Chest
Volume 124, Issue 4, October 2003, Pages 1400-1405
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Clinical Investigations
Sleep and Breathing
The Relationship Between Congestive Heart Failure, Sleep Apnea, and Mortality in Older Men

https://doi.org/10.1378/chest.124.4.1400Get rights and content

Study objectives

To examine the association of sleep apnea with heart disease.

Design

Prospective study.

Setting

Medical wards at the Veterans Affairs San Diego Healthcare System.

Patients

Three hundred fifty-three randomly selected inpatient men.

Measurements and results

Sleep was recorded for 2 nights in the hospital. Medical conditions were obtained from hospital medical records. Cox proportional hazards analyses indicated that patients with congestive heart failure (CHF) plus central sleep apnea (CSA) had shorter survival than those with just CHF, just sleep apnea (obstructive or central), or neither. Survival for those with obstructive sleep apnea (OSA) or CSA and no CHF was no different than for those with neither disorder. Follow-up analysis showed that for those with no CHF, neither CSA nor OSA shortened survival (p > 0.80). For those with CHF, having CSA shortened the life span with a hazard ratio of 1.66 (p = 0.012), but having OSA had no effect. Patients with CHF had more severe sleep apnea than those with no heart disease.

Conclusions

This study does not clarify the issues of cause and effect, but does reinforce the strong associations between sleep apnea and heart disease in elderly men. These data suggest that people with coronary disease should be regarded as a risk group for sleep apnea.

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.

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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.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail:[email protected]).

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