Sleep disordered breathing in patients with acutely decompensated heart failure

Padeletti, Margherita; Green, Philip; Mooney, Anne M.; Basner, Robert C.; Mancini, Donna M.

doi:10.1016/j.sleep.2008.03.010

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Volume 10, Issue 3 , Pages 353-360, March 2009

Sleep disordered breathing in patients with acutely decompensated heart failure

Margherita Padeletti
- Division of Cardiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH1273, New York, NY 10032, USA
- Department of Critical Care Medicine and Surgery, Unit of Geriatrics, University of Florence, Florence, Italy
Philip Green
- Division of Cardiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH1273, New York, NY 10032, USA
Anne M. Mooney
- Division of Pulmonary, Allergy & Critical Care, and The Cardiopulmonary Sleep and Ventilatory Disorders Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
Robert C. Basner
- Division of Pulmonary, Allergy & Critical Care, and The Cardiopulmonary Sleep and Ventilatory Disorders Center, Columbia University College of Physicians and Surgeons, New York, NY, USA
Donna M. Mancini
- Division of Cardiology, Columbia University College of Physicians and Surgeons, 622 West 168th Street, PH1273, New York, NY 10032, USA
- Corresponding author. Tel.: +1 212 305 4629; fax: +1 212 305 2591.

Received 4 October 2007; received in revised form 15 January 2008; accepted 16 March 2008.

Abstract

Objective: The purpose of this study is to systematically characterize sleep disordered breathing (SDB) during acute heart failure (HF) decompensation.

Background: SDB, both Cheyne–Stokes breathing (CSB) and obstructive sleep apnea, is common in stable congestive HF patients, but its presence and characteristics in decompensated HF is unknown.

Methods: Eighteen men and 11 women (mean age 57±17 years, plasma brain-natriuretic peptide 1660±1179pg/ml, left ventricular ejection fraction 20±6%) admitted with decompensated systolic HF without other active cardiorespiratory morbidity underwent echocardiography and overnight bedside polysomnography within 48h of admission. Ten patients underwent follow-up polysomnography just before or immediately after hospital discharge.

Results: Twenty-eight of 29 patients demonstrated an apnea+hypopnea index (AHI)>5 events/h (mean AHI 41±29/h); 22 patients had an AHI>15/h. SDB was predominantly CSB (central events 39±29/h; obstructive events 2±2/h, p<0.001). Time in CSB was 51±33% of total sleep time (TST); nadir oxygen saturation (SaO₂) was 81±10%. SDB was similar on admission vs. follow-up polysomnography (mean AHI 44±39/h vs. 38±31/h; CSB 53±38% vs. 46±37% TST). Follow-up polysomnography showed a higher nadir SaO₂ than admission (84±11% vs. 79±12%, p=0.05), but TST with SaO₂<90% was not reduced.

Conclusions: CSB is common and severe in patients hospitalized with decompensated HF. Acute treatment of HF does not consistently improve CSB. The effect of CSB on ventricular function and prognosis in decompensated HF remains to be demonstrated.

Keywords: Cheyne–Stokes breathing, Heart failure, Sleep disordered breathing, Central apnea, Polysomnography, BNP, Acute decompensated heart failure