Sleep-breathing disordered in stable chronic congestive heart failure

Objective: To determine the prevalence and effect of sleep-disordered breathing in patients with stable, optimally treated chronic congestive heart failure.

Methods: Patients with stable, optimally treated chronic congestive heart failure were monitored by polysomnography (Polywin 1000, Respironics Inc.).

Results: Patients were divided into two groups. Group I (n = 21) had a rate of apnea and hypopnea (apnea-hypopnea index) of 15 or less episodes per hour; group II (n = 15) had a rate of more than 15 episodes per hour. In group II, the rate varied from 16.8 to 78.8 episodes per hour 42.6 +/- 15.5, in which the obstructive apnea-hypopnea index was 11.1 +/- 8.4 and the central AHI was 31.5 +/- 9.6. Group II had significantly more arousals (36.8 +/- 21.3 compared with 19.4 +/- 11.2 in group I) that were directly attributable to episodes of apnea and hypopnea, lower arterial oxyhemoglobin saturation during sleep [(76.7 +/- 4.6)% compared with (86.5 +/- 2.8)%] and lower left ventricular ejection fraction [(24.2 +/- 8.8)% compared with (31.5 +/- 10.6)%].

Conclusions: The prevalence of sleep-disordered breathing (mainly periodic respiration or Cheyne-Stokes respiration with central sleep apnea) is high in patients with stable chronic congestive heart failure. The sleep-disordered breathing episodes are associated with severe nocturnal arterial blood oxyhemoglobin desaturation and excessive arousals. Severe untreated sleep-disordered breathing may affect left ventricular function and could contribute to death in patients with congestive heart failure.