

doi:10.1183/09031936.00037106

Cited by 193 publications

(116 citation statements)

References 22 publications

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“…In our cohort, 21.6% of the subjects had an AHI o15 events?h -1 , which is higher than in the general population [9], but comparable to populations with heart failure [24], arterial hypertension [28] or coronary artery disease [10], as reported previously. Our data confirm the established impact of cardiac frequency, BMI and LVM on diastolic function.…”

Section: Discussionsupporting

confidence: 52%

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Impact of obstructive sleep apnoea on diastolic function

et al. 2012

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We investigated whether obstructive sleep apnoea (OSA) independently affects diastolic function in a primary care cohort of patients with cardiovascular risk factors.378 study participants with risk factors for diastolic dysfunction were prospectively included and a polygraphy was performed in all patients. Diastolic dysfunction was assessed by comprehensive echocardiography including tissue Doppler. Sleep apnoea was classified according to apnoea/ hypopnoea index (AHI) as none (AHI ,5 events?h ). Patients with central sleep apnoea (n514) and patients with previously diagnosed sleep apnoea (n512) were excluded. In the remaining 352 subjects, 21.6% had an AHI o15 events?h -1 . The prevalence of diastolic dysfunction increased with the severity of sleep apnoea from 44.8% (none) to 56.8% (mild) to 69.7% (moderate-to-severe sleep apnoea) (p50.002). The degree of diastolic dysfunction also increased with sleep apnoea severity (p50.004). In univariate regression analysis, age, desaturation index, AHI, cardiac frequency, angiotensin receptor 1 antagonist therapy, body mass index (BMI) and left ventricular mass were associated with diastolic dysfunction. In multivariate regression analysis, only age, BMI, AHI and cardiac frequency were independently associated with diastolic dysfunction.Moderate-to-severe OSA is independently associated with diastolic dysfunction in patients with classical risk factors for diastolic dysfunction.

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Section: Discussionsupporting

confidence: 52%

“…Over an inclusion period of 18 months, ambulatory investigation for sleep-disordered breathing was performed with the Stardust II Sleep recorder (Philips Respironics, Best, the Netherlands), as desribed previously [24]. The median time between the echocardiographic examination and the sleep recorder study was 11.5 days (range 6-29 days).…”

Section: Polygraphymentioning

confidence: 99%

Impact of obstructive sleep apnoea on diastolic function

et al. 2012

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“…One such comorbidity is sleep‐disordered breathing (SDB), which is more common in HF patients than in the general population 7, 8. Data from the SchlaHF (Sleep‐Disordered Breathing in Heart Failure) registry showed that SDB in HF is highly prevalent, with nearly half of all studied patients with HF with reduced ejection fraction (HFrEF) having moderate to severe SDB, and identifying a number of risk factors for SDB in these patients, including increasing age and body mass index (BMI), decreasing left ventricular ejection fraction (LVEF), male sex, and the presence of atrial fibrillation 9…”

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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“…2005; Schulz et al. 2007). CHF patients with an AHI ≥10 events/h with >50% of apneas classified as obstructive were classified as having OSA.…”

Section: Methodsmentioning

confidence: 99%

Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

et al. 2017

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The increased prevalence of obstructive sleep apnea (OSA) in congestive heart failure (CHF) may be associated with rostral fluid shift. We investigated the effect of overnight rostral fluid shift on pharyngeal collapsibility (Pcrit), pharyngeal caliber (APmean), and apnea‐hypopnea index (AHI) in CHF patients. Twenty‐three optimally treated systolic CHF patients were studied. Neck circumference was measured immediately prior to sleep in the evening and immediately after waking in the morning as a marker of rostral fluid shift. Pcrit was measured during sleep, early and late in the night. APmean was measured using acoustic reflection at the same times as neck circumference measurements. 15/23 CHF patients experienced an overnight increase in neck circumference; overall neck circumference significantly increased overnight (mean±SD, evening: 41.7 ± 3.2 cm; morning: 42.3 ± 3.1 cm; P = 0.03). Pcrit increased significantly overnight (early‐night: −3.8 ± 3.3 cmH2O; late‐night: −2.6 ± 3.0 cmH2O; P = 0.03) and APmean decreased (evening: 4.2 ± 1.3 cm2; morning: 3.7 ± 1.3 cm2; P = 0.006). The total AHI correlated with neck circumference (r = 0.4; P = 0.04) and Pcrit (r = 0.5; P = 0.01). APmean correlated with neck circumference (r = −0.47; P = 0.02). There was no significant change in AHI between the first and second half of the night (first‐half: 12.9 ± 12.4/h; second‐half: 13.7 ± 13.3/h; P = 0.6). Overnight rostral fluid shift was associated with increased pharyngeal collapsibility and decreased pharyngeal caliber during sleep in CHF patients. Rostral fluid shift may be an important mechanism of OSA in this patient group.

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Sleep apnoea in heart failure

Cited by 193 publications

References 22 publications

Impact of obstructive sleep apnoea on diastolic function

Impact of obstructive sleep apnoea on diastolic function

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

Investigation of the link between fluid shift and airway collapsibility as a mechanism for obstructive sleep apnea in congestive heart failure

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