© 2005 European Society of Cardiology
Impact of sleep-related breathing disorders on health-related quality of life in patients with chronic heart failure
a Department of Cardiology and Pulmonary Disease, RWTH University Hospital Aachen, Pauwelsstraβe 30, 52074 Aachen, Germany
b Department of Psychiatry and Psychotherapy, RWTH University Hospital Aachen, Germany
* Corresponding author. Tel.: +49 241 808 9858; Fax: +49 241 808 2414. E-mail address: erik.skobel{at}t-online.de
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Abstract |
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Background: Quality of life in patients with chronic heart failure (HF) is often severely compromised. Sleep-related breathing disorders (SRBD) like Cheyne–Stokes Respiration (CSR) or obstructive sleep apnea (OSAS) are often observed in patients with severe HF resulting in fragmentation of sleep, excessive daytime sleepiness and an increased mortality. While an apnea/hypopnea-index (AHI) >30/h represents an independent predictor of poor prognosis, clinical relevance of even minor SRBD with an AHI <30/h remains unclear with respect to quality of life, exercise capacity or depression rate.
Methods: Sixty-nine consecutive ambulatory patients with stable HF (NYHA II–III, EF 25%) underwent two night polygraphies with a six-channel ambulatory recording. Spiroergometry was performed, and patients were examined for sleep quality (PSQI), depressed mood (BDI) and health-related quality of life (SF-36). The data were compared to 10 age-matched healthy controls and 11 patients with OSAS (AHI 14–29/h) not suffering from HF.
Results: Fifty-one patients completed follow up. 52% were positively diagnosed for SRBD (AHI 16–30/h: 12 patients CSR, 5 patients OSAS, 9 patients mixed); 25 patients (48%) showed no relevant SRBD. Patients with HF and SRBD had lower quality of life than patients without SRBD and HF. The severity of SRBD as indicated by the AHI significantly correlated with quality of life measures: Bodily pain, physical functioning and social functioning showed largest impairment in patients with HF and SRBD. Furthermore, elevated depression rates in correlation to the AHI were only observed in patients with SRBD similar to patients with OSAS without HF.
Conclusion: Even minor SRBD in patients with HF independently influence quality of life and correlate with estimation of depression and sleep disturbances.
Key Words: Sleep apnea • Heart failure • Cheyne–Stokes respiration • Quality of life • Depression
Received February 27, 2004; Revised May 5, 2004; Accepted July 21, 2004
All pertinent involvement with any organization with financial interest with the subject matter is disclosed.