Clinical Investigation
Prevalence and Physiological Predictors of Sleep Apnea in Patients With Heart Failure and Systolic Dysfunction

https://doi.org/10.1016/j.cardfail.2008.11.015Get rights and content

Abstract

Background

Previous studies reported high prevalences of obstructive and central sleep apnea (OSA and CSA, respectively) in patients with heart failure (HF). However, these preceded widespread use of β-blockers and spironolactone that might have reduced their prevalences. We therefore determined, in patients with HF, prevalences and predictors of OSA and CSA and the influence of changes in HF therapy on prevalences.

Methods and Results

A total of 218 HF patients with left ventricular ejection fraction (LVEF) ≤45% underwent sleep studies between 1997 and 2004 and were classified as having moderate to severe sleep apnea (apnea-hypopnea index ≥15hours of sleep, either OSA or CSA), or mild to no sleep apnea. The prevalence of moderate to severe OSA was 26% and of CSA was 21%. Predictors of OSA were older age, male sex, and greater body mass index, and of CSA were older age, male sex, atrial fibrillation, hypocapnia, and diuretic use. Between 1997 and 2004, the prevalences of OSA and CSA did not change significantly (Ptrend =.460, Ptrend =.211, respectively) despite increased use of β-blockers and spironolactone (Ptrend < .001, Ptrend < .001, respectively), and an increase in LVEF (Ptrend=.005).

Conclusions

OSA and CSA remain common in patients with HF, despite increases in β-blocker and spironolactone use.

Section snippets

Subjects

Subjects were recruited from the Heart Failure Clinic of the Mount Sinai Hospital where newly referred patients undergo baseline evaluation of cardiovascular function. Their HF therapy was then optimized, after which cardiovascular function was reassessed. After optimization of HF therapy, consecutive patients who met the following inclusion criteria between September 1, 1997, and December 1, 2004, underwent overnight polysomnography regardless of symptoms or signs of sleep apnea. Inclusion

Subjects

Of the 242 patients meeting eligibility criteria, 90% (218) agreed to have a sleep study. Of 218 patients enrolled, 168 (77%) were men and 50 (23%) were women, age 18 to 84 years (mean 55.6±12.7 years), and whose BMI was 29.2±5.3kg/m2. Fifty-four percent of patients were in NYHA Class II, 45% in Class III, and 1% in Class IV, and the mean LVEF was 24.7±10.0%. Etiology of HF was ischemic in 40% and nonischemic in 60%. At the time of assessment, 92% were taking angiotensin-converting enzyme

Discussion

This prospective study has given rise to several novel observations. First, in HF patients with systolic dysfunction on optimal contemporary therapy, we found a high prevalence of both OSA and CSA. Among our 218 patients, 47% had sleep apnea (AHI ≥15). This compares with a prevalence of 6.5% for an AHI ≥15 in an otherwise healthy community sample.21 Second, older age, male sex, and greater BMI were independent predictors of OSA, whereas older age, male sex, atrial fibrillation, hypocapnia, and

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    Supported by program grant PRG-5275 from the Heart and Stroke Foundation of Ontario. D. Yumino was supported by an unrestricted research fellowship from Respironics Inc.; H. Wang by research fellowships from the Departments of Medicine of the University of Toronto and Merck-Frosst; J.S. Floras by a Canada Research Chair in Integrative Cardiovascular Biology and a Career Investigator Award from the Heart and Stroke Foundation of Ontario; S. Mak by a New Investigator Award from the Heart and Stroke Foundation of Ontario; P. Ruttanaumpawan by a research fellowship from Siriraj Hospital, Mahidol University, Bangkok, Thailand; and J.D. Parker by a Career Investigator Award from the Heart and Stroke Foundation of Ontario.

    Conflict of interest: None

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