Prevalence and risk factors of sleep disordered breathing in patients with rheumatic valvular heart disease.
OBJECTIVE
Sleep disordered breathing (SDB) is common in patients with chronic heart failure secondary to non-valvular heart disease; however, the prevalence and characteristics of SDB in patients with rheumatic valvular heart disease (RVHD) are unclear. This study was designed to determine the prevalence, characteristics, and risk factors for SDB in RVHD patients.


METHODS
A cross-sectional study was conducted in 260 RVHD patients. The following data were recorded: types of heart valve lesions, electrocardiographic, echocardiographic, arterial blood gas analysis findings, baseline medication, 6-minute walk test (6MWT) distance, and sleep parameters.


RESULTS
Compared to patients with single leftsided valve lesions, patients with left- and rightsided valve lesions had a higher prevalence of SDB (46.2% vs. 31.2%, p = 0.013); the increased prevalence of SDB only involved central sleep apnea (CSA) (31.1% vs. 14.1%, p = 0.001). Patients with obstructive sleep apnea (OSA) or CSA were older and had a shorter 6MWT distance, lower left ventricle ejection fraction and PaO₂, a longer lung-to-finger circulation time, and a higher prevalence of atrial fibrillation (AF) and hypertension (all p < 0.05) as compared with patients without SDB. Multinomial logistic regression analysis showed that PaO2 ≤ 85 mm Hg was the only risk factor for OSA. Male gender, AF, 6MWT distance ≤ 300 m, PaO₂ ≤ 85 mmHg, and PaCO₂ ≤ 40 mm Hg were risk factors for CSA.


CONCLUSIONS
Patients with RVHD had a high prevalence of SDB (predominantly CSA). RVHD patients with SDB, particularly those who had CSA, manifested more severe symptoms and greater impairment of cardiac function. Assessments of clinical manifestations of cardiac dysfunction may be important for predicting the risk factors for SDB.
Department of Respiratory Medicine, the First Affiliated Hospital of Nanjing Medical University, China.
Ning
N
Ding
Bu-Qing
BQ
Ni
Xi-Long
XL
Zhang
Han-Peng
HP
Huang
Mei
M
Su
Shi-Jiang
SJ
Zhang
Hong
H
Wang
D000704:Analysis of Variance; D015984:Causality; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004562:Electrocardiography / Q000379:methods; D005080:Exercise Test / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012214:Rheumatic Heart Disease / Q000453:epidemiology* / Q000503:physiopathology*; D012307:Risk Factors; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000453:epidemiology* / Q000503:physiopathology*
Sleep disordered breathing; central sleep apnea; chronic heart failure; obstructive sleep apnea; rheumatic valvular heart disease