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:



      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.


      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).


      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.


      The majority of patients with CHF and SDB have several potential SDB-related symptoms and objective impairment of vigilance as potential treatment targets.



      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.


      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).


      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.


      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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