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Free Content Sleep-disordered breathing in a general heart failure population: relationships to neurohumoral activation and subjective symptoms

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Abstract:

Summary

The aim of this study was to determine the prevalence of sleep-related breathing disorders (SDB) in a UK general heart failure (HF) population, and assess its impact on neurohumoral markers and symptoms of sleepiness and quality of life. Eighty-four ambulatory patients (72 male, mean (SD) age 68.6 (10) yrs) attending UK HF clinics underwent an overnight recording of respiratory impedance, SaO2 and heart rate using a portable monitor (Nexan). Brain natriuretic peptide (BNP) and urinary catecholamines were measured. Subjective sleepiness and the impairment in quality of life were assessed (Epworth Sleepiness Scale (ESS), SF-36 Health Performance Score). SDB was classified using the Apnoea/Hypopnoea Index (AHI). The prevalence of SDB (AHI > 15 events h−1) was 24%, increasing from 15% in mild-to-moderate HF to 39% in severe HF. Patients with SDB had significantly higher levels of BNP and noradrenaline than those without SDB (mean (SD) BNP: 187 (119) versus 73 (98) pg mL−1, P = 0.02; noradrenaline: 309 (183) versus 225 (148) nmol/24 h, P = 0.05). There was no significant difference in reported sleepiness or in any domain of SF-36, between groups with and without SDB (ESS: 7.8 (4.7) versus 7.5 (3.6), P = 0.87). In summary, in a general HF clinic population, the prevalence of SDB increased with the severity of HF. Patients with SDB had higher activation of a neurohumoral marker and more severe HF. Unlike obstructive sleep apnoea, SDB in HF had little discernible effect on sleepiness or quality of life as measured by standard subjective scales.

Keywords: Cheyne–Stokes respiration; heart failure; quality of life; sleep apnoea; sleep-disordered breathing

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-2869.2006.00494.x

Affiliations: 1: Queen's Medical Centre, University of Nottingham, Nottingham, UK 2: Department of Clinical Cardiology, Royal Brompton Hospital, National Heart & Lung Institute, Imperial College School of Medicine, London, UK 3: Second Department of Cardiology, ‘Onassis’ Cardiac Surgery Centre, Athens, Greece 4: Clinical and Academic Sleep and Breathing Unit, Royal Brompton Hospital, National Heart & Lung Institute, Imperial College School of Medicine, London, UK

Publication date: March 1, 2006

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