Chest
Volume 111, Issue 6, June 1997, Pages 1488-1493
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Clinical Investigations: Sleep and Breathing
Prevalence of Sleep-Disordered Breathing in Diastolic Heart Failure

https://doi.org/10.1378/chest.111.6.1488Get rights and content

Objective

Sleep-disordered breathing (SDB) is common in congestive heart failure. While isolated diastolic heart failure (DHF) accounts for up to a third of all cases of congestive heart failure, the prevalence of SDB in DHF is unknown. We aim to determine the prevalence and characteristics of SDB in a group of patients with symptomatic DHF.

Methods

Twenty subjects with symptomatic DHF (New York Heart Association class II or III) and isolated diastolic dysfunction on echocardiography were assessed with lung function tests, modified sleep and health questionnaire, and overnight polysomnography. Significant SDB was defined as an apnea/hypopnea index (AHI) >10.

Results

Thirteen female and seven male subjects (mean age, 65±6.0 years; mean body mass index (BMI), 28 ±3.2) were evaluated, of whom 17 (85%) had a diagnosis of hypertension. Overall sleep quality was poor, with fragmentation and frequent arousals associated with respiratory events. Fifty-five percent of the patients had significant SDB, mainly obstructive apneas. BMI and the prevalence of hypertension were similar in patients with and without SDB. The deceleration time, an index of diastolic dysfunction, was more prolonged in the group with SDB (236±40 ms vs 282±31 ms; p<0.05). As a group, a lower minimum percentage arterial oxygen saturation during sleep, but not the AHI was associated with more severe degree of diastolic dysfunction on echocardiogram, including a lower ratio between the early peak transmittal flow velocity and the late peak atrial systolic velocity (rho=0.57; p<0.05) and a prolonged isovolumic relaxation time (rho=—0.54; p<0.05).

Conclusions

SDB is common in patients with DHF. Patients with DHF and SDB may be associated with worse diastolic dysfunction than those without SDB, although a causal relationship remains to be established.

Section snippets

Subjects

Subjects were recruited from the cardiology outpatient clinic in our hospital with symptoms of heart failure (New York Heart Association class II or III). The diagnosis of hypertension was based on BP readings of >140/90 mm Hg on three separate occasions prior to commencement of treatment with antihypertensive medications. Those who had normal systolic function (LVEF >50%) and diastolic dysfunction on two-dimensional echocardiogram and Doppler studies were selected. Patients were receiving

Results

Thirteen male and seven female patients were evaluated (mean age = 65±6.0 years; mean body mass index [BMI]=28±3.2). Seventeen of 20 patients (85%) had a diagnosis of hypertension. As a group, the mean BP recorded on hospital admission was 136±10/83±8 mm Hg. Based on the Likert scale, more than half of the patients reported significant symptoms related to sleep apnea such as heavy snoring, excessive daytime somnolence, and nocturnal awakenings. The mean scores on the Likert scale were as

Discussion

We have shown that SDB, in particular OSA, was common in a group of patients with symptomatic DHF. Hypertension, the most common cause of DHF, was present in a large proportion (85%) of our patients. The association between SDB and essential hypertension is firmly established. Among patients with OSA, 40 to 60% had hypertension.13 Among unselected hypertensive patients, OSA was found with a prevalence of 30 to 50%.14 Confounding risk factors for both hypertension and SDB such as obesity, age,

References (29)

  • FindleyL.J. et al.

    Cheynes-Stokes breathing during sleep in patients with left ventricular heart failure

    South Med J

    (1985)
  • NaughtonM.T. et al.

    The role of hyperventilation in the pathogenesis of central sleep apnoea in patients with congestive heart failure

    Am Rev Respir Dis

    (1993)
  • NaughtonM.T. et al.

    Treatment of congestive heart failure and Cheynes-Stokes respiration during sleep by continuous positive airways pressure

    Am Rev Respir Dis

    (1995)
  • KumpK. et al.

    Assessment of the validity and utility of a sleep-symptom questionnaire

    Am J Respir Crit Care Med

    (1994)
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