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Prevalence of sleep-disordered breathing in diastolic heart failure
1Department of Medicine, Prince of Wales Hospital, Shatin, NT, Hong Kong.
Insights
Sleep-disordered breathing (SDB) is common in diastolic heart failure (DHF). Patients with DHF and SDB showed worse diastolic dysfunction, suggesting a link between breathing issues during sleep and heart health.
Area of Science:
- Cardiology
- Pulmonology
- Sleep Medicine
Background:
- Sleep-disordered breathing (SDB) is prevalent in heart failure.
- Diastolic heart failure (DHF) constitutes a significant portion of heart failure cases.
- The prevalence of SDB in DHF remains largely unknown.
Purpose of the Study:
- To determine the prevalence of SDB in patients with symptomatic DHF.
- To characterize the SDB in this patient group.
- To explore the relationship between SDB and diastolic dysfunction severity.
Main Methods:
- Twenty patients with symptomatic DHF (NYHA class II-III) and isolated diastolic dysfunction underwent polysomnography.
- Sleep quality, apnea/hypopnea index (AHI), and oxygen saturation were assessed.
- Echocardiographic parameters of diastolic function were analyzed.
Main Results:
- 85% of patients had hypertension; 55% exhibited significant SDB, primarily obstructive sleep apnea.
- Patients with SDB had more prolonged deceleration time, indicating worse diastolic dysfunction.
- Lower minimum oxygen saturation correlated with more severe diastolic dysfunction.
Conclusions:
- SDB is common in patients diagnosed with DHF.
- SDB in DHF patients may be linked to more severe diastolic dysfunction.
- Further research is needed to establish a causal relationship.
Objective:
Sleep-disordered breathing (SDB) is common in congestive heart failure. While isolated diastolic heart failure (DHF) accounts for up to a third of all cases of congestive heart failure, the prevalence of SDB in DHF is unknown. We aim to determine the prevalence and characteristics of SDB in a group of patients with symptomatic DHF.
Methods:
Twenty subjects with symptomatic DHF (New York Heart Association class II or III) and isolated diastolic dysfunction on echocardiography were assessed with lung function tests, modified sleep and health questionnaire, and overnight polysomnography. Significant SDB was defined as an apnea/hypopnea index (AHI) > 10.
Results:
Thirteen female and seven male subjects (mean age, 65+/-6.0 years; mean body mass index (BMI), 28+/-3.2) were evaluated, of whom 17 (85%) had a diagnosis of hypertension. Overall sleep quality was poor, with fragmentation and frequent arousals associated with respiratory events. Fifty-five percent of the patients had significant SDB, mainly obstructive apneas. BMI and the prevalence of hypertension were similar in patients with and without SDB. The deceleration time, an index of diastolic dysfunction, was more prolonged in the group with SDB (236+/-40 ms vs 282+/-31 ms; p<0.05). As a group, a lower minimum percentage arterial oxygen saturation during sleep, but not the AHI was associated with more severe degree of diastolic dysfunction on echocardiogram, including a lower ratio between the early peak transmittal flow velocity and the late peak atrial systolic velocity (rho=0.57; p<0.05) and a prolonged isovolumic relaxation time (rho=-0.54; p<0.05).
Conclusions:
SDB is common in patients with DHF. Patients with DHF and SDB may be associated with worse diastolic dysfunction than those without SDB, although a causal relationship remains to be established.