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European Journal of Heart Failure 2009 11(6):602-608; doi:10.1093/eurjhf/hfp057
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Sleep-disordered breathing in heart failure with normal left ventricular ejection fraction

Thomas Bitter*, Lothar Faber, Detlef Hering, Christoph Langer, Dieter Horstkotte and Olaf Oldenburg

Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstasse 11, D–32545 Bad Oeynhausen, Germany

* Corresponding author. Tel: +49 5731 97 1258, Fax: +49 5731 97 2194, Email: akohlstaedt{at}hdz-nrw.de


  Abstract

Aims: In patients with systolic heart failure (SHF) a high prevalence of sleep-disordered breathing (SDB) has been documented. The purpose of this study was to investigate the prevalence and type of SDB in patients with heart failure with normal left ventricular ejection fraction (HFNEF).

Methods and results: Two hundred and forty-four consecutive patients (87 women, aged 65.3 ± 1.4 years) with HFNEF underwent capillary blood gas analysis, measurement of NT-proBNP concentrations, echocardiography, cardiopulmonary exercise testing (CPX), cardiorespiratory polygraphy, and simultaneous right and left heart catheterization. Sleep-disordered breathing was defined as an apnoea–hypopnoea-index (AHI) ≥5/h. Sleep-disordered breathing was documented in 69.3% of all patients, 97 patients (39.8%) presented with OSA and 72 patients (29.5%) with CSA. With an increasing impairment of diastolic function the proportion of SDB, and CSA in particular, increased. Patients with SDB performed worse on CPX and six-minute walk test. Partial pressure of CO2 was lower in CSA, whereas AHI, left atrial diameter, NT-proBNP, LVEDP, PAP, and PCWP were higher.

Conclusion: There is a high prevalence of SDB in HFNEF. In parallel to SHF, CSA patients in particular are characterized by a more impaired cardiopulmonary function. Whether SDB is of prognostic relevance in HFNEF needs to be determined.

Key Words: Heart failure with normal left ventricular ejection fraction • HFNEF • Diastolic heart failure • Sleep disordered breathing • Prevalence

Received September 1, 2008; Revised February 25, 2009; Accepted March 6, 2009


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