<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_pneum-2019-0002_s_006_w2aab3b7b2b1b6b1aab1c16b1Aa"><h3>Background</h3><p>Patients with sleep apnea syndrome (SAS) and heart failure (HF) have concomitant different comorbidities and increased risk of morbidity.</p></sec><sec id="j_pneum-2019-0002_s_007_w2aab3b7b2b1b6b1aab1c16b2Aa"><h3>Aim</h3><p>The aim of this study was to analyze differences between patients with SAS and heart failure with preserved ejection fraction (HFpEF; ejection fraction [EF]≥50%) – group 1 and those with SAS and heart failure with reduced ejection fraction (HFrEF; EF&lt;50%) – group 2.</p></sec><sec id="j_pneum-2019-0002_s_008_w2aab3b7b2b1b6b1aab1c16b3Aa"><h3>Methods</h3><p>We evaluated 51 patients with SAS and HF in the sleep laboratory of Timisoara Victor Babes Hospital. We collected general data, sleep questionnaires, anthropometric measurements (neck circumference [NC], abdominal circumference [AC]), somnography for apnea–hypopnea index (AHI), oxygen desaturation index (ODI), echocardiographic data, comorbidities, and laboratory test.</p></sec><sec id="j_pneum-2019-0002_s_009_w2aab3b7b2b1b6b1aab1c16b4Aa"><h3>Results</h3><p>The study included 51 patients who were divided into two groups depending on EF, with the following characteristics: Group 1 (HFpEF): 26 patients, 19 males, seven females, age 61.54±9.1 years, body mass index (BMI) 37±6.4 kg/m<sup>2</sup>, NC 45.4±3.6 cm, AC 126.6±12.9 cm, AHI 48.3±22.6 events/hour, central apnea 5.6±11.4 events/hour, obstructive apnea 25.7±18.7 events/hour, ODI 41.2±21.2/hour and lowest SpO<sub>2</sub> –72.1±14%.</p><p>Group 2 (HFrEF): 25 patients, 18 males, seven females, age 63.6±8.8 years, BMI 37.9±7.5 kg/m<sup>2</sup>, NC 46±4.4 cm, AC 127.2±13.9 cm, AHI 46.4±21.7 events/hour, central apnea 4.6±8.3 events/hour, obstructive apnea 25.9±18.5 events/hour, ODI 44.8±27.1/hour and lowest SpO<sub>2</sub> –70.6±12.1%. Differences between groups regarding anthropometric and somnographic measurements and lipidic profile were not statistically significant.</p><p>Significant differences were observed regarding stroke (23% vs. 4%, p=0.04) in the group with HFpEF and regarding creatinine measurements (1.1±0.2 vs. 1.4±0.7, p=0.049), aortic insufficiency (11.5% vs. 36%, p=0.04) and tricuspid insufficiency (6.1% vs. 80%, p=0.01) in the group with HFrEF.</p></sec><sec id="j_pneum-2019-0002_s_010_w2aab3b7b2b1b6b1aab1c16b5Aa"><h3>Conclusions</h3><p>Patients with SAS and HFpEF have a higher risk of stroke. Patients with SAS and HFrEF have a significantly increased risk of developing a life-long chronic kidney disease and aortic and tricuspid insufficiency. These results may suggest pathogenic links between SAS and the mentioned comorbidities, and this may explain the higher mortality when this association is present.</p></sec></abstract>

BackgroundPatients with sleep apnea syndrome (SAS) and heart failure (HF) have concomitant different comorbidities and increased risk of morbidity.AimThe aim of this study was to analyze differences between patients with SAS and heart failure with preserved ejection fraction (HFpEF; ejection fraction [EF]≥50%) – group 1 and those with SAS and heart failure with reduced ejection fraction (HFrEF; EF<50%) – group 2.MethodsWe evaluated 51 patients with SAS and HF in the sleep laboratory of Timisoara Victor Babes Hospital. We collected general data, sleep questionnaires, anthropometric measurements (neck circumference [NC], abdominal circumference [AC]), somnography for apnea–hypopnea index (AHI), oxygen desaturation index (ODI), echocardiographic data, comorbidities, and laboratory test.ResultsThe study included 51 patients who were divided into two groups depending on EF, with the following characteristics: Group 1 (HFpEF): 26 patients, 19 males, seven females, age 61.54±9.1 years, body mass index (BMI) 37±6.4 kg/m2, NC 45.4±3.6 cm, AC 126.6±12.9 cm, AHI 48.3±22.6 events/hour, central apnea 5.6±11.4 events/hour, obstructive apnea 25.7±18.7 events/hour, ODI 41.2±21.2/hour and lowest SpO2 –72.1±14%.Group 2 (HFrEF): 25 patients, 18 males, seven females, age 63.6±8.8 years, BMI 37.9±7.5 kg/m2, NC 46±4.4 cm, AC 127.2±13.9 cm, AHI 46.4±21.7 events/hour, central apnea 4.6±8.3 events/hour, obstructive apnea 25.9±18.5 events/hour, ODI 44.8±27.1/hour and lowest SpO2 –70.6±12.1%. Differences between groups regarding anthropometric and somnographic measurements and lipidic profile were not statistically significant.Significant differences were observed regarding stroke (23% vs. 4%, p=0.04) in the group with HFpEF and regarding creatinine measurements (1.1±0.2 vs. 1.4±0.7, p=0.049), aortic insufficiency (11.5% vs. 36%, p=0.04) and tricuspid insufficiency (6.1% vs. 80%, p=0.01) in the group with HFrEF.ConclusionsPatients with SAS and HFpEF have a higher risk of stroke. Patients with SAS and HFrEF have a significantly increased risk of developing a life-long chronic kidney disease and aortic and tricuspid insufficiency. These results may suggest pathogenic links between SAS and the mentioned comorbidities, and this may explain the higher mortality when this association is present.

Risk for stroke and chronic kidney disease in patients with sleep apnea syndrome and heart failure with different ejection fractions

University of Medicine and Pharmacy “Dr. Victor Babes”

Pulmonology Department, CardioPrevent Foundation

Pneumologia

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Riscul de atac ischemic și boală cronică de rinichi la pacienții cu sindrom de apnee în somn și insuficiență cardiacă cu diferite fracții de ejecție

BackgroundPatients with sleep apnea syndrome (SAS) and heart failure (HF) have concomitant different comorbidities and increased risk of morbidity.AimThe aim...

	HFrEF	HFpEF
Laboratory parameters	Mean value±standard deviation	Mean value±standard deviation	p value
ESR (mg/dl)	21.5±24.3	14.4±9	0.21
Uric acid (mg/dl)	7.4±2.8	6.6±1.8	0.36
Creatinine (mg/dl)	1.4±0.7	1.1±0.2	0.049
Erythrocyte count (*106/ml)	4.9±0.9	4.8±0.5	0.8
Cholesterol (mg/dl)	164.7±38.4	164.7±54.2	0.9
LDL-cholesterol (mg/dl)	94.1±29	79.1±25.3	0.15
HDL-cholesterol (mg/dl)	42.4±10.7	41.9±10.4	0.88
Triglycerides (mg/dl)	133.5±81.6	191.4±105.6	0.06

Valve alteration	HFrEF (n, %)		HFpEF (n, %)		p value
Mitral insufficiency	24 patients	96%	21 patients	80.7%	0.09
Aortic insufficiency	9 patients	36%	3 patients	11.5%	0.04
Tricuspid insufficiency	20 patients	80%	12 patients	46.1%	0.01
Pulmonary insufficiency	1 patient	4%	3 patients	11.5%	0.32

Comorbidities	HFrEF (n, %)		HFpEF (n, %)		p value
COPD	8 patients	32%	3 patients	11.5%	0.07
Diabetes	7 patients	28%	14 patients	53.8%	0.06
Dyslipidemia	15 patients	60%	18 patients	69.2%	0.5
Coronary artery disease	20 patients	80%	18 patients	69.2%	0.38
Arrhythmias	18 patients	72%	13 patients	50%	0.11
Stroke	1 patient	4%	6 patients	23%	0.04
Smoking status	11 patients	44%	11 patients	42.3%	0.9

	HFrEF	HFpEF
Polygraphic parameters	Mean value ± standard deviation	Mean value ± standard deviation	p value
AHI (n/h)	46.4±21.7	48.3±22.6	0.75

Central apnea (n/h)	4.6±8.3	5.6±11.4	0.7
Obstructive apnea (n/h)	25.9±18.5	25.7±18.7	0.97
Mixed apnea (n/h)	4.6±7.6	6.2±10.7	0.44
Desaturation index (n/h)	44.8±27.1	41.2±21.2	0.59
Mean saturation (%)	90.2±6.3	89.8±5.3	0.84
Lowest SpO₂ (%)	70.6±12.1	72.1±14	0.69
Longest SpO₂ <88% (min)	3±5.8	10.5±33.5	0.29
Epworth scale	14±6	13.3±5.6	0.69
SAS score	4.6±0.8	4.5±0.7	0.71

	HFrEF (25 patients)	HFpEF (26 patients)
	Mean value ± standard deviation	Mean value ± standard deviation	p value
Age (years)	63.6±8.8	61.54±9.1	0.39
Gender	7 females (28%)	7 females (27%)
	18 males (72%)	19 males (73)
BMI (kg/m²)	37.9±7.5	37±6.4	0.65
Neck circumference (cm)	46±4.4	45.4±3.6	0.57
Abdominal circumference (cm)	127.2±13.9	126.6±12.9	0.87

Risk for stroke and chronic kidney disease in patients with sleep apnea syndrome and heart failure with different ejection fractions

Article Category: Original Papers

Published Online: Jul 02, 2019

Page range: 15 - 20

DOI: https://doi.org/10.2478/pneum-2019-0002

Keywords
sleep apnea, stroke, chronic kidney disease, heart failure

© 2019 Ardelean et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Laboratory parameter values in groups with HFrEF and HFpEF and p value.

The number of patients with valvular pathology in the groups with HFrEF and HFpEF and p value.

The number of patients with different comorbidities in the groups with HFrEF and HFpEF and p value.

The values of the polygraphic parameters in the groups with HFrEF and HFpEF.

Anthropometric values in the groups with HFrEF versus HFpEF.

Risk for stroke and chronic kidney disease in patients with sleep apnea syndrome and heart failure with different ejection fractions

Article Category: Original Papers

Published Online: Jul 02, 2019

Page range: 15 - 20

DOI: https://doi.org/10.2478/pneum-2019-0002

Keywordssleep apnea, stroke, chronic kidney disease, heart failure

© 2019 Ardelean et al., published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Laboratory parameter values in groups with HFrEF and HFpEF and p value.

The number of patients with valvular pathology in the groups with HFrEF and HFpEF and p value.

The number of patients with different comorbidities in the groups with HFrEF and HFpEF and p value.

The values of the polygraphic parameters in the groups with HFrEF and HFpEF.

Anthropometric values in the groups with HFrEF versus HFpEF.

Keywords
sleep apnea, stroke, chronic kidney disease, heart failure