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Association of Central Sleep Apnea with Impaired Heart Structure and Cardiovascular Hemodynamics in Patients with

Anna Kazimierczak1, Paweł Krzesiński1, Grzegorz Gielerak1

  • 1Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.

Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
|August 26, 2016
PubMed

Insights

Central sleep apnea with Cheyne-Stokes respiration (CSA/CSR) in heart failure (HF) patients is linked to worse heart function and higher NYHA class. Patient functional status is the primary driver of CSA/CSR presence.

Area of Science:

  • Cardiology
  • Sleep Medicine
  • Pulmonology

Background:

  • Advanced heart failure (HF) frequently co-occurs with central sleep apnea (CSA) characterized by Cheyne-Stokes respiration (CSR).
  • Understanding the interplay between CSA/CSR and cardiovascular hemodynamics in HF is crucial for patient management.

Purpose of the Study:

  • To investigate the association between CSA/CSR and clinical features of heart failure.
  • To specifically evaluate the relationship between CSA/CSR and cardiovascular hemodynamic parameters in HF patients.

Main Methods:

  • 161 stable HF patients with left ventricular ejection fraction (LVEF) ≤45% were assessed.
  • Clinical evaluation included echocardiography (LVEF, LVDd, RVDd, E/e') and impedance cardiography (SI, HR, CI, SVRI).
  • Patients were categorized into moderate/severe CSA/CSR (CSR_ [+]) and mild or no CSA/CSR (CSR_ [-]) groups for comparison.

Main Results:

  • CSR_ [+] patients exhibited more advanced NYHA class, higher prevalence of atrial fibrillation, and significantly impaired cardiac structure and function.
  • Key differences included lower LVEF, higher ventricular diameters (LVDd, RVDd), elevated E/e', and reduced cardiac output (SI, CI) in the CSR_ [+] group.
  • Independent predictors for CSR_ [+] were NYHA class, atrial fibrillation, RV enlargement, LVEF<35%, E/e', and SI<35 ml/m2, with NYHA class being the strongest predictor.

Conclusions:

  • The presence of CSA/CSR in heart failure patients is strongly associated with indicators of advanced disease, including functional class, atrial fibrillation, and compromised cardiovascular hemodynamics.
  • Patient functional status, as indicated by NYHA class, is the primary determinant influencing the occurrence of CSA/CSR in heart failure.

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