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. 2022 Dec;9(6):4100-4111.
doi: 10.1002/ehf2.14027. Epub 2022 Sep 2.

Prevalence and predictors of sleep-disordered breathing in chronic heart failure: the SchlaHF-XT registry

Michael Arzt  1 , Olaf Oldenburg  2 , Andrea Graml  3 , Jürgen Schnepf  3 , Erland Erdmann  4 , Helmut Teschler  5 , Christoph Schoebel  5 , Holger Woehrle  6 ; SchlaHF-XT investigators
Affiliations

Prevalence and predictors of sleep-disordered breathing in chronic heart failure: the SchlaHF-XT registry

Michael Arzt et al. ESC Heart Fail. 2022 Dec.

Abstract

Aims: Heart failure with preserved ejection fraction (HFpEF) is a condition with increasing prevalence. Sleep-disordered breathing (SDB) is an important co-morbidity in HFpEF. The SchlaHF-XT registry evaluated the sex-specific prevalence and predictors of SDB, including obstructive (OSA) and central sleep apnoea, in patients with HFpEF compared with heart failure with mildly reduced (HFmrEF) or reduced (HFrEF) ejection fraction.

Methods and results: Consecutive adults with chronic heart failure treated according to current guidelines were enrolled. The presence of moderate-to-severe SDB (apnoea-hypopnoea index ≥15/h) was determined using Type 3 polygraphic devices. Of 3289 patients included, 2032 had HFpEF, 559 had HFmrEF, and 698 had HFrEF, of whom 34, 21, 23, and 42%, respectively, were female. Prevalence of SDB in HFpEF was high, but significantly lower than in HFmrEF or HFrEF (36% vs. 41 and 48%, respectively). Rates of SDB in males and females were 41 and 28% in HFpEF, 44 and 30% in HFmrEF, and 50 and 40% in HFrEF. The proportion of males and females with SDB who had OSA was significantly greater in those with HFpEF vs. HFrEF. Male sex, older age, higher body mass index, and New York Heart Association functional Class III/IV were significant predictors of moderate-to-severe SDB in HFpEF patients.

Conclusions: Prevalence of SDB in HFpEF was high, but lower than in patients with HFmrEF or HFrEF. Moderate-to-severe SDB occurred more frequently in males than in females across the whole spectrum of heart failure. In both sexes, the proportion of OSA in SDB patients with HFpEF was higher than in those with HFrEF.

Trial registration: ClinicalTrials.gov NCT02301689.

Keywords: Central sleep apnoea; Heart failure; Heart failure with preserved ejection fraction; Obstructive sleep apnoea; Predictors; Prevalence.

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Conflict of interest statement

M.A. has received consulting fees from ResMed, Philips Respironics, Boehringer Ingelheim, NRI, Novartis, JAZZ Pharmaceuticals, Bayer, Inspire, and Bresotec and grant support from ResMed Foundation, ResMed, Philips Respironics, and Else‐Kroehner Fresenius Foundation (2018_A159), outside the submitted work. H.W., H.T., C.S., and O.O. have received research grants, consulting fees, and lecture fees from ResMed. E.E. has received consulting fees from ResMed. A.G. and J.S. are employees of ResMed, Germany.

Figures

Figure 1
Figure 1
Patient flow in the SchlaHF‐XT registry. AHI, apnoea–hypopnoea index; BMI, body mass index; LVEF, left ventricular ejection fraction; HF, heart failure.
Figure 2
Figure 2
Overall prevalence of sleep‐disordered breathing (SDB; apnoea–hypopnoea index ≥15/h) and prevalence of obstructive (OSA) and central (CSA) sleep apnoea in patients with different heart failure phenotypes in the total population (A) and in males and females (B). HFpEF, heart failure with preserved ejection fraction; HFmrEF, heart failure with mildly‐reduced ejection fraction; HFrEF, heart failure with reduced ejection fraction.
Figure 3
Figure 3
Proportion of patients with obstructive sleep apnoea (OSA) as a percentage of the total sleep‐disordered breathing (SDB) population by heart failure phenotype in the total population and in males and females.
Figure 4
Figure 4
Predictors of sleep‐disordered breathing (SDB; apnoea–hypopnoea index ≥15/h vs. <15/h) in patients with heart failure with preserved ejection fraction (HFpEF; A), heart failure with mildly‐reduced ejection fraction (HFmrEF; B) or heart failure with reduced ejection fraction (HFrEF; C). BMI, body mass index; CI, confidence interval; OR, odds ratio.
Figure 5
Figure 5
Predictors of having obstructive (OSA) vs. central (CSA) sleep apnoea in patients with heart failure with preserved ejection fraction (HFpEF; A), heart failure with mildly‐reduced ejection fraction (HFmrEF; B) or heart failure with reduced ejection fraction (HFrEF; C). BMI, body mass index; CI, confidence interval; OR, odds ratio.
See this image and copyright information in PMC

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