Advertisement
Canadian Journal of Cardiology

Prevalence of Sleep-Disordered Breathing-Related Symptoms in Patients with Chronic Heart Failure and Reduced Ejection Fraction

Published:February 24, 2015DOI:https://doi.org/10.1016/j.cjca.2015.02.025

      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Canadian Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Bradley T.D.
        • Floras J.S.
        Sleep apnea and heart failure: part I: obstructive sleep apnea.
        Circulation. 2003; 107: 1671-1678
        • Bradley T.D.
        • Floras J.S.
        Sleep apnea and heart failure: part II: central sleep apnea.
        Circulation. 2003; 107: 1822-1826
        • Tkacova R.
        • Niroumand M.
        • Lorenzi-Filho G.
        • Bradley T.D.
        Overnight shift from obstructive to central apneas in patients with heart failure: role of PCO2 and circulatory delay.
        Circulation. 2001; 103: 238-243
        • Somers V.K.
        • Dyken M.E.
        • Clary M.P.
        • Abboud F.M.
        Sympathetic neural mechanisms in obstructive sleep apnea.
        J Clin Invest. 1995; 96: 1897-1904
        • Bradley T.D.
        • Hall M.J.
        • Ando S.
        • Floras J.S.
        Hemodynamic effects of simulated obstructive apneas in humans with and without heart failure.
        Chest. 2001; 119: 1827-1835
        • Peppard P.E.
        • Young T.
        • Palta M.
        • Skatrud J.
        Prospective study of the association between sleep-disordered breathing and hypertension.
        N Engl J Med. 2000; 342: 1378-1384
        • Htoo A.K.
        • Greenberg H.
        • Tongia S.
        • et al.
        Activation of nuclear factor kappaB in obstructive sleep apnea: a pathway leading to systemic inflammation.
        Sleep Breath. 2006; 10: 43-50
        • Ryan S.
        • Taylor C.T.
        • McNicholas W.T.
        Systemic inflammation: a key factor in the pathogenesis of cardiovascular complications in obstructive sleep apnoea syndrome?.
        Postgrad Med J. 2009; 85: 693-698
        • Dickstein K.
        • Cohen-Solal A.
        • Filippatos G.
        • et al.
        ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).
        Eur Heart J. 2008; 29: 2388-2442
        • Jilek C.
        • Krenn M.
        • Sebah D.
        • et al.
        Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study.
        Eur J Heart Fail. 2011; 13: 68-75
        • Damy T.
        • Margarit L.
        • Noroc A.
        • et al.
        Prognostic impact of sleep-disordered breathing and its treatment with nocturnal ventilation for chronic heart failure.
        Eur J Heart Fail. 2012; 14: 1009-1019
        • Javaheri S.
        • Parker T.J.
        • Wexler L.
        • et al.
        Occult sleep-disordered breathing in stable congestive heart failure.
        Ann Intern Med. 1995; 122: 487-492
        • Sin D.D.
        • Fitzgerald F.
        • Parker J.D.
        • et al.
        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
        • Yumino D.
        • Wang H.
        • Floras J.S.
        • et al.
        Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction.
        J Cardiac Fail. 2009; 15: 279-285
        • Oldenburg O.
        • Bitter T.
        • Fox H.
        • Horstkotte D.
        Herzinsuffizienz.
        Somnologie (Berl). 2014; 18: 19-25
        • Pepperell J.C.
        • Maskell N.A.
        • Jones D.R.
        • et al.
        A randomized controlled trial of adaptive ventilation for Cheyne-Stokes breathing in heart failure.
        Am J Respir Crit Care Med. 2003; 168: 1109-1114
        • Philippe C.
        • Stoica-Herman M.
        • Drouot X.
        • et al.
        Compliance with and effectiveness of adaptive servoventilation versus continuous positive airway pressure in the treatment of Cheyne-Stokes respiration in heart failure over a six month period.
        Heart. 2006; 92: 337-342
        • Mansfield D.R.
        • Gollogly N.C.
        • Kaye D.M.
        • et al.
        Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure.
        Am J Respir Crit Care Med. 2004; 169: 361-366
        • Arzt M.
        • Young T.
        • Finn L.
        • et al.
        Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea.
        Arch Intern Med. 2006; 166: 1716-1722
        • Hastings P.C.
        • Vazir A.
        • O'Driscoll D.M.
        • Morrell M.J.
        • Simonds A.K.
        Symptom burden of sleep-disordered breathing in mild-to-moderate congestive heart failure patients.
        Eur Respir J. 2006; 27: 748-755
        • Rao A.
        • Georgiadou P.
        • Francis D.P.
        • et al.
        Sleep-disordered breathing in a general heart failure population: relationships to neurohumoral activation and subjective symptoms.
        J Sleep Res. 2006; 15: 81-88
        • Chervin R.D.
        • Aldrich M.S.
        The Epworth Sleepiness Scale may not reflect objective measures of sleepiness or sleep apnea.
        Neurology. 1999; 52: 125-131
        • Sangal R.B.
        • Sangal J.M.
        • Belisle C.
        Subjective and objective indices of sleepiness (ESS and MWT) are not equally useful in patients with sleep apnea.
        Clin Electroencephalogr. 1999; 30: 73-75
        • Buysse D.J.
        • Hall M.L.
        • Strollo P.J.
        • et al.
        Relationships between the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and clinical/polysomnographic measures in a community sample.
        J Clin Sleep Med. 2008; 4: 563-571
        • Bitter T.
        • Westerheide N.
        • Hossain S.M.
        • et al.
        Symptoms of sleep apnoea in chronic heart failure—results from a prospective cohort study in 1,500 patients.
        Sleep Breath. 2012; 16: 781-791
        • Reinhard W.
        • Plappert N.
        • Zeman F.
        • et al.
        Prognostic impact of sleep duration and sleep efficiency on mortality in patients with chronic heart failure.
        Sleep Med. 2013; 14: 502-509
        • Johns M.W.
        A new method for measuring daytime sleepiness: the Epworth sleepiness scale.
        Sleep. 1991; 14: 540-545
        • Bloch K.E.
        • Schoch O.D.
        • Zhang J.N.
        • Russi E.W.
        German version of the Epworth Sleepiness Scale.
        Respiration. 1999; 66: 440-447
        • Lichstein K.L.
        • Riedel B.W.
        • Richman S.L.
        The Mackworth Clock Test: a computerized version.
        J Psychol. 2000; 134: 153-161
        • Mackworth N.H.
        The breakdown of vigilance during prolonged visual search.
        Q J Exp Psychol. 1948; 1: 6-21