Sleep Disordered Breathing in Patients with Acutely Decompensated Heart Failure

Objective: The purpose of this study is to systematically characterize sleep disordered breathing (SDB) during acute heart failure (HF) decompensation.

Background: SDB, both Cheyne-Stokes breathing (CSB) and obstructive sleep apnea, is common in stable congestive HF patients, but its presence and characteristics in decompensated HF is unknown.

Methods: Eighteen men and 11 women (mean age 57+/-17 years, plasma brain-natriuretic peptide 1660+/-1179pg/ml, left ventricular ejection fraction 20+/-6%) admitted with decompensated systolic HF without other active cardiorespiratory morbidity underwent echocardiography and overnight bedside polysomnography within 48h of admission. Ten patients underwent follow-up polysomnography just before or immediately after hospital discharge.

Results: Twenty-eight of 29 patients demonstrated an apnea+hypopnea index (AHI)>5 events/h (mean AHI 41+/-29/h); 22 patients had an AHI>15/h. SDB was predominantly CSB (central events 39+/-29/h; obstructive events 2+/-2/h, p<0.001). Time in CSB was 51+/-33% of total sleep time (TST); nadir oxygen saturation (SaO2) was 81+/-10%. SDB was similar on admission vs. follow-up polysomnography (mean AHI 44+/-39/h vs. 38+/-31/h; CSB 53+/-38% vs. 46+/-37% TST). Follow-up polysomnography showed a higher nadir SaO2 than admission (84+/-11% vs. 79+/-12%, p=0.05), but TST with SaO2<90% was not reduced.

Conclusions: CSB is common and severe in patients hospitalized with decompensated HF. Acute treatment of HF does not consistently improve CSB. The effect of CSB on ventricular function and prognosis in decompensated HF remains to be demonstrated.