title: Portable recording for detecting sleep disorder breathing in patients under the care of a heart failure clinic.
abstract: BACKGROUND
  Sleep disordered breathing (SDB) has important clinical implications in patients with congestive heart failure (CHF). We performed portable recording in unselected CHF patients on contemporary therapy. Data on the interactions of SDB in patients supervised at heart failure clinics are rare and we illustrate diversities of obstructive sleep apnoea (OSA) and central sleep apnoea (CSA).
  
  
  METHODS
  We studied 176 consecutive subjects on contemporary medical therapy with a median left ventricular ejection fraction of 25.0 % (range 7-35%) and median NT-pro BNP levels of 3,413.0 pg/ml (range 305.1-35,000.0 pg/ml). Participants underwent prospective overnight portable recording.
  
  
  RESULTS
  50% presented with an at least moderate form of nocturnal breathing disorder [apnoea-hypopnoea index (AHI) ≥15/h]. Only 15 patients (17.1%) with AHI ≥15/h reported excessive daytime sleepiness. Irrespective of left ventricular ejection fraction, patients with CSA had higher levels of NT-pro BNP compared to patients with OSA (differences in medians = 2,639.0 pg/ml, p = 0.016), and compared to patients with an AHI <15/h (differences in medians = 2,710.0 pg/ml, p < 0.001). OSA affected 26 patients (14.8%).
  
  
  CONCLUSIONS
  Patients with severe stable CHF on contemporary therapy have a prevalence of 50.0% of moderate to severe SDB. The natural cascade of the failing heart is initially characterised by absent SDB or OSA, whereas end-stage CHF is associated with CSA.
authors.affiliation: Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. peter.dolliner@meduniwien.ac.at
authors.forename: Peter
authors.initials: P
authors.lastname: Dolliner
authors.forename: Lindsay
authors.initials: L
authors.lastname: Brammen
authors.forename: Senta
authors.initials: S
authors.lastname: Graf
authors.forename: Martin
authors.initials: M
authors.lastname: Huelsmann
authors.forename: Leopold
authors.initials: L
authors.lastname: Stiebellehner
authors.forename: Andreas
authors.initials: A
authors.lastname: Gleiss
authors.forename: Philipp
authors.initials: P
authors.lastname: Ubl
authors.forename: Guenter
authors.initials: G
authors.lastname: Steurer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006970:Disorders of Excessive Somnolence / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000453:epidemiology; D020182:Sleep Apnea, Central / Q000175:diagnosis / Q000453:epidemiology*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000453:epidemiology*; D016277:Ventricular Function, Left
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain