Sleep-disordered breathing in a general heart failure population: relationships to neurohumoral activation and subjective symptoms.
The aim of this study was to determine the prevalence of sleep-related breathing disorders (SDB) in a UK general heart failure (HF) population, and assess its impact on neurohumoral markers and symptoms of sleepiness and quality of life. Eighty-four ambulatory patients (72 male, mean (SD) age 68.6 (10) yrs) attending UK HF clinics underwent an overnight recording of respiratory impedance, SaO2 and heart rate using a portable monitor (Nexan). Brain natriuretic peptide (BNP) and urinary catecholamines were measured. Subjective sleepiness and the impairment in quality of life were assessed (Epworth Sleepiness Scale (ESS), SF-36 Health Performance Score). SDB was classified using the Apnoea/Hypopnoea Index (AHI). The prevalence of SDB (AHI > 15 events h(-1)) was 24%, increasing from 15% in mild-to-moderate HF to 39% in severe HF. Patients with SDB had significantly higher levels of BNP and noradrenaline than those without SDB (mean (SD) BNP: 187 (119) versus 73 (98) pg mL(-1), P = 0.02; noradrenaline: 309 (183) versus 225 (148) nmol/24 h, P = 0.05). There was no significant difference in reported sleepiness or in any domain of SF-36, between groups with and without SDB (ESS: 7.8 (4.7) versus 7.5 (3.6), P = 0.87). In summary, in a general HF clinic population, the prevalence of SDB increased with the severity of HF. Patients with SDB had higher activation of a neurohumoral marker and more severe HF. Unlike obstructive sleep apnoea, SDB in HF had little discernible effect on sleepiness or quality of life as measured by standard subjective scales.
Queen's Medical Centre, University of Nottingham, Nottingham, UK.
Archana
A
Rao
Panagiota
P
Georgiadou
Darrel P
DP
Francis
Andrew
A
Johnson
Dimitris Th
DT
Kremastinos
Anita K
AK
Simonds
Andrew J S
AJ
Coats
Alan
A
Cowley
Mary J
MJ
Morrell
D000368:Aged; D001921:Brain / Q000276:immunology* / Q000378:metabolism*; D002395:Catecholamines / Q000652:urine; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008297:Male; D045265:Natriuretic Peptides / Q000378:metabolism*; D010100:Oxygen / Q000378:metabolism; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D011788:Quality of Life; D012891:Sleep Apnea Syndromes / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000503:physiopathology
D002395:Catecholamines; D045265:Natriuretic Peptides; D010100:Oxygen