Journal
JOURNAL OF CARDIAC FAILURE
Volume 23, Issue 2, Pages 131-137Publisher
CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
DOI: 10.1016/j.cardfail.2016.09.004
Keywords
Sleep; heart failure; hypoxia and mortality
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Funding
- Suzuken Memorial Foundation
- JSPS KAKENHI [26461094, 23700544]
- National Heart, Lung, and Blood Institute of the National Institutes of Health [R01HL065176]
- Grants-in-Aid for Scientific Research [23700544, 26461094] Funding Source: KAKEN
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Background: Sleep-disordered breathing, particularly central sleep apnea (CSA), is highly prevalent in heart failure (HF) and an independent prognostic marker. We assessed the hypothesis that an increased hypoxemic burden during sleep may have greater prognostic value than the frequency of apneic and hypopneic episodes. Methods and Results: We prospectively conducted overnight cardiorespiratory polygraphy on consecutive HF patients referred to our hospital from 2008 to 2011. We studied CSA defined by an apnea-hypopnea index (AHI) of >= 5 events/h with >75% of all events being central in origin. We determined the AHI, proportion of the sleep time with SpO(2) <90% (T90%), and proportion of the recording time that 4% desaturation events occurred (4%POD). We studied 112 HF patients with either systolic or diastolic dysfunction. During a follow-up period of 37 +/- 25 months, 32 patients (29%) died. Nonsurvivors had a higher 4%POD compared with survivors (11 +/- 6.4% vs 19 +/- 13%; P=.001), but did not differ significantly from survivors regarding AHI and T90%. An adjusted logistic regression analysis revealed that the 4%POD was the best independent predictor of mortality. Conclusions: The 4%POD, a novel metric for the nocturnal hypoxemic burden, is an independent prognostic marker in HF patients affected by CSA.
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