Chest
Clinical InvestigationsSleep and BreathingThe Relationship Between Congestive Heart Failure, Sleep Apnea, and Mortality in Older Men
Section snippets
Subjects
Three hundred fifty-three men who were inpatients on the medical wards at the Veterans Affairs San Diego Healthcare System (VASDHS) were randomly selected from all new daily admissions to the medical wards. Exclusion criteria included being < 60 years old; diagnosis of cancer, dementia, or infectious disease; and being too sick to consent or being in the ICU. Initial data gathering occurred over a 5-year period from 1985 to 1989. The project was approved by the University of California, San
Demographics
The mean age of the 353 men was 69 years (SD, 7.7 years; range, 60 to 99 years). Mean BMI was 25.4 (SD, 5.0; range, 14.2 to 47.6). Eighty-five percent of the sample were white, 4% were African American, and 11% were “other.” Table 1 shows the percentage of the sample with different medical conditions, as listed in medical records. Table 2 shows the medications received by these patients.
Prevalence
In this sample, at the initial visit, 53% of the men (n = 186) had an AHI ≥ 15. The mean AHI for the entire
Discussion
Our study examined randomly selected Veteran men > 60 years old who were inpatients on a medical ward at the VASDHS, and who were followed up for 17.5 years. In this sample, there were significantly greater mortality rates in patients who had both CHF and CSA than in those with just CHF or just CSA or just OSA. Patients with CSA or OSA survived > 6.75 years, patients with CHF survived just > 4 years, while patients with both CHF and CSA survived just > 2.5 years. Survival of patients with just
ACKNOWLEDGMENT
These data were originally collected in collaboration with Daniel F. Kripke, MD, and Melville R. Klauber, PhD.
References (41)
- et al.
When people die: cause of death versus time of death
Am J Med
(1987) Sleep apnea, hypoxemia, and cardiac arrhythmias
Chest
(1986)- et al.
Relationship of ventricular ectopy to oxyhemoglobin desaturation in patients with obstructive sleep apnea
Chest
(1985) - et al.
Cardiac arrhythmia and conduction disturbances during sleep in 400 patients with sleep apnea syndrome
Am J Cardiol
(1983) - et al.
Sleep apnea syndrome and essential hypertension
Am J Cardiol
(1985) - et al.
Prevalence of sleep-disordered breathing in diastolic heart failure
Chest
(1997) - et al.
The role of continuous positive airway pressure in the treatment of congestive heart failure
Chest
(2001) - et al.
Sleep apnea in congestive heart failure
Clin Chest Med
(1998) - et al.
Cheyne-Stokes respiration and prognosis in congestive heart failure
Am J Cardiol
(1996) - et al.
Effect of continuous positive airway pressure on mitral regurgitant fraction and atrial natriuretic peptide in patients with heart failure
J Am Coll Cardiol
(1997)
Morbidity, mortality and sleep disordered breathing in community dwelling elderly
Sleep
Sleep disordered breathing in community-dwelling elderly
Sleep
Coronary heart disease in patients with obstructive sleep apnea
Dtsch Med Wochenschr
Sleep apnea and cardiovascular risk
Z Kardiol
Prevalence of sleep disorder breathing in patients on a heart transplant waiting list
Chest
Occult sleep-disordered breathing in stable congestive heart failure
Ann Intern Med
Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalences, consequences, and presentations
Circulation
Prospective study of the association between sleep-disordered breathing and hypertension
N Engl J Med
Association of sleep-disordered breathing, sleep apnea, and hypertension in a large community-based study
JAMA
Effect of nasal continuous positive airway pressure on sleep apnea in congestive heart failure
Am Rev Respir Dis
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All work was performed at University of California San Diego and VASDHS.
Supported by NIA AG02711, NIA AG08415, NCI CA85264, NHLBI HL44915, NHLBI HL36005; the Department of Veterans Affairs VISN-22 Mental Illness Research, Education, and Clinical Center; and the Research Service of the VASDHS.
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