Abstract
Background
Sleep-disordered breathing (SDB) is highly prevalent in patients with chronic heart
failure (CHF) and is associated with a poor prognosis. Data on SDB-related symptoms
and vigilance impairment in patients with CHF and SDB are rare. Thus, the objective
of the present study was to assess a wide spectrum of SDB-related symptoms and objective
vigilance testing in patients with CHF with and without SDB.
Methods
Patients with CHF (n = 222; average age, 62 years; left ventricular ejection fraction
[LVEF], 34%) underwent polysomnography regardless of the presence or absence of SDB-related
symptoms. Patients were stratified into those with no SDB (apnea-hypopnea index [AHI]
< 15 episodes/h), moderate SDB (AHI ≥ 15 to < 30 episodes/h), and severe SDB (AHI
≥ 30 episodes/h). A standardized institutional questionnaire assessing a wide spectrum
of SDB-related symptoms was applied. A subset of patients underwent objective vigilance
testing (Quatember Maly, 100 stimuli within 25 minutes).
Results
Daytime fatigue (no SDB, moderate SDB, and severe SDB: 53%, 69%, and 80%, respectively;
P = 0.005), unintentional sleep (9%, 15%, and 32%, respectively; P = 0.004), and xerostomia (52%, 49%, and 70%, respectively; P = 0.018), as well as an impaired objective vigilance test result (mean reaction time,
0.516, 0.497, and 0.579 ms, respectively; P < 0.001) occurred more frequently with increasing severity of SDB. Seventy-eight
percent of patients with CHF and SDB had at least 3 SDB-related symptoms. In a linear
multivariable regression model, the frequency of daytime fatigue (P = 0.014), unintentional sleep (P = 0.001), xerostomia (P = 0.016), and mean reaction time (P = 0.001) were independently associated with increasing AHI independent of age, body
mass index, New York Heart Association functional class, and LVEF.
Conclusions
The majority of patients with CHF and SDB have several potential SDB-related symptoms
and objective impairment of vigilance as potential treatment targets.
Résumé
Introduction
Les troubles respiratoires du sommeil (TRS) qui sont très fréquents chez les patients
souffrant d’insuffisance cardiaque chronique (ICC) sont associés à un mauvais pronostic.
Les données sur les symptômes liés aux TRS et la diminution de la vigilance chez les
patients ayant une ICC et des TRS sont rares. Par conséquent, l’objectif de la présente
étude était d’évaluer un large éventail de symptômes liés aux TRS et de tests objectifs
de vigilance chez les patients souffrant d’ICC qui n’ont pas de TRS.
Méthodes
Les patients souffrant d’ICC (n = 222; âge moyen, 62 ans; fraction d’éjection ventriculaire
gauche [FEVG], 34 %) ont subi une polysomnographie indépendamment de la présence ou
de l’absence de symptômes liés aux TRS. Les patients ont été stratifiés comme ce qui
suit : ceux n’ayant pas de TRS (index d’apnées-hypopnées [IAH] < 15 épisodes/h), ceux
ayant des TRS modérés (IAH ≥ 15 à < 30 épisodes/h) et ceux ayant des TRS graves (IAH
≥ 30 épisodes/h). Un questionnaire institutionnel standardisé évaluant un large éventail
de symptômes liés aux TRS a été appliqué. Un sous-ensemble de patients a subi le test
objectif de vigilance (Quatember Maly, 100 stimuli en 25 minutes).
Résultats
La fatigue diurne (des patients sans TRS, ayant des TRS modérés et des TRS graves
: 53 %, 69 % et 80 %, respectivement; P = 0,005), le sommeil involontaire (9 %, 15 % et 32 %, respectivement; P = 0,004) et la xérostomie (52 %, 49 % et 70 %, respectivement; P = 0,018), ainsi qu’une diminution des résultats au test objectif de vigilance (temps
de réaction moyen, 0,516, 0,497 et 0,579 ms, respectivement; P < 0,001) étaient plus fréquents lorsque la gravité des TRS augmentait. Soixante-dix-huit
pour cent des patients souffrant d’ICC et de TRS avaient au moins 3 symptômes liés
aux TRS. Dans un modèle de régression linéaire multiple, la fréquence de la fatigue
diurne (P = 0,014), du sommeil involontaire (P = 0,001), de la xérostomie (P = 0,016) et du temps de réaction moyen (P = 0,001) était indépendamment associée à l’augmentation de l’IAH, et ce, indépendamment
de l’âge, de l’indice de masse corporelle, de la classification fonctionnelle de la
New York Heart Association et de la FEVG.
Conclusions
La majorité des patients souffrant d’ICC et de TRS ont potentiellement plusieurs symptômes
liés aux TRS et une diminution objective de la vigilance comme cibles de traitement
potentielles.
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Article info
Publication history
Published online: February 24, 2015
Accepted:
February 12,
2015
Received:
November 15,
2014
Footnotes
See page 844 for disclosure information.
Identification
Copyright
© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
