Sleep-disordered breathing in chronic compensated heart failure

Abstract

Objective Our study aimed to examine the frequency and variety of sleep-disordered breathing (SDB) in different types of chronic compensated heart failure (HF), evaluate the sensitivity and specificity of Epworth sleepiness scale (ESS), Berlin, and STOP-BANG Questionnaires in diagnosing SDB in patients with chronic compensated HF and to establish the relation between ejection fraction (EF) and type of SDB that may assist in identifying the population at riskPatients and methods Fifty-three chronic compensated HF adult patients were enrolled, but only 40 cases underwent full-night attended polysomnography and completed the study and were available for final analysis. HF is classified into three groups: HFpEF, HFmrEF, and HFrEF according to ESC. SDB is classified according to the central apnea–hypopnea index and obstructive apnea–hypopnea index and their proportions into total apnea and hypopnea index into: OSA, coexisting OSA-CSA (predominantly OSA or CSA), and CSA. Results Statistically significant higher Mallampati score in those with SDB versus those without SDB. STOP-BANG questionnaire was the most sensitive SDB prediction score followed by Berlin score and the least was ESS. Berlin score and ESS were more specific than the STOP-BANG score. Statistically significantly lower left ventricular EF was observed in SDB patients in comparison with patients without SDB. There was significantly higher NC in OSA patients versus coexisting OSA/CSA either predominantly OSA or CSA. Significant higher BMI and Mallampati score in OSA group in comparison to coexisting OSA/CSA predominantly CSA patients. Significant lower left ventricular EF was found in patients with coexisting OSA/CSA whether predominantly CSA or OSA versus LVEF in OSA patients. Significant association between SDB and HF types (OSA was significantly associated with HFpEF). Significant differences between OSA and coexisting OSA/CSA predominantly OSA as regards AF. Conclusions Despite optimized therapy, SDB was prevalent in chronic compensated HF patients (82.5%). Among all studied patients, 40% suffer from obstructive sleep apnea, while 42.5% suffer from coexisting OSA/CSA. SDB in HF patients was best predicted using the STOP-BANG questionnaire, while Berlin and ESS were most accurate. SDB in HF may be predicted by higher Mallampati scores and lower LVEF. OSA is more prevalent in chronic HF patients who have large BMIs, neck circumferences, and Mallampati scores. HFrEF and HFmrEF are the only two forms of HF that are associated with OSA/CSA. Central apnea and hypopnea events were predicted by lower LVEF and AF.

Keywords

• apnea
• heart failure
• sleep-disordered breathing