Sleep-Disordered Breathing in Stable Heart Failure Patients
What is the prevalence of sleep-disordered breathing (SDB) among patients in a large sample of heart failure (HF) practices?
The SchlaHF (Sleep-Disordered Breathing in Heart Failure) registry consists of heart failure (HF) patients recruited in Germany. Cardiologists were asked to refer all HF patients between 2008 and 2011 from 138 centers (91 outpatient practices and 47 hospital departments). SDB was assessed by a two-channel respiratory monitor (ApneaLink, ResMed). Patients with moderate-to-severe SDB (apnea-hypopnea index ≥15/hours) were selected. Inclusion criteria included HF diagnosis >12 weeks prior to enrollment, left ventricular ejection fraction (LVEF) <45%, and class III or IV CHF symptoms at inclusion or class II symptoms with >1 hospitalization for HF in the last year. Exclusion criteria included concurrent treatment for SDB, angioplasty, bypass, or infarction within 6 months to randomization; cardiac resynchronization therapy; stroke within 3 months; unable to survive >1 year due to chronic illness; and primary uncorrected valvular HF.
Data from 6,876 chronic stable HF patients with reduced EF were analyzed. The prevalence of moderate-to-severe SDB was 46%. Included were gender differences: 36% in women (n = 1,448) vs. 49% in men (n = 5,428). Risk factors for SDB included body mass index (per 5 units; odds ratio [OR], 1.29; 95% confidence interval [CI], 1.22-1.36), LVEF (per 5% decrement from 45%; OR, 1.10; 95% CI, 1.06-1.39), age (per 10-year difference to 60 years; OR, 1.41; 95% CI, 1.34-1.49), atrial fibrillation (OR, 1.19; 95% CI, 1.06-1.34), and male gender (OR, 1.90; 95% CI, 1.67-2.17).
The authors concluded that patients with HF have a high prevalence of SDB, with clinical predictors including male gender, body mass index, symptom severity, and LVEF.
Prevalence of SBD in the general adult population is 6-20%; the higher rate is associated with the older age group. The last prospective study to report prevalence of SDB among HF patients recruited patients from subspecialty HF clinics. The present study included younger patients and women, which allowed for gender, age, and extent of LV function dependent differences to be described. Findings do not apply to HF patients with preserved EF. No discrimination between central sleep apnea (CSA) and obstructive sleep apnea (OSA) is included here, since full sleep studies were not performed. Future use of screening devices capable of discriminating CSA and OSA would be useful as HF patients are risk stratified.
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