Sleep Disordered Breathing is Associated with Appropriate Implantable Cardioverter Defibrillator Therapy in Congestive Heart Failure Patients

Abstract

Background: Implantable cardioverter defibrillators (ICDs) are increasingly employed in patients affected by congestive heart failure (CHF) and sleep disordered breathing (SDB) is frequent in this population. Hypothesis: To investigate SDB prevalence and influence on appropriate ICD discharges in CHF patients. Methods: A total of 22 consecutive ICD patients with systolic CHF (left ventricular ejection fraction [LVEF]<45%) were studied by polysomnography. Results: A total of 17 (77.2%) showed SDB (apnea-hypopnea index [AHI] 10 events/hour). After controlling for LVEF and New York Heart Association (NYHA) class, AHI and severity of hypoxia during sleep results correlated to appropriate ICD discharges (r = 0.718; P < .001, r = −0.619; P = .003, respectively). Conclusions: Sleep disordered breathing is frequent in ICD recipients due to left systolic ventricular dysfunction and may increase the risk of ventricular arrhythmia and appropriate ICD discharges.

Sleep, Psychosocial Functioning, and Device-Specific Adjustment in Patients with Implantable Cardioverter Defibrillators (ICDs)

“…The prevalence rate of OSA in our sample (40.5%) is consistent with previous findings in the literature (40–77%; Fries et al, 1999; Grimm et al, 2013; Mehra et al, 2006; Serizawa et al, 2008; Tomaello et al, 2010), although our rate of OSA and comorbid insomnia (11.9%) is low relative to previously reports in ICD patients with nocturnal ventricular arrhythmias (22–54.9%; Al-Jawder & Bahammam, 2011). Our prevalence rate for insomnia within the sample (28.6%) is lower but somewhat comparable to previous findings in heart failure patients (44%; Taylor et al, 2007), and suggests that insomnia is a considerable problem with these patients as a less-recognized and/or treated condition that until recently has received little attention (Cross et al, 2010).…”

“…The identification of an under-recognized condition, such as insomnia, could warrant the inclusion of psychological and/or hypnotic therapy to the constellation of medical care ICD patients receive which could substantially improve their cardiovascular functioning and/or quality of life. Apnea, whether alone or comorbid with insomnia, is particularly problematic for ICD patients as the aggregate cardiovascular effects of apnea (Kasai & Bradley, 2011) have been associated with arrhythmia and subsequent ICD discharge (Fichter et al, 2002; Serizawa et al, 2008; Tomaello et al, 2010). The finding that insomnia and apnea have the potential to co-occur suggests that concurrent psychological treatment for insomnia and respiratory therapy (i.e., continuous positive airway pressure [CPAP], the gold standard treatment for sleep apnea) in this population may be indicated; previous research demonstrates both the cardiovascular and psychological benefit of this dual approach (Abe et al, 2010).…”

“…Prevalence rates of sleep disordered breathing (SDB), primarily obstructive sleep apnea (OSA), in patients with ICDs are estimated at 40–77% (Fries et al, 1999; Grimm, Apelt, Timmesfeld, & Koehler, 2013; Serizawa et al, 2008; Tomaello, Zanolla, Vassanelli, LoCascio, & Ferrari, 2010). The pathophysiological consequences of OSA (e.g., increased heart rate and blood pressure, sympathetic nervous system activity) are particularly problematic to the patient with an ICD, as these cardiovascular events may increase risk of shock and subsequent shock-related psychological distress (Kasai & Bradley, 2011).…”

Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure

“…Four studies reported SDB without differentiating subtypes. 13, 17–19 Three studies reported OSA and CSA separately. 12, 14, 16 Two studies included patients with only CSA.…”

Sleep-Disordered Breathing and Cardiac Arrhythmias

“…In a small cohort, Tomaello et al found a higher number of ICD therapies in CHF patients with concomitant SDB. 75 In 255 patients screened for SDB 6 months after implantation of a cardiac resynchronization device with defibrillator, we found an independent association between SDB and appropriate defibrillator therapies during a 48-month follow-up period (Fig. 2).…”