Indian Journal of Sleep Medicine

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VOLUME 5 , ISSUE 4 ( October-December, 2010 ) > List of Articles

ORIGINAL ARTICLE

Prevalence and profile of sleep disordered breathing amongst patients with congestive heart failure

Geeta Kampani, J. C. Suri, Manish Sharma

Keywords : sleep disordered breathing, central sleep apnea, Cheyne-Stokes respiration, congestive heart failure

Citation Information : Kampani G, Suri JC, Sharma M. Prevalence and profile of sleep disordered breathing amongst patients with congestive heart failure. Indian Sleep Med 2010; 5 (4):120-127.

DOI: 10.5005/ijsm-5-4-120

License: NA

Published Online: 01-07-2018

Copyright Statement:  NA


Abstract

Introduction: It has been observed that since heart failure is highly prevalent and central sleep apnea (CSA) is common in patients with a failing heart, heart failure is the commonest cause of CSA in the general population. Aims & Objectives: The present study was undertaken with the purpose of finding prevalence of sleep disordered breathing (SDB) in patients of heart failure and also to find the association of severity of SDB with severity of heart failure. Material & Methods: Forty patients suffering from systolic heart failure were selected on random basis. All these patients underwent complete evaluation of history, physical examination and overnight polysomnography. The patients were divided into two groups, namely group 1 and group 2, on the basis of polysomnography. Group 1 consisted of 17 patients who did not have sleep disordered breathing i.e. AHI (central or obstructive) < 5. Group 2 consisted of 23 patients who had sleep disordered breathing i.e. AHI (central or obstructive) > 5. Comparison of biochemical profile and sleep parameters was made between group 1 and group 2 and results analyzed. Observations: Aetiology of heart failure was ischemic heart disease in 34 patients, viral myocarditis in 3 patients and postpartum cardiomyopathy in 3 patients. Total prevalence of CSA in heart failure was 57.5%.Prevelance in males and females was 47.6% and 68.42% respectively. There was a significant difference in O2 desaturation index, minimum O2, arousal index, total sleep time, AHI (central), sleep efficiency and wake O2 amongst the two groups. A negative correlation was observed between ejection fraction and O2 desaturation index, AHI (central), and arousal index. A positive correlation was found between ejection fraction and wake O2. Conclusions: A fairly high prevalence of sleep-disordered breathing (57.5%) was found in patients of heart failure in the present study. With increasing severity of HF a significant worsening of CSACSR was observed. The treatment of CSA-CSR may prevent the worsening status of HF. Hence long term randomized and controlled interventions are required to further substantiate these fact.


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  1. Mann D.L. Heart failure and cor pulmonale, in Harrison's Principles of Internal Medicine, 17th ed. A. S. Fauci et al (eds). New York, McGraw Hill Medical, 2008, pp 1443- 1455.
  2. Kee K., Sands S.A., Edwards B.A.,Berger P.J., Naughton M.T. positive airway pressure in congestive heart failure. Sleep Med Clin 2010, 5:393-405.
  3. Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 1995; 26(7):1565–74.
  4. AASM Manual for scoring sleep, 2007.
  5. Reddy EV, Kadhiravan T, Mishra HK et al. Prevalence and risk factors of obstructive sleep apnea among middle-aged urban Indians: a community-based study. Sleep Med. 2009 Sep; 10(8):913-8.
  6. Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Circulation 1998; 2154-2159.
  7. R. Schulz, A. Blau, J. Börgel et al Sleep apnoea in heart failure. Eur Respir J 2007; 29:1201-1205.
  8. Sonia Ancoli-Israel, Einat R. Duhamel, Carl Stepnowsky et al. The relationship between congestive heart failure, sleep apnea, and mortality in older men. Chest 2003; 124:1400-1405
  9. Köhnlein T, Welte T. Does beta-blocker treatment influence central sleep apnoea? Respir Med 2007; 101:850–853
  10. Tamura A, Kawano Y, Naono S, Kotoku M, Kadota J. Relationship between beta-blocker treatment and the severity of central sleep apnea in chronic heart failure. Chest 2007; 131:130–135
  11. Sin DD, Fitzgerald F, Parker JD, Newton G, Floras JS, Bradley TD. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 1999; 160:1101–1106.
  12. Tremel F, Pepin JL, Veale D, et al. High prevalence and persistence of sleep apnea in patients referred for acute left ventricular failure and medically treated for 2 months. Eur Heart J. 1999; 20:1201-1209.
  13. Tkacova R, Hall MJ, Liu PP, et al, Left ventricular volume in patients with heart failure and Cheyne-Stokes respiration during sleep. Am j respire Crit Care Med 1997; 156:1549- 1555.
  14. Moratara A, Sleight P, Pinna GD, et al. Association between hemodynamic impairment and Cheyne-stokes respiration and periodic breathing in chronic stable congestive heart failure patients secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1999; 84:900-904.
  15. Khoo MCK. Theoretical models of periodic breathing in sleep apnea. In: Bradley TD, Floras JS (eds): Sleep Apnea: Implications in cardiovascular and cerebrovascular Disease. New York, Marcel Dekker, 2000:335-384.
  16. Guyton AC, Crowell JW: Basic oscillating mechanism of Cheyne-Stokes breathing. Am J of Physiol 1956;187:395- 398.
  17. Hanly O, Zuberi – Khokhar N. Daytime sleepiness in patients with congestive heart failure and Cheyne-Stokes respiration. Chest1995;107:952-958
  18. Patidar AB, Andrews GR, Seth S. Prevalence of obstructive sleep apnea, associated risk factors, and quality of life among Indian congestive heart failure patients: A crosssectional survey. J Cardiovasc Nurs. 2011 Mar 2. [Epub ahead of print]
  19. Monda C, Scala O, Paolillo S, Savarese G, Cecere M, D'Amore C, Parente A, Musella F, Mosca S, Filardi PP. Sleep apnea and heart failure: pathophysiology, diagnosis and therapy. G Ital Cardiol (Rome). 2010 Nov; 11(11):815- 22.
  20. Kasai T, Bradley TD. Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications. J Am Coll Cardiol. 2011 Jan 11; 57(2):119-27
  21. Varol E, Akcay S, Ozaydin M, Ozturk O, Cerci SS, Sahin U. Influence of obstructive sleep apnea on left ventricular mass and global function: sleep apnea and myocardial performance index. Heart Vessels 2010 Sep; 25(5):400-4.
  22. Javaheri S, Caref EB, Chen E, Tong KB, Abraham WT. Sleep apnea testing and outcomes in a large cohort of medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med. 2011 Feb 15;183(4):539-46.
  23. Sleep Related Breathing Disorders In: Winkelman J, Kotagal S, Olson E et al.(eds.) The International Classification of Sleep Disorders Diagnostic& Coding Manual. American Academy of Sleep Medicine, Illinois, 2006:47-56.
  24. Javaheri S. Central sleep apnea. Clin Chest Med 2010; 31:235-248.
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