title: Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is recommended to prevent sudden cardiac death in some of these patients. Sleep-disordered breathing (SDB) is highly prevalent in this population and may impact arrhythmogenicity. We performed a systematic review and meta-analysis of prospective studies that assessed the impact of SDB on ICD therapy.
  
  
  RESULTS
  Relevant prospective studies were identified in the Ovid MEDLINE, EMBASE, and Google Scholar databases. Weighted risk ratios of the association between SDB and appropriate ICD therapies were estimated using random effects meta-analysis. Nine prospective cohort studies (n=1274) were included in this analysis. SDB was present in 52% of the participants. SDB was associated with a 55% higher risk of appropriate ICD therapies (45% versus 28%; risk ratio, 1.55; 95% confidence interval, 1.32-1.83). In a subgroup analysis based on the subtypes of SDB, the risk was higher in both central (risk ratio, 1.50; 95% confidence interval, 1.11-2.02) and obstructive (risk ratio, 1.43; 95% confidence interval, 1.01-2.03) sleep apnea.
  
  
  CONCLUSIONS
  SDB is associated with an increased risk of appropriate ICD therapy in patients with heart failure and reduced ejection fraction.
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.). yk2j@hscmail.mcc.virginia.edu.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Koene
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
authors.forename: Osung
authors.initials: O
authors.lastname: Kwon
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
authors.forename: Jessica V
authors.initials: JV
authors.lastname: Kealhofer
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
authors.forename: Selcuk
authors.initials: S
authors.lastname: Adabag
authors.affiliation: From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
mesh_terms: D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D012307:Risk Factors; D012891:Sleep Apnea Syndromes / Q000150:complications*; D013318:Stroke Volume
keywords: death, sudden, cardiac; defibrillators, implantable; heart failure; meta-analysis; sleep apnea syndrome