European Journal of Heart Failure Advance Access originally published online on February 3, 2009
European Journal of Heart Failure 2009 11(3):264-272; doi:10.1093/eurjhf/hfp006
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathophysiological and clinical relevance of simplified monitoring of nocturnal breathing disorders in heart failure patients
1 Department of Biomedical Engineering and Cardiology, Salvatore Maugeri Foundation-IRCCS, Scientific Institute of Montescano, Montescano, PV 27040, Italy
2 Department of Cardiology, Policlinic of Monza, Monza, Italy
3 Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
4 Department of Cardiology, Clinical Military Hospital, Wroclaw, Poland
5 Department of Cardiology, Centre for Heart Disease, Military Hospital, Wroclaw, Poland
6 Department of Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Poland
* Corresponding author. Tel: +39 0385 247256, Fax: +39 0385 61386, Email: giandomenico.pinna{at}fsm.it
 |
Abstract |
|---|
Aims: Nocturnal breathing disorders in the form of periodic breathing (PB) are very common in heart failure (HF) patients. There is an increasing interest in simple and affordable tools to screen patients and monitor these disorders at home on a long-term basis. We aimed to assess the pathophysiological and clinical relevance of a simplified method for monitoring of PB suitable to be self-managed by the patient at home.
Methods and results: A night-time respiratory recording was performed in 397 optimally treated HF patients (age 60 ± 11 years, NYHA class 2.4 ± 0.6, left ventricular ejection fraction 29 ± 7%) and the duration of PB (PBDur) automatically computed. Patients were followed-up for 1 year and the prognostic value of PBDur evaluated. In 45 patients, we assessed the association between PBDur and severity of oxygen desaturations (number of desaturations >3%). Twenty six of the 397 patients died of cardiac causes. A PBDur 
2 h was significantly associated with an increased risk of cardiac death after adjustment for major clinical predictors [hazard ratio (95% CI): 3.5 (1.6–7.9), P = 0.002]. The correlation between PBDur and severity of desaturations was 0.94 (P < 0.0001).
Conclusion: Relevant pathophysiological and clinical information can be obtained from simplified monitoring of breathing disorders managed by the patient. These results provide new perspectives in the investigation of the clinical impact of abnormal breathing in HF patients.
Key Words: Heart failure • Sleep apnoea • Periodic breathing • Monitoring • Self-management • Prognosis
Received July 8, 2008; Revised October 11, 2008; Accepted November 26, 2008