Sleep-Disordered Breathing Prevalent in Patients with Stable Chronic Heart Failure

Results from the SchlaHF Registry suggest that patients with heart failure (HF) often experience sleep-disordered breathing (SDB), with male gender, age and body mass index (BMI) among the predictors for SDB.

“SchlaHF registry data demonstrate a high prevalence of SDB in a representative population of stable chronic HF patients receiving contemporary medical management,” the researchers wrote.

The aim of the study was to better understand the prevalence of SDB, as well as the clinical predictors of the condition that are routinely assessed in the clinical work-up of chronic HF patients.

The prospective study included 6876 patients from the multicenter SchlaHF registry. The registry featured demographic and clinical data on patients with chronic, stable, symptomatic HF, which was defined as New York Heart Association (NYHA) class ≥II and left ventricular ejection fraction ≤45%.

Researchers used a 2-channel screening device (ApneaLink, ResMed) to verify moderate-to-severe SDB. They defined SDB by 2 different abnormal breathing patterns: obstructive sleep apnea (OSA) and central sleep apnea (CSA) with Cheyne-Stokes respiration.

In all, 46% of the population had moderate-to-severe SDB, with a higher prevalence reported in men than women (49% vs 36%).

As age increased, so too did the rate of SDB: ≤50 years, 31%; >50 to 60 years, 39%; >60 to 70 years, 45%; >70 to 80 years, 52%; and >80 years, 59%.

Risk factors for SDB, in addition to age (per 10-year difference to 60 years, odds ratio [OR]=1.41) and male gender (OR=1.90), included BMI (per 5 units, OR=1.29), left ventricular ejection fraction (per 5% decrement from 45%, OR=1.10) and atrial fibrillation (OR=1.19).

“Data from the SchlaHF registry, and the fact that chronic HF patients with SDB often do not show typical SDB symptoms, suggest that the presence of one or more predictors of SDB … should prompt clinicians to perform device-based screening for SDB,” the researchers wrote. “In view of the various phenotypes of SDB and their potential differential clinical implications in chronic HF, the development of easy-to-use screening devices for SDB with the ability to discriminate OSA and CSA with and without periodic breathing is warranted. This could be useful for risk stratification in patients with chronic HF.”

Reference

Arzt M, Woehrle H, Oldenburg O, et al. Prevalence and predictors of sleep-disordered breathing in patients with stable chronic heart failure: the SchlaHF Registry. JACC: Heart Fail. 2015. doi:10.1016/S0735-1097(15)61042-7.