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J Am Coll Cardiol, 2007; 49:2028-2034, doi:10.1016/j.jacc.2007.01.084 (Published online 3 May 2007). © 2007 by the American College of Cardiology Foundation

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CLINICAL RESEARCH: HEART FAILURE

Central Sleep Apnea, Right Ventricular Dysfunction, and Low Diastolic Blood Pressure Are Predictors of Mortality in Systolic Heart Failure

Department of Veterans Affairs Medical Center, Cincinnati, Ohio; and the Departments of Medicine and Environmental Health, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Manuscript received November 9, 2006; revised manuscript received January 19, 2007, accepted January 29, 2007.

^_* Reprint requests and correspondence: Dr. Shahrokh Javaheri, Pulmonary Section (111F), VA Medical Center, Cincinnati, Ohio 45220. (Email: Javaheri{at}snorenomore.com).

Objectives: The purpose of this study was to determine whether central sleep apnea (CSA) contributes to mortality in patients with heart failure (HF).

Background: Cheyne-Stokes breathing with CSA commonly occurs in patients with systolic HF. Consequences of CSA, including altered blood gases and neurohormonal activation, could result in further left ventricular dysfunction. Therefore, we hypothesized that CSA might contribute to mortality of patients with HF.

Methods: We followed 88 patients with systolic HF (left ventricular ejection fraction 45%) with (n = 56) or without (n = 32) CSA. The median follow-up was 51 months.

Results: The mean (±SD) of apnea-hypopnea index was significantly higher in patients with CSA (34 ± 25/h) than those without CSA (2 ± 1/h). Most of these events were central apneas. In Cox multiple regression analysis, 3 of 24 confounding variables independently correlated with survival. The median survival of patients with CSA was 45 months compared with 90 months of those without CSA (hazard ratio = 2.14, p = 0.02). The other 2 variables that correlated with poor survival were severity of right ventricular systolic dysfunction and low diastolic blood pressure.

Conclusions: In patients with systolic HF, CSA, severe right ventricular systolic dysfunction, and low diastolic blood pressure might have an adverse effect on survival.

Abbreviations and Acronyms   AHI = apnea-hypopnea index   CPAP = continuous positive airway pressure   CSA = central sleep apnea   CSB = Cheyne-Stokes breathing   HF = heart failure   LVEF = left ventricular ejection fraction   RVEF = right ventricular ejection fraction

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