Abstract
Background--Different sleep-disordered breathing (SDB) phenotypes, including coexisting obstructive and central sleep apnea (OSA-CSA), have not yet been characterized in a large sample of patients with heart failure and reduced ejection fraction (HFrEF) receiving guideline-based therapies. Therefore, the aim of the present study was to determine the proportion of OSA, CSA, and OSA-CSA, as well as periodic breathing, in HFrEF patients with SDB. Methods and Results--The German SchlaHF registry enrolled patients with HFrEF receiving guideline-based therapies, who underwent portable SDB monitoring. Polysomnography (n=2365) was performed in patients with suspected SDB. Type of SDB (OSA, CSA, or OSA-CSA), the occurrence of periodic breathing (proportion of Cheyne-Stokes respiration ≥ 20%), and blood gases were determined in 1557 HFrEF patients with confirmed SDB. OSA, OSA-CSA, and CSA were found in 29%, 40%, and 31% of patients, respectively; 41% showed periodic breathing. Characteristics differed significantly among SDB groups and in those with versus without periodic breathing. There was a relationship between greater proportions of CSA and the presence of periodic breathing. Risk factors for having CSA rather than OSA were male sex, older age, presence of atrial fibrillation, lower ejection fraction, and lower awake carbon dioxide pressure (PCO2). Periodic breathing was more likely in men, patients with atrial fibrillation, older patients, and as left ventricular ejection fraction and awake PCO2 decreased, and less likely as body mass index increased and minimum oxygen saturation decreased. Conclusions--SchlaHF data show that there is wide interindividual variability in the SDB phenotype of HFrEF patients, suggesting that individualized management is appropriate.
| Original language | English |
|---|---|
| Article number | e005899 |
| Journal | Journal of the American Heart Association |
| Volume | 6 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 01.12.2017 |
Funding
Philips Respironics (Murrysville, PA). Arzt was the holder of an endowed professorship from the Free State of Bavaria at the University of Regensburg that was donated by ResMed (Martinsried, Germany) and Philips Respironics (Murrysville, PA); Arzt has previously received lecture fees from Philips Respironics (Murrysville, PA) and ResMed (Martinsried, Germany). Teschler received grant support from ResMed (Sydney, Australia), the ResMed Foundation (San Diego, CA), and Linde (Munich, Germany). Teschler has previously received lecture fees from AstraZeneca, Novartis, Linde, Boehringer Ingelheim, Berlin Chemie, and ResMed Germany. Oldenburg has acted as a consultant for ResMed, LivaNova, Novartis, and Boehringer Ingelheim, received a research grant from ResMed, and has received lecture honoraria from ResMed, Respicardia, Liva-Nova, Novartis, and Boehringer Ingelheim. Erdmann and Wegscheider received consulting fees or honoraria and travel grants from ResMed. Wegscheider and Graml are employees of ResMed, Germany. Suling has no conflicts of interest to declare. The SchlaHF registry was funded by ResMed Ltd, Sydney, Australia and ResMed Germany Inc, Martinsried, Germany. ResMed also providing funding for English language editing assistance by an independent medical writer (Nicola Ryan).
