Abstract 3596: Obstructive Sleep Apnea and Cheyne-Stokes Respiration: Idependent Risk Factors for Malignant Ventricular Arrhythmias and Appropriate Cardioverter-Defibrillator Therapies in Patients With Congestive Heart Failure
Background: In heart failure patients prevalence of sleep disordered breathing (SDB) is high and is accompanied by a poor prognosis. Aim of this first large scale, long term study was to investigate, whether Cheyne-Stokes respiration (CSR) and/or obstructive sleep apnea (OSA) is associated with an increased risk of cardiac arrhythmias and sudden cardiac death.
Methods: A total of 216 heart failure patients (pts, 52 female, 63±10 years) were screened for sleep disordered breathing by cardiorespiratory polygraphy six month after guideline conform implantation of a cardiac resyn-chronisation therapy device plus cardioverter-defibrillator (CRT-D). During follow up (mean 43±7 months) appropriate monitored ventricular arrhythmias (non sustained or sustained ventricular tachycardia and ventricular fibrillation) as well as appropriate cardioverter-defibrillator therapies were analyzed.
Results: CSR was documented in 78 pts (36%), OSA in 80 pts (37%), and 58 pts (27%) presented without SDB (noSDB). Time period to first monitored ventricular arrhythmias (CSR 17±2 months, OSA 24±3 months, noSDB 68±7 months) and to first appropriate cardioverter-defibrillator therapy (CSR 39±5 months, OSA 44±3 months, noSDB (80±7 months was significantly shorter in pts with SDB. Multiple COX proportional hazard regression analysis, adjusted for all significant cofactors revealed an independent correlation for SDB regarding detected malignant ventricular tachycardias (CSA: HR 1.86, CI 1.07 to 3.22, p=0.003; OSA: HR 1.93, CI 1.12 to 3.33, p=0.002) and appropriate cardioverter-defibrillator therapies (CSA: HR 2.11, CI 1.07 to 4.17, p=0.003; OSA: HR 2.4, CI 1.18 to 4.90, p=0.002).
Conclusion: OSA and CSA are independently associated with an increased risk for malignant ventricular tachycardias and appropriate cardioverter-defibrillator therapies. Whether adequate therapy of SDB is accompanied by an improved event-free survival is currently studied.