Abstract P075: Prevalence and Characterization of Sleep Disordered Breathing in Heart Failure Patients
Introduction: There is increasing evidence that sleep-disordered breathing (SDB) plays a significant role in progression of heart failure (HF) and increased risk of mortality, yet it remains underdiagnosed among HF patients. Retrospective studies suggest that the prevalence of SDB among patients with HF is approximately 50%, with more than 40% having central sleep apnea (CSA) and about 27% having obstructive sleep apnea (OSA). Few studies have prospectively evaluated the prevalence of SDB in a cohort of patients recently hospitalized for heart failure.
Hypothesis: Prevalence of SDB among patients with a recent HF hospitalization is greater than 50% and that greater than 40% will have CSA.
Methods: Patients hospitalized with a primary diagnosis of HF were enrolled. Diagnosis was verified using elevated B-type natruietic peptide, Framingham criteria, and validated by a cardiologist. Subjects completed standard sleep questionnaires and underwent ambulatory sleep tests. Overnight polysomonography (PSG) was recommended for validation and treatment titration if there was evidence of CSA or inadequate ambulatory sleep test. Recordings were considered interpretable if they included ≥ 2hours of recording. Standard AASM definitions were used for diagnosis of SDB. CSA was defined as an AHI > 5 with > 50% of the events being central apnea.
Results: For 35 subjects, mean (±S.D.) age was 66.8 (10.5) years; BMI was 29.2 (5.6) with 67% (24 of 35) BMI<30; neck circumference was 16.7 in. (1.6); abdominal circumference was 44.7 in. (5.4); and 74% (26 of 35) had HF with reduced ejection fraction (EF<50).
Only 13% (13 of 35) were classified as “high risk” by the Berlin Questionnaire, and scored mean (±S.D.) of 9.2 (5.3) on the Epsworth Sleep Scale from 0-24, 14.9 (7.9) on the Insomnia Severity Index on a 0-28 scale, and 10.1 (5.6) on the Pittsburgh Sleep Quality Index (Global Score) on a 0-21 scale. Higher scores from ESS, ISI, and PSQI are suggestive of increased risk of SDB.
Of the subjects with diagnostic sleep tests, 100% (27) had SDB, 67% (18) had CSA, 70% (19) had OSA, and 41% (11) had both CSA/OSA. Mean (±S.D.) Apnea-Hypopnea Index AHI was 28.8/hour (19.6) and oxygen desaturation index was 34.7 (21.2).
Conclusion: Prevalence of sleep disordered breath, CSA and OSA, was higher than expected in the HF patient population. The current screening questionnaires were not found to be predictive of this population being at high risk. The preliminary findings from this pilot study suggest all HF patients should undergo testing for presence of SDB.
Author Disclosures: Z. Ghaznavi: None. A. Warner: None. A. Ryden: None. D. Jun: None. M. Zeidler: None.
- © 2015 by American Heart Association, Inc.