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J Am Coll Cardiol, 2004; 44:68-71, doi:10.1016/j.jacc.2004.03.040
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE

Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure

Anil-Martin Sinha, MD, DPhil*, Erik C. Skobel, MD*, Ole-Alexander Breithardt, MD*, Christine Norra, MD{dagger}, Kai U. Markus, MD*, Christian Breuer, MD*, Peter Hanrath, MD, FESC, FACC* and Christoph Stellbrink, MD, FESC*,*

* Department of Cardiology, University Hospital, RWTH, Aachen, Germany
{dagger} Clinic for Psychiatry and Psychotherapy, University Hospital, RWTH, Aachen, Germany

Manuscript received September 16, 2003; revised manuscript received March 11, 2004, accepted March 16, 2004.

* Reprint requests and correspondence: Dr. Christoph Stellbrink, Medizinische Klinik I, University Hospital, RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany.
cstellbrink{at}ukaachen.de

OBJECTIVES: We studied the effects of cardiac resynchronization therapy (CRT) on heart failure (HF) patients with central sleep apnea (CSA).

BACKGROUND: Patients with advanced HF often suffer from CSA with Cheyne-Stokes respiration. Cardiac resynchronization therapy improves myocardial function and exercise capacity in HF patients with conduction disturbances. The relationship between CRT and CSA is currently unknown.

METHODS: Twenty-four patients (7 females; 62 ± 11 years) with HF, a reduced left ventricular ejection fraction (24 ± 6%), and left bundle branch block (QRS duration 173 ± 22 ms) received a CRT device. The number of apneas and hypopneas per hour (apnea-hypopnea index [AHI]) and minimal oxygen saturation (SaO2min) were quantified by cardiorespiratory polygraphy. Fourteen patients showed CSA (AHI >5/h), and 10 patients had an AHI <5/h without CSA. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were evaluated before and after 17 ± 7 weeks of CRT.

RESULTS: In patients with CSA, CRT led to a significant decrease in AHI (19.2 ± 10.3 to 4.6 ± 4.4, p < 0.001) and PSQI (10.4 ± 1.6 to 3.9 ± 2.4, p < 0.001) without Cheyne-Stokes respiration and to a significant increase in SaO2min (84 ± 5% to 89 ± 2%, p < 0.001). There was no significant change in AHI (1.7 ± 0.7 to 1.5 ± 1.6), PSQI (2.4 ± 0.5 to 2.6 ± 0.9), and SaO2min (90 ± 2% to 91 ± 1%) in patients without CSA.

CONCLUSIONS: Cardiac resynchronization therapy leads to a reduction of CSA and to increased sleep quality in patients with HF and sleep-related breathing disorders. This may have prognostic implications in patients receiving CRT.

Abbreviations and Acronyms
  AHI = apnea hypopnea index
  CRT = cardiac resynchronization therapy
  CSA = central sleep apnea
  HF = heart failure
  LV = left ventricular
  NYHA = New York Heart Association
  PSQI = Pittsburgh Sleep Quality Index
  SaO2min = minimal oxygen saturation
  VE/VCO2 = slope of increase in ventilation relative to carbon dioxide production
  VO2 = oxygen consumption




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