title: Sleep duration and quality in heart failure patients.
abstract: OBJECTIVE
  Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure and reduced left ventricular ejection fraction (HF-REF). SDB is classified as predominant obstructive (OSA) or central (CSA) and may alter sleep duration, sleep quality, and quality of life. This study describes sleep quality and duration in well-characterized cohorts of these patients.
  
  
  METHODS
  Two hundred fifty consecutive patients with HF-REF (NYHA class ≥II, ejection fraction ≤45%) underwent cardiac and pulmonary examination, plus full attended in-hospital overnight polysomnography (PSG). PSG recordings were performed according to current recommendations and underwent independent, blinded analysis at a core laboratory.
  
  
  RESULTS
  Patients with HF-REF and CSA were older and had more impaired cardiac function compared to those with OSA. With respect to sleep parameters, patients with CSA spent more time in bed than those with OSA (468 ± 52 vs 454 ± 46 min, p = 0.021) while sleep efficiency was lower (67 ± 14 vs 72 ± 13% of total sleep time (TST), p = 0.008). In addition, CSA patients spent more time awake after sleep onset (101 ± 61 vs 71 ± 46 min, p = 0.001) and had more stage N1 (light) sleep (33 ± 19 vs 28 ± 16% of TST, p = 0.017). Overall, the proportion of sleep spent in N3 (slow-wave/deep) sleep in HF-REF patients with SDB was low (4.1 ± 6.3% of TST) compared with healthy adults.
  
  
  CONCLUSIONS
  HF-REF patients with CSA compared to OSA have worse sleep efficiency and quality. This could result in less restorative sleep, changes in sympathovagal balance, and impaired resetting of important reflexes, which might contribute to worse cardiovascular outcomes in HF-REF patients with SDB.
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.|Emergency Department, Asklepios Klinik Wansbek, Hamburg, Germany.
authors.forename: Anke
authors.initials: A
authors.lastname: Türoff
authors.affiliation: Department of Medical Informatics, Biometry and Epidemiology, University of Bochum, Bochum, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Thiem
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Fox
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.|Department of Pulmonology, Hanover Medical School, Hanover, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Spießhöfer
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bitter
authors.affiliation: HP2 Laboratory, Inserm U1042, Grenoble Alps University and Sleep, Exercise and Physiology Laboratory, EFCR, Grenoble University Hospital, Grenoble, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Tamisier
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Naresh M
authors.initials: NM
authors.lastname: Punjabi
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
authors.affiliation: Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany. akleemeyer@hdz-nrw.de.
authors.forename: Olaf
authors.initials: O
authors.lastname: Oldenburg
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011788:Quality of Life; D012189:Retrospective Studies; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000503:physiopathology*; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology; D013997:Time Factors
keywords: Central sleep apnea; Heart failure; Obstructive sleep apnea; Sleep; Sleep-disordered breathing