Relationship Between β-Blocker Treatment and the Severity of Central Sleep Apnea in Chronic Heart Failure

doi:10.1378/chest.06-0919

Chest

Volume 131, Issue 1, January 2007, Pages 130-135

https://doi.org/10.1378/chest.06-0919 Get rights and content

Abstract

Background:We sought to examine the relationship between use of β-blockers and the severity of central sleep apnea (CSA) in patients with chronic heart failure.

Methods:We performed polysomnography in 45 patients with chronic heart failure (New York Heart Association functional class II/III and left ventricular ejection fraction < 50%) and examined the relationship between use of β-blockers and the severity of CSA. Central apnea index (CAI) was used as an indicator of CSA.

Results:Patients receiving β-blockers (ie, carvedilol; n = 27) had lower apnea-hypopnea index (AHI) and CAI than patients not receiving β-blockers (n = 18) [mean ± SD, 14 ± 11 vs 33 ± 17, p < 0.0001; and 1.9 ± 3.2 vs 11 ± 12, p = 0.0004, respectively]. AHI and CAI were negatively correlated with the dose of carvedilol (Spearman ρ = − 0.61, p < 0.0001; and Spearman ρ = − 0.57, p = 0.0002, respectively). Multiple regression analysis selected no use of β-blockers as an independent factor of CAI (p = 0.0006). In five patients with CAI > 5 who underwent serial sleep studies, CAI decreased significantly after 6 months of treatment with carvedilol (9.5 ± 4.9 to 1.3 ± 2.4, p = 0.03).

Conclusions:In patients with chronic heart failure, CAI was lower according to the dose of β-blockers, and no use of β-blockers was independently associated with CAI. In addition, 6 months of treatment with carvedilol decreased CAI. These results suggest that β-blocker therapy may dose-dependently suppress CSA in patients with chronic heart failure.

Section snippets

Patients

Between January 2004 and May 2005, 45 consecutive patients (31 men and 14 women; mean age ± SD, 64 ± 13 years) with chronic heart failure who were admitted to our hospital and who met the following criteria were enrolled into this study. Inclusion criteria were chronic heart failure with New York Heart Association (NYHA) functional class II or III and left ventricular ejection fraction (LVEF) < 50%. Exclusion criteria were previous cerebrovascular disease, recent (< 6 months) acute coronary

Results

Clinical characteristics of patients studied are shown inTable 1. The β-blocker administered was carvedilol. Of 18 patients not receiving β-blockers, 14 patients received β-blockers at a later time, and 4 patients were not treated with β-blockers because of hypotension and bradycardia. Patients receiving β-blocker treatment (n = 27) had lower AHI and CAI than those not receiving β-blocker treatment (n = 18) [14 ± 11 vs 33 ± 17, p < 0.0001; and 1.9 ± 3.2 vs 11 ± 12, p = 0.0004, respectively].

Discussion

The major findings of the present study are as follows: (1) patients with chronic heart failure receiving β-blocker therapy had lower AHI and CAI than patients not receiving β-blocker therapy; (2) the dose of carvedilol was negatively correlated with AHI and CAI; (3) the multiple regression analysis selected no use of β-blockers as an independent factor of CAI; and (4) 6 months of treatment with carvedilol decreased CAI in five patients with CAI > 5 who underwent serial sleep studies. These

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None of the authors have any conflicts of interest to disclose.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestjournal.org/misc/reprints.shtml).

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Chest

Original Research: Sleep MedicineRelationship Between β-Blocker Treatment and the Severity of Central Sleep Apnea in Chronic Heart Failure

Abstract

Section snippets

Patients

Results

Discussion

Am J Cardiol

J Am Coll Cardiol

Am Heart J

J Am Coll Cardiol

Int J Cardiol

J Am Coll Cardiol

Chest

Chest

Treatment of congestive heart failure and Cheyne-Stokes respiration during sleep by continuous positive airway pressure

Am J Respir Crit Care Med

Occult sleep-disordered breathing in stable congestive heart failure

Ann Intern Med

Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalences, consequences, and presentations

Circulation

Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure

Am J Respir Crit Care Med

Increased mortality associated with Cheyne-Stokes respiration in patients with congestive heart failure

Am J Respir Crit Care Med

Prognosis and sleep disordered breathing in heart failure

Thorax

Prognostic value of nocturnal Cheyne-Stokes respiration in chronic heart failure

Circulation

Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration

Circulation

Original Research: Sleep Medicine
Relationship Between β-Blocker Treatment and the Severity of Central Sleep Apnea in Chronic Heart Failure