Journal Article

Cheyne–Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure

Thomas Bitter, Nina Westerheide, Christian Prinz, Mohamed Sajid Hossain, Jürgen Vogt, Christoph Langer, Dieter Horstkotte and Olaf Oldenburg

in European Heart Journal

Published on behalf of European Society of Cardiology

Volume 32, issue 1, pages 61-74
Published in print January 2011 | ISSN: 0195-668x
Published online September 2010 | e-ISSN: 1522-9645 | DOI: http://dx.doi.org/10.1093/eurheartj/ehq327
Cheyne–Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure

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Aims

The aim of this first large-scale long-term study was to investigate whether obstructive sleep apnoea (OSA) and/or central sleep apnoea (CSA) are associated with an increased risk of malignant cardiac arrhythmias in patients with congestive heart failure (CHF).

Methods and results

Of 472 CHF patients who were screened for sleep disordered breathing (SDB) 6 months after implantation of a cardiac resynchronization device with cardioverter-defibrillator, 283 remained untreated [170 with mild or no sleep disordered breathing (mnSDB) and 113 patients declined ventilation therapy] and were included into this study. During follow-up (48 months), data on appropriately monitored ventricular arrhythmias as well as appropriate cardioverter-defibrillator therapies were obtained from 255 of these patients (90.1%). Time period to first monitored ventricular arrhythmias and to first appropriate cardioverter-defibrillator therapy were significantly shorter in patients with either CSA or OSA. Forward stepwise Cox models revealed an independent correlation for CSA and OSA regarding monitored ventricular arrhythmias [apnoea–hypopnoea index (AHI) ≥5 h−1: CSA HR 2.15, 95% CI 1.40–3.30, P < 0.001; OSA HR 1.69, 95% CI 1.64–1.75, P = 0.001; AHI ≥15 h−1: CSA HR 2.06, 95% CI 1.40–3.05, P < 0.001; OSA HR 1.69, 95% CI 1.14–2.51, P = 0.02] and appropriate cardioverter-defibrillator therapies (AHI ≥5 h−1: CSA HR 3.24, 95% CI 1.86–5.64, P < 0.001; OSA HR 2.07, 95% CI 1.14–3.77, P = 0.02; AHI ≥15 h−1: CSA HR 3.41, 95% CI 2.10–5.54, P < 0.001; OSA HR 2.10, 95% CI 1.17–3.78, P = 0.01).

Conclusion

In patients with CHF, CSA and OSA are independently associated with an increased risk for ventricular arrhythmias and appropriate cardioverter-defibrillator therapies.

Keywords: Heart failure; Arrhythmias; Cheyne–Stokes respiration; Sleep disordered breathing; Ventricular tachycardias

Journal Article.  7289 words.  Illustrated.

Subjects: Cardiovascular Medicine

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