Research Article. Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

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Objectives. Evaluation of the characteristics of sleep apnea (SA) in patients hospitalized with acute heart failure, considering that undiagnosed SA could contribute to early rehospitalization. Methods. 56 consecutive patients (13 women, 43 men, mean age 63.12 years) with acute heart failure, in stable condition, underwent nocturnal polygraphy before hospital discharge. The type and severity of SA was determined. Besides descriptive statistics, correlations between the severity of SA and clinical and paraclinical characteristics were also analyzed (t-test, chi-square test, significancy at alpha < 0.05). Results. 12 (21.4%) subjects were free of SA (AHI - apnea-hipopnea index <5/h), 15 (26.7%) had mild SA (AHI=5-14/h), 17 (30.3%) had moderate SA (AHI 15-30/h), and 12 (21.4 %) had severe SA (AHI>30/h). The apnea was predominantly obstructive (32 cases vs. 12 with central SA). Comparing the patients with mild or no SA with those with severe SA, we did not find statistically significant correlations (p>0.05) between the severity of SA and the majority of main clinical and paraclinical characteristics - age, sex, BMI, cardiac substrates of heart failure, comorbidities. Paradoxically, arterial hypertension (p=0.028) and atrial fibrillation (p=0.041) were significantly more prevalent in the group with mild or no SA. Conclusions. Before discharge, in the majority of patients hospitalized with acute heart failure moderate and severe SA is present, and is not related to the majority of patient related factors. Finding of significant SA in this setting is important, because its therapy could play an important role in preventing readmissions and improving prognosis.

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  • 1. Lévy P Ryan S Oldenburg O Parati G - Sleep apnoea and the heart. Eur Respir Rev. 2013;22:333-352.

  • 2. Linz D Woehrle H Bitter T et al. - The importance of sleep-disordered breathing in cardiovascular disease. Clin Res Cardiol. 2015;104:705-718.

  • 3. Vrints H Shivalkar B Hilde H et al. - Cardiovascular mechanisms and consequences of obstructive sleep apnoea. Acta Clin Belg. 2013; 68:169-178.

  • 4. Damiani MF Zito A Carratu P et al. - Obstructive sleep apnea hypertension and their additive effects on atherosclerosis. Biochem Res Int. 2015;

  • 5. Young T Palta M Dempsey J Skatrud J Weber S Badr S - The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med. 1993;328:1230-1235.

  • 6. Oldenburg O Lamp B Faber L Teschler H Horstkotte D Töpfer V - Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence and characteristics of 700 patients. Eur J Heart Fail. 2007; 9:251-257.

  • 7. Bitter T Faber L Hering D Langer C Horstkotte D Oldenburg O - Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction. Eur J Heart Fail. 2009;11:602-608.

  • 8. Gheorghiade M Bonow RO. - Heart failure: early follow-up after hospitalization for heart failure. Nat Rev Cardiol. 2010;7:422- 424.

  • 9. Ponikowski P Voors AA Anker SD et al. - 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891-975.

  • 10. Pearse SG Cowie MR - Sleep-disordered breathing in heart failure. Eur J Heart Fail. 2016;18:353-361.

  • 11. Collop NA McDowell AW Boehlecke B et al. - Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. J Clin Sleep Med. 2007;3:737-747.

  • 12. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999;22:667-89.

  • 13. Punjabi NM - The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008;5:136-143.

  • 14. Khayat R Jarjoura D Patt B Yamokoski T Abraham WT - In-hospital testing for sleep-disordered breathing in hospitalized patients with decompensated heart failure: report of prevalence and patient characteristics. J Card Fail 2009;15:739-746.

  • 15. Khayat R Abraham WT Patt B et al. - Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure. J Card Fail. 2012;18:534-540.

  • 16. Khayat R Jarjoura D Porter K et al. - Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. Eur Heart J. 2015; 36:1463-1469.

  • 17. Kaneko Y Floras JS Usui K et al - Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. N Engl J Med. 2003;348:1233-1241.

  • 18. Cowie MR Woehrle H Wegscheider K et al. - Adaptive servoventilation for central sleep apnea in systolic heart failure. N Engl J Med. 2015; 373:1095-1105.

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