title: Sleep-disordered breathing and inappropriate defibrillator shocks in chronic heart failure.
abstract: OBJECTIVE
  Supraventricular tachyarrhythmias are a major cause of inappropriate defibrillator shocks. Sleep-disordered breathing (SDB) is a known risk factor for atrial fibrillation (AF). We hypothesized that Cheyne-Stokes respiration (CSA) and obstructive sleep apnea (OSA) have an impact on inappropriate defibrillator discharges in patients witch chronic heart failure (CHF) and cardiac resynchronization therapy with defibrillator (CRT-D).
  
  
  METHODS
  In this study, 172 patients with CHF (LVEF ≤ 45 %, NYHA-class ≥ 2) and CRT-D underwent overnight polygraphy; 54 had no SDB (apnea-hypopnea index < 5/h), 59 had OSA, and 59 had CSA. During follow-up (36 months), inappropriate defibrillator shocks were documented.
  
  
  RESULTS
  In all, 17 patients had inappropriate defibrillator shocks (9.9 %; eight oversensing due to lead fractures, five caused by atrial fibrillation, four because of sinus tachycardia). Mean event-free survival time was 33.5 ± 1.2 months in the CSA group, 35.2 ± 0.7 months in the OSA group, and 32.1 ± 1.5 months in the no SDB group, respectively (CSA vs. no SDB p = 0.63; OSA vs. no SDB p = 0.31; CSA vs. OSA p = 0.45). Stepwise Cox proportional hazard regression analysis revealed an independent association for age (per year: hazard ratio 0.90, 95 % confidence interval 0.85-0.96, p < 0.001), but not for any kind of SDB.
  
  
  CONCLUSIONS
  SDB was not associated with inappropriate defibrillator shocks. We assume this is due to the low incidenceand low proportion of inappropriate therapies in response to AF.
authors: Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany, akleemeyer@hdz-nrw.de.
authors: Thomas
authors: T
authors: Bitter
authors: Klaus-Jürgen
authors: KJ
authors: Gutleben
authors: Georg
authors: G
authors: Nölker
authors: Zisis
authors: Z
authors: Dimitriadis
authors: Christian
authors: C
authors: Prinz
authors: Jürgen
authors: J
authors: Vogt
authors: Dieter
authors: D
authors: Horstkotte
authors: Olaf
authors: O
authors: Oldenburg
mesh_terms: D000368:Aged; D015984:Causality; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data*; D004556:Electric Injuries / Q000401:mortality*; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000401:mortality*; D015996:Survival Rate