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

https://doi.org/10.1016/j.jacc.2007.01.084Get rights and content
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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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This work was supported by grants from the Merit Review Program.