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Observational Study
. 2016 Mar 1;193(5):561-8.
doi: 10.1164/rccm.201503-0536OC.

Sleep-disordered Breathing and Incident Heart Failure in Older Men

Sogol Javaheri  1 , Terri Blackwell  2 , Sonia Ancoli-Israel  3 , Kristine E Ensrud  4 , Katie L Stone  2 , Susan Redline  1   5 ; Osteoporotic Fractures in Men Study Research Group
Collaborators, Affiliations
Observational Study

Sleep-disordered Breathing and Incident Heart Failure in Older Men

Sogol Javaheri et al. Am J Respir Crit Care Med. .

Abstract

Rationale: The directionality of the relationship between sleep-disordered breathing and heart failure is controversial.

Objectives: We assessed whether elevations in the obstructive or central sleep apnea index or the presence of Cheyne-Stokes breathing are associated with decompensated and/or incident heart failure.

Methods: We conducted a prospective, longitudinal study of 2,865 participants derived from the Osteoporotic Fractures in Men Study, a prospective multicenter observational study of community-dwelling older men. Participants underwent baseline polysomnography and were followed for a mean 7.3 years for development of incident or decompensated heart failure. Our main exposures were the obstructive apnea-hypopnea index (AHI), central apnea index (CAI ≥ 5), and Cheyne-Stokes breathing. Covariates included age, race, clinic site, comorbidities, physical activity, and alcohol and tobacco use.

Measurements and main results: CAI greater than or equal to five and presence of Cheyne-Stokes breathing but not obstructive AHI were significant predictors of incident heart failure (adjusted hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.16-2.77 for CAI ≥ 5) (HR, 2.23; 95% CI, 1.45-3.43 for Cheyne-Stokes breathing). After excluding those with baseline heart failure, the incident risk of heart failure was attenuated for those with CAI greater than or equal to five (HR, 1.57; 95% CI, 0.92-2.66) but remained significantly elevated for those with Cheyne-Stokes breathing (HR, 1.90; 95% CI, 1.10-3.30).

Conclusions: An elevated CAI/Cheyne-Stokes breathing, but not an elevated obstructive AHI, is significantly associated with increased risk of decompensated heart failure and/or development of clinical heart failure in a community-based cohort of older men.

Keywords: Cheyne-Stokes breathing; epidemiology; heart failure; sleep apnea.

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Figures

Figure 1.
Figure 1.
Flow diagram presenting information regarding progress through the phases of the trial from MrOS Study to MrOS Sleep ancillary study to present cohort. MrOS = Osteoporotic Fractures in Men.
See this image and copyright information in PMC

Comment in

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