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(Circulation. 1998;97:2154-2159.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Sleep Apnea in 81 Ambulatory Male Patients With Stable Heart Failure

Types and Their Prevalences, Consequences, and Presentations

S. Javaheri, MD; T. J. Parker, MD; J. D. Liming, MD; W. S. Corbett, BS; H. Nishiyama, MD; L. Wexler, MD; ; G. A. Roselle, MD

From the Sleep Disorders Laboratory, Department of Veterans Affairs Medical Center, and the Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Background—Heart failure is a highly prevalent disorder that continues to be associated with repeated hospitalizations, high morbidity, and high mortality. Sleep-related breathing disorders with repetitive episodes of asphyxia may adversely affect heart function. The main aims of this study were to determine the prevalence, consequences, and differences in various sleep-related breathing disorders in ambulatory male patients with stable heart failure.

Methods and Results—This article reports the results of a prospective study of 81 of 92 eligible patients with heart failure and a left ventricular ejection fraction <45%. There were 40 patients without (hourly rate of apnea/hypopnea, 4±4; group 1) and 41 patients with (51% of all patients; hourly rate of apnea/hypopnea, 44±19; group 2) sleep apnea. Sleep disruption and arterial oxyhemoglobin desaturation were significantly more severe and the prevalence of atrial fibrillation (22% versus 5%) and ventricular arrhythmias were greater in group 2 than in group 1. Forty percent of all patients had central sleep apnea, and 11% had obstructive sleep apnea. The latter patients had significantly greater mean body weight (112±30 versus 75±16 kg) and prevalence of habitual snoring (78% versus 28%). However, the hourly rate of episodes of apnea and hypopnea (36±10 versus 47±21), episodes of arousal (20±14 versus 23±11), and desaturation (lowest saturation, 72±11% versus 78±12%) were similar in patients with these different types of apnea.

Conclusions—Fifty-one percent of male patients with stable heart failure suffer from sleep-related breathing disorders: 40% from central and 11% from obstructive sleep apnea. Both obstructive and central types of sleep apnea result in sleep disruption and arterial oxyhemoglobin desaturation. Patients with sleep apnea have a high prevalence of atrial fibrillation and ventricular arrhythmias.

Key Words: lung • pulmonary heart disease • oxygen • arrhythmia

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