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