Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure.
OBJECTIVE
To determine whether severity patterns or nocturnal ventilation to treat sleep-disordered breathing (SDB) during chronic heart failure (CHF) is associated with adverse outcomes. Although SDB is frequent during CHF, the relationships between SDB and CHF outcomes are unknown.


RESULTS
A total of 384 CHF patients (82% men, mean age 59 ± 13 years) with a left ventricular ejection fraction (LVEF) of ≤45% (mean LVEF 29 ± 9%) were assessed by polygraphy in our clinic between 2001 and 2009. Nocturnal ventilation was started according to the severity of SDB. Combined endpoints were death, heart transplant, and implant of a ventricular assist device. The prevalence of obstructive sleep apnoea (OSA), central sleep apnoea (CSA), and Cheyne-Stokes respiration (CSR) was 62, 26, and 29%, respectively. A primary endpoint occurred in 31%. Mean follow-up for survivors was 47 ± 25 months. Those with moderate [apnoea-hypopnoea index (AHI) ≤5-20/h] and severe SDB (AHI ≥20/h), and OSA and CSA, had poor prognoses compared with patients without SDB (P = 0.036, P = 0.003, respectively). A total of 31% of SDB patients were treated with nocturnal ventilation. Treated SDB had a better outcome than untreated severe SDB after adjustment for confounding factors [P = 0.031; hazard ratio (HR) 0.56; 95% confidence interval (CI) 0.33-0.95]. Subgroup analysis that included only OSA showed a similar result after adjustment (P = 0.017; HR 0.40; 95% CI 0.19-0.95).


CONCLUSIONS
In CHF, SDB is associated with a poor prognosis whatever the SDB pattern, and nocturnal ventilation is associated with a better outcome.
Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier, Créteil, France. thibaud.damy@hmn.aphp.fr
Thibaud
T
Damy
Laurent
L
Margarit
Ala
A
Noroc
Diane
D
Bodez
Soulef
S
Guendouz
Laurent
L
Boyer
Xavier
X
Drouot
Aurélia
A
Lamine
Alexandra
A
Paulino
Stéphane
S
Rappeneau
Maria-Hermann
MH
Stoica
Jean-Luc
JL
Dubois-Randé
Serge
S
Adnot
Luc
L
Hittinger
Marie Pia
MP
d'Ortho
D000368:Aged; D002639:Cheyne-Stokes Respiration / Q000503:physiopathology / Q000628:therapy*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000628:therapy; D020182:Sleep Apnea, Central / Q000503:physiopathology / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome