Sleep-disordered Breathing and Incident Heart Failure in Older Men.
BACKGROUND
The directionality of the relationship between sleep-disordered breathing and heart failure is controversial.


OBJECTIVE
We assessed whether elevations in the obstructive or central sleep apnea index or the presence of Cheyne-Stokes breathing are associated with decompensated and/or incident heart failure.


METHODS
We conducted a prospective, longitudinal study of 2,865 participants derived from the Osteoporotic Fractures in Men Study, a prospective multicenter observational study of community-dwelling older men. Participants underwent baseline polysomnography and were followed for a mean 7.3 years for development of incident or decompensated heart failure. Our main exposures were the obstructive apnea-hypopnea index (AHI), central apnea index (CAI ≥ 5), and Cheyne-Stokes breathing. Covariates included age, race, clinic site, comorbidities, physical activity, and alcohol and tobacco use.


RESULTS
CAI greater than or equal to five and presence of Cheyne-Stokes breathing but not obstructive AHI were significant predictors of incident heart failure (adjusted hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.16-2.77 for CAI ≥ 5) (HR, 2.23; 95% CI, 1.45-3.43 for Cheyne-Stokes breathing). After excluding those with baseline heart failure, the incident risk of heart failure was attenuated for those with CAI greater than or equal to five (HR, 1.57; 95% CI, 0.92-2.66) but remained significantly elevated for those with Cheyne-Stokes breathing (HR, 1.90; 95% CI, 1.10-3.30).


CONCLUSIONS
An elevated CAI/Cheyne-Stokes breathing, but not an elevated obstructive AHI, is significantly associated with increased risk of decompensated heart failure and/or development of clinical heart failure in a community-based cohort of older men.
1 Brigham and Women's Hospital, Boston, Massachusetts.
Sogol
S
Javaheri
2 California Pacific Medical Center Research Institute and San Francisco Coordinating Center, San Francisco, California.
Terri
T
Blackwell
3 University of California, San Diego, San Diego, California.
Sonia
S
Ancoli-Israel
4 University of Minnesota, Minneapolis, Minnesota; and.
Kristine E
KE
Ensrud
2 California Pacific Medical Center Research Institute and San Francisco Coordinating Center, San Francisco, California.
Katie L
KL
Stone
1 Brigham and Women's Hospital, Boston, Massachusetts.|5 Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Susan
S
Redline
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology; D002639:Cheyne-Stokes Respiration / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D017286:Polysomnography; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D020182:Sleep Apnea, Central / Q000453:epidemiology*; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology*; D020521:Stroke / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
Cheyne-Stokes breathing; epidemiology; heart failure; sleep apnea