HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: j.jacc.2007.01.084v1 49/20/2028    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Javaheri, S. Articles by Wexler, L. Search for Related Content PubMed Articles by Javaheri, S. Articles by Wexler, L.

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. This work was supported by grants from the Merit Review Program

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

This article has been cited by other articles:

				V. K. Somers, D. P. White, R. Amin, W. T. Abraham, F. Costa, A. Culebras, S. Daniels, J. S. Floras, C. E. Hunt, L. J. Olson, et al. Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health) J. Am. Coll. Cardiol., August 19, 2008; 52(8): 686 - 717. [Full Text] [PDF]

				L. K. Brown Filling in the Gaps: The Role of Noninvasive Adaptive Servoventilation for Heart Failure-Related Central Sleep Apnea Chest, July 1, 2008; 134(1): 4 - 7. [Full Text] [PDF]

				M. Arzt, R. Wensel, S. Montalvan, T. Schichtl, S. Schroll, S. Budweiser, F. C. Blumberg, G. A. J. Riegger, and M. Pfeifer Effects of Dynamic Bilevel Positive Airway Pressure Support on Central Sleep Apnea in Men With Heart Failure Chest, July 1, 2008; 134(1): 61 - 66. [Abstract] [Full Text] [PDF]

				A. Garcia-Touchard, V. K. Somers, L. J. Olson, and S. M. Caples Central Sleep Apnea: Implications for Congestive Heart Failure Chest, June 1, 2008; 133(6): 1495 - 1504. [Abstract] [Full Text] [PDF]

				D. Yumino and T. D. Bradley Central Sleep Apnea and Cheyne-Stokes Respiration Proceedings of the ATS, February 15, 2008; 5(2): 226 - 236. [Abstract] [Full Text] [PDF]

				O. Oldenburg, B. Lamp, G. Freudenberg, and D. Horstkotte Screening for sleep-disordered breathing is recommended in patients with chronic heart failure Eur. Respir. J., November 1, 2007; 30(5): 1023 - 1023. [Full Text] [PDF]

				K. A. Franklin From the author Eur. Respir. J., November 1, 2007; 30(5): 1023 - 1024. [Full Text] [PDF]