Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction.
BACKGROUND
Previous studies reported high prevalences of obstructive and central sleep apnea (OSA and CSA, respectively) in patients with heart failure (HF). However, these preceded widespread use of beta-blockers and spironolactone that might have reduced their prevalences. We therefore determined, in patients with HF, prevalences and predictors of OSA and CSA and the influence of changes in HF therapy on prevalences.


RESULTS
A total of 218 HF patients with left ventricular ejection fraction (LVEF) <or=45% underwent sleep studies between 1997 and 2004 and were classified as having moderate to severe sleep apnea (apnea-hypopnea index >or=15 hours of sleep, either OSA or CSA), or mild to no sleep apnea. The prevalence of moderate to severe OSA was 26% and of CSA was 21%. Predictors of OSA were older age, male sex, and greater body mass index, and of CSA were older age, male sex, atrial fibrillation, hypocapnia, and diuretic use. Between 1997 and 2004, the prevalences of OSA and CSA did not change significantly (P(trend) =.460, P(trend) =.211, respectively) despite increased use of beta-blockers and spironolactone (P(trend) < .001, P(trend) < .001, respectively), and an increase in LVEF (P(trend)=.005).


CONCLUSIONS
OSA and CSA remain common in patients with HF, despite increases in beta-blocker and spironolactone use.
Yumino
Dai
D
Sleep Research Laboratory, Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
Wang
Hanqiao
H
Floras
John S
JS
Newton
Gary E
GE
Mak
Susanna
S
Ruttanaumpawan
Pimon
P
Parker
John D
JD
Bradley
T Douglas
TD
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D054143:Heart Failure, Systolic / Q000188:drug therapy / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D012737:Sex Factors; D020182:Sleep Apnea, Central / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D020181:Sleep Apnea, Obstructive / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology*; D013148:Spironolactone / Q000627:therapeutic use; D055815:Young Adult
D000319:Adrenergic beta-Antagonists; D013148:Spironolactone