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Sleep disordered breathing in patients with heart failure: association with biomarkers and clinical parameters

Session Poster Session 3

Speaker Elena Medvedeva

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : EA Medvedeva (Saint-Petersburg,RU), LS Korostovtseva (Saint-Petersburg,RU), MA Simonenko (Saint-Petersburg,RU), YV Sviryaev (Saint-Petersburg,RU)

Authors:
EA Medvedeva1 , LS Korostovtseva1 , MA Simonenko1 , YV Sviryaev1 , 1Almazov National Medical Research Centre - Saint-Petersburg - Russian Federation ,

Citation:

Sleep disordered breathing (SDB) is frequent in patients with chronic heart failure (CHF). The assessment of the severity of sleep apnea is mainly based on the apnea-hypopnea index (AHI), but this event-based parameter alone may not sufficiently reflect the complex pathophysiological mechanisms underlying SDB potentially contributing to adverse outcomes in patients with heart failure.

 Purpose. To assess SDB in patients with CHF with reduced ejection fraction (EF), their prognostic role and relationship with biomarkers and clinical parameters.

Methods. 117 patients (mean age 52.4 ± 4.7 years) with NYHA class II-IV were included in the prospective cohort study, follow-up period was 5 years. The left ventricular ejection fraction (LVEF) was 28.05±9.57%. All patients underwent a comprehensive clinical examination, echocardiography, polysomnography (PSG, Embla N7000, Natus, USA). The plasma level of NT-proBNP and hs-CRP were analyzed by immunoassay (ELISA). The SPSS statistical software (version 23.0) was used.

 Results. PSG showed the following types of SDB in the studied cohort: obstructive sleep apnoea (OSA) was diagnosed in 48 patients (41%), central - in 20 (17%), mixed - in 26 (22%). Among them mild SDB diagnosed in 29 cases, moderate in 32 and severe in 33 patients. SDB was not found in 23 patients. The comparison of 2 groups with EF>35% and <35% demonstrated significant differences in obstructive (7.1 and 3.96 episodes per hour, respectively, p = 0.039) and central apnea indices (1.38 / 5.32 episodes per hour, p = 0.05). Moreover, in the group with EF <35% there was a significant higher concentration of plasma hs-CRP (p = 0.026) and NT-proBNP (p = 0.01). The following correlations were identified: NT-proBNP and obstructive apnea index (OAI) (r = -0.44, p = 0.007), NT-proBNP and sleep efficiency (r = -0.71, p = 0.006), AHI and body mass index (BMI) (r = 0.32, p = 0.01), OAI and BMI index (r = 0.34, p <0.001), desaturation index and BMI (r = 0.43, p <0.001), average saturation oxygen and BMI (r = -0,6, p <0,001). Patients with CHF with reduced EF (<35%) and moderate apnea showed worse survival rates (?² = 3.699; p = 0.05 ).

Conclusion. We found very high rate of SDB (80%) in patients with systolic HF, the predominant type was OSA.  AHI, OAI and indicators of oxygen saturation correlate with BMI and biomarkers. In patients with CHF with reduced EF moderate apnea is associated with adverse outcome.

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