Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations.
BACKGROUND
Heart failure is a highly prevalent disorder that continues to be associated with repeated hospitalizations, high morbidity, and high mortality. Sleep-related breathing disorders with repetitive episodes of asphyxia may adversely affect heart function. The main aims of this study were to determine the prevalence, consequences, and differences in various sleep-related breathing disorders in ambulatory male patients with stable heart failure.


RESULTS
This article reports the results of a prospective study of 81 of 92 eligible patients with heart failure and a left ventricular ejection fraction < 45%. There were 40 patients without (hourly rate of apnea/hypopnea, 4 +/- 4; group 1) and 41 patients with (51% of all patients; hourly rate of apnea/hypopnea, 44 +/- 19; group 2) sleep apnea. Sleep disruption and arterial oxyhemoglobin desaturation were significantly more severe and the prevalence of atrial fibrillation (22% versus 5%) and ventricular arrhythmias were greater in group 2 than in group 1. Forty percent of all patients had central sleep apnea, and 11% had obstructive sleep apnea. The latter patients had significantly greater mean body weight (112 +/- 30 versus 75 +/- 16 kg) and prevalence of habitual snoring (78% versus 28%). However, the hourly rate of episodes of apnea and hypopnea (36 +/- 10 versus 47 +/- 21), episodes of arousal (20 +/- 14 versus 23 +/- 11), and desaturation (lowest saturation, 72 +/- 11% versus 78 +/- 12%) were similar in patients with these different types of apnea.


CONCLUSIONS
Fifty-one percent of male patients with stable heart failure suffer from sleep-related breathing disorders: 40% from central and 11% from obstructive sleep apnea. Both obstructive and central types of sleep apnea result in sleep disruption and arterial oxyhemoglobin desaturation. Patients with sleep apnea have a high prevalence of atrial fibrillation and ventricular arrhythmias.
Javaheri
S
S
Sleep Disorders Laboratory, Department of Veterans Affairs Medical Center, Cincinnati, Ohio, USA.
Parker
T J
TJ
Liming
J D
JD
Corbett
W S
WS
Nishiyama
H
H
Wexler
L
L
Roselle
G A
GA
D001145:Arrhythmias, Cardiac / Q000209:etiology; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D008297:Male; D010108:Oxyhemoglobins / Q000378:metabolism; D015995:Prevalence; D011446:Prospective Studies; D012119:Respiration; D012891:Sleep Apnea Syndromes / Q000453:epidemiology / Q000209:etiology*
D010108:Oxyhemoglobins