Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients

Abstract

Aim: Evaluation of the prevalence and nature of sleep-disordered breathing (SDB) in patients with symptomatic chronic heart failure (CHF) receiving therapy according to current guidelines.

Methods and results: We prospectively screened 700 patients with CHF (NYHA class> or =II, LV-EF< or =40%) for SDB using cardiorespiratory polygraphy (Embletta). Furthermore, echocardiography, cardiopulmonary exercise and 6-min walk testing were performed. Medication included ACE-inhibitors and/or AT1-receptor blockers in at least 94%, diuretics in 87%, beta-blockers in 85%, digitalis in 61% and spironolactone in 62% of patients. SDB was present in 76% of patients (40% central (CSA), 36% obstructive sleep apnoea (OSA)). CSA patients were more symptomatic (NYHA class 2.9+/-0.5 vs. no SDB 2.57+/-0.5 or OSA 2.57+/-0.5; p<0.05) and had a lower LV-EF (27.4+/-6.6% vs. 29.3+/-2.6%, p<0.05) than OSA patients. Oxygen uptake (VO(2)) was lowest in CSA patients: predicted peak VO(2) 57+/-16% vs. 64+/-18% in OSA and 63+/-17% in no SDB, p<0.05. 6-min walking distances were 331+/-111 m in CSA, 373+/-108 m in OSA and 377+/-118 m in no SDB (p<0.05).

Conclusions: This study confirms the high prevalence of SDB, particularly CSA in CHF patients. CSA seems to be a marker of heart failure severity.