Cardiac resynchronization therapy improves central sleep apnea and Cheyne-Stokes respiration in patients with chronic heart failure.

Abstract

OBJECTIVES:

We studied the effects of cardiac resynchronization therapy (CRT) on heart failure (HF) patients with central sleep apnea (CSA).

BACKGROUND:

Patients with advanced HF often suffer from CSA with Cheyne-Stokes respiration. Cardiac resynchronization therapy improves myocardial function and exercise capacity in HF patients with conduction disturbances. The relationship between CRT and CSA is currently unknown.

METHODS:

Twenty-four patients (7 females; 62 +/- 11 years) with HF, a reduced left ventricular ejection fraction (24 +/- 6%), and left bundle branch block (QRS duration 173 +/- 22 ms) received a CRT device. The number of apneas and hypopneas per hour (apnea-hypopnea index [AHI]) and minimal oxygen saturation (SaO2min) were quantified by cardiorespiratory polygraphy. Fourteen patients showed CSA (AHI >5/h), and 10 patients had an AHI <5/h without CSA. Subjective sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Data were evaluated before and after 17 +/- 7 weeks of CRT.

RESULTS:

In patients with CSA, CRT led to a significant decrease in AHI (19.2 +/- 10.3 to 4.6 +/- 4.4, p < 0.001) and PSQI (10.4 +/- 1.6 to 3.9 +/- 2.4, p < 0.001) without Cheyne-Stokes respiration and to a significant increase in SaO2min (84 +/- 5% to 89 +/- 2%, p < 0.001). There was no significant change in AHI (1.7 +/- 0.7 to 1.5 +/- 1.6), PSQI (2.4 +/- 0.5 to 2.6 +/- 0.9), and SaO2min (90 +/- 2% to 91 +/- 1%) in patients without CSA.

CONCLUSIONS:

Cardiac resynchronization therapy leads to a reduction of CSA and to increased sleep quality in patients with HF and sleep-related breathing disorders. This may have prognostic implications in patients receiving CRT.

• Authors: Anil-Martin Sinha, Erik C Skobel, Ole-Alexander Breithardt, Christine Norra, Kai U Markus, Christian Breuer, Peter Hanrath, Christoph Stellbrink
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 44 Issue 1 Pg. 68-71 (Jul 07 2004) ISSN: 0735-1097 [Print] United States
• PMID: 15234409 (Publication Type: Comparative Study, Evaluation Study, Journal Article)

Topics

• Aged
• Cardiac Pacing, Artificial
• Cheyne-Stokes Respiration (physiopathology, therapy)
• Chronic Disease
• Exercise Test
• Exercise Tolerance (physiology)
• Female
• Heart Failure (physiopathology, therapy)
• Humans
• Male
• Middle Aged
• Positive-Pressure Respiration
• Prospective Studies
• Sleep Apnea, Central (physiopathology, therapy)
• Statistics as Topic
• Treatment Outcome