title: Sleep apnea in heart transplant recipients: type, symptoms, risk factors, and response to nasal continuous positive airway pressure.
abstract: BACKGROUND
  We determined the type, symptoms, and risk factors for sleep apnea in heart transplant recipients and the response to nasal continuous positive airway pressure.
  
  
  METHODS
  A retrospective study on heart transplant recipients with sleep apnea was conducted in a tertiary care medical center with follow-up telephone interviews. Between February 1988 and August 1998, 147 patients underwent orthotopic heart transplantation at our institution. Seventeen patients (11.6%) who were suspected of having sleep apnea underwent polysomnography at a mean interval of 17.5 months after transplantation.
  
  
  RESULTS
  All were diagnosed with sleep apnea: 13 had obstructive sleep apnea and 4 had mixed sleep apnea. Mean age at polysomnography was 50.8 years (range, 24-67 years). The patients presented with snoring (100%), excessive daytime somnolence (65%), witnessed apneas (53%), and morning fatigue (53%). Sixteen (94%) had a mean weight gain of 10.4 kg after transplantation, and 1 patient lost 14.6 kg. In the 11 patients with obstructive sleep apnea who underwent nasal continuous positive airway pressure titration, significant improvements occurred in the apnea-hypopnea index (decreased from 37.6 to 10.4; p = 0.01) and mean arousal index (decreased from 44.5 to 19.4; p = 0.01). Only 2 of the 8 patients with sleep apnea for whom nasal continuous positive airway pressure was recommended continued to use it at the time of telephone follow-up.
  
  
  CONCLUSIONS
  Sleep apnea, especially obstructive sleep apnea, occurs frequently in heart transplant recipients. Obstructive sleep apnea appears to present in the typical manner, and although a positive response to nasal continuous positive airway pressure can be documented by polysomnography, long-term use of nasal continuous positive airway pressure may be low.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA.
authors.forename: E S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: E J
authors.initials: EJ
authors.lastname: Olson
authors.forename: C G
authors.initials: CG
authors.lastname: McGregor
authors.forename: L J
authors.initials: LJ
authors.lastname: Olson
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008397:Masks; D008875:Middle Aged; D017286:Polysomnography; D011175:Positive-Pressure Respiration / Q000379:methods*; D015995:Prevalence; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D015996:Survival Rate; D016896:Treatment Outcome