Sleep-disordered breathing in patients with heart failure with preserved left ventricular ejection fraction

Data on sleep-disordered breathing (SDB) in patients with heart failure with preserved left ventricular ejection fraction (HFpEF) are sparse. Therefore, we aimed to determine the prevalence and characteristics of SDB in a large patient cohort with HFpEF.

A total of 233 patients with HFpEF were prospectively enrolled at our cardiology outpatient department after excluding patients with a history of SDB. The presence of moderate to severe SDB with an apnea-hypopnea index ≥ 15/h was determined using cardiorespiratory polygraphy. All patients underwent assessment of HFpEF comorbidities, comprehensive echocardiographic studies, NT-proBNP levels and calculation of HFpEF-scores.

SDB was found in 97 of 233 patients (42%) with predominantly obstructive sleep apnea (OSA) in 64 patients (27%) and predominantly central sleep apnea (CSA) in 33 patients (14%). Male sex, body mass index, NYHA heart failure class III, NT-proBNP levels, HFpEF scores, chronic kidney disease, coronary artery disease, left ventricular (LV) mass index and E/E' ratio by echocardiography were significant predictors of SDB by univariate analysis. Patients with predominantly CSA were significantly older and had higher NT-proBNP levels and a higher NYHA heart failure class than patients with OSA. Patients with OSA had a significantly higher body mass index (BMI) and a higher Epworth Sleepiness score. Multivariate analysis revealed male gender, BMI and LV mass index as significant predictors for OSA, whereas CSA was associated with a higher HFA-PEFF score and male gender.

Moderate to severe SDB is a frequent comorbidity in patients with HFpEF. Predominantly OSA is more frequent than CSA with significant clinical differences between patients with OSA compared to CSA. Whereas OSA is associated with a higher BMI in addition to male gender, CSA is associated with more advanced heart failure as indicated by higher HFA-PEFF scores, NYHA heart failure class and NT-proBNP levels.