Effect of Respiratory Therapy on the Prognosis of Chronic Heart Failure Patients Complicated With Sleep-Disordered Breathing　- A Pilot Efficacy Trial.
BACKGROUND
Sleep-disordered breathing (SDB) has been reported to influence mortality and occurrence of ventricular tachyarrhythmia in patients with chronic heart failure (CHF). It remains to be elucidated, however, whether respiratory therapy (RT) can affect the occurrence of fatal ventricular tachyarrhythmia in CHF patients with SDB.


RESULTS
We prospectively examined whether the severity of SDB was associated with fatal cardiac events in CHF patients and, if so, whether RT for SDB improved prognosis. We enrolled 95 patients with stable CHF, in whom SDB was examined on overnight polygraphy. The severity of SDB was quantified using the apnea-hypopnea index (AHI). All patients with AHI ≥10 (n=42) at initial evaluation were recommended to have RT, such as home oxygen therapy and continuous positive airway pressure, and 24 agreed to this. During the follow-up period of 29±17 months, 8 ventricular tachyarrhythmias occurred and 14 of the 95 patients died. On multivariate proportional hazard analysis AHI ≥5 was a risk factor for fatal arrhythmic events (P=0.026). Although RT significantly reduced AHI, it did not significantly reduce the event rates, but 4 patients with AHI <5 on RT had no fatal arrhythmic events or death.


CONCLUSIONS
SDB is an independent prognostic factor and thus an important therapeutic target in CHF patients.
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine.
Hiroyuki
H
Satake
Koichiro
K
Sugimura
Yoshihiro
Y
Fukumoto
Koji
K
Fukuda
Makoto
M
Nakano
Masateru
M
Kondo
Shigefumi
S
Fukui
Hiromasa
H
Ogawa
Tsuyoshi
T
Shinozaki
Hiroaki
H
Shimokawa
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012138:Respiratory Therapy; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000150:complications / Q000401:mortality / Q000628:therapy