Predictive value of respiratory parameters in patients with obstructive sleep apnea and chronic heart failure with preserved ejection fraction
- Authors: Yakovlev AV1, Mayanskaya SD2, Shilov SN1, Teplyakov AT3, Shirinsky IV4, Yakovleva NF1
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Affiliations:
- Novosibirsk State Medical University
- Kazan State Medical University
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
- Research Institute of Fundamental and Clinical Immunology
- Issue: Vol 101, No 5 (2020)
- Pages: 652-660
- Section: Theoretical and clinical medicine
- URL: https://journals.rcsi.science/kazanmedj/article/view/41901
- DOI: https://doi.org/10.17816/KMJ2020-652
- ID: 41901
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Abstract
Aim. To study individual functional parameters of respiration in different phases of sleep in patients with obstructive sleep apnea (OSA) and chronic heart failure with preserved ejection fraction (HFpEF) and to assess their effect on the clinical course of the disease.
Methods. The study included 86 men with OSA [with an apnea-hypopnea index (AHI) ≥15 per hour]. Upon inclusion in the study, all patients underwent a polysomnographic study and echocardiography, the level of brain natriuretic peptide (NT-proBNP) was determined, a six-minute walk test was performed. After 12 months of prospective observation, the patients were divided into 2 groups according to the clinical course of chronic heart failure: with unfavorable (n=33) and favorable (n=53) clinical course. The prognostic significance of the studied parameters of respiration to the course of the disease was assessed by using logistic and linear regression.
Results. A significant role of the following respiratory parameters as predictors of chronic heart failure progression was established: obstructive apnea-hypopnea index for the entire night sleep [odds ratio (OR) 1.04, p=0.002] and in the phase of rapid eye movement sleep (REM) (ОR 1.24, p=0.001); the index of respiratory disorders for the entire sleep period (ОR 1.06, p=0.044) and in REM sleep phase (ОR 1.25, p=0.003). For hospital readmission, the predictive role was determined for obstructive apnea/hypopnea index for REM phase (ОR 1.07, p=0.044) and index of respiratory disorders for REM phase (ОR 1.13, p=0.040).
Conclusion. The prognostic value of the obstructive apnea-hypopnea index and the index of respiratory disorders for the entire night sleep and in the phase of REM sleep was revealed for patients with OSA and chronic heart failure with preserved ejection fraction, which allows considering these parameters as independent predictors of an unfavorable clinical course in this group of patients.
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##article.viewOnOriginalSite##About the authors
A V Yakovlev
Novosibirsk State Medical University
Author for correspondence.
Email: alex-yak-card@mail.ru
Russian Federation, Novosibirsk, Russia
S D Mayanskaya
Kazan State Medical University
Email: alex-yak-card@mail.ru
Russian Federation, Kazan, Russia
S N Shilov
Novosibirsk State Medical University
Email: alex-yak-card@mail.ru
Russian Federation, Novosibirsk, Russia
A T Teplyakov
Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences
Email: alex-yak-card@mail.ru
Russian Federation, Tomsk, Russia
I V Shirinsky
Research Institute of Fundamental and Clinical Immunology
Email: alex-yak-card@mail.ru
Russian Federation, Novosibirsk, Russia
N F Yakovleva
Novosibirsk State Medical University
Email: alex-yak-card@mail.ru
Russian Federation, Novosibirsk, Russia
References
- Butt M., Dwivedi G., Khair O., Lip G.Y.H. Obstructive sleep apnea and cardiovascular disease. Int. J. Cardiol. 2010; 139: 7–16. doi: 10.1016/j.ij.card.2009.05.021.
- Mentz R.J., Fiuzat M. Sleep-disordered breathing in patients with heart failure. Heart Failure Clin. 2014; 10: 243–250. doi: 10.1016/j.hfc.2013.10.001.
- Lindberg E. Epidemiology of OSA. Eur. Respir. Mon. 2010 (50): 51–68. doi: 10.1183/1025448x.00025909.
- Peppard P.E., Yooung T., Barnet J.H. et al. Increased prevalence of sleep-disordered breathing in adults. Am. J. Epidemiol. 2013; (177): 1006–1014. doi: 10.1093/aje/kws342.
- Fletcher E.C. Effect of episodic hypoxia on sympathetic activity and blood pressure Respir. Physiol. 2000; 119 (2–3): 189–197. doi: 10.1016/s0034-5687(99)00114-0.
- Frantz R.P., Farber H.W., Badech D.B. et al. Benzal Baseline and serial brain natriuretic peptide level predicts 5-year overall survival in patients with pulmonary arterial hypertension. CHEST. 2018; 154: 126–135. doi: 10.1016/j.chest.2018.01.009.
- Kasai T., Bradley T.D. Obstructive sleep apnea and heart failure: pathophysiologic and therapeutic implications. J. Am. Coll. Cardiol. 2011; 57 (2): 119–127. doi: 10.1016/j.jacc.2010.08.627.
- Van Deursen V.M., Urso R., Laroche C. et al. Comorbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur. J. Heart Fail. 2014; 16: 103–111. doi: 10.1016/s0735-1097(13)60738-x.
- Bitter T., Westerheide N., Prinz C. et al. Cheyne–Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. Eur. Heart J. 2011; 32: 61–74. doi: 10.1093/eurheartj/ehq327.
- Patrick J., Hanly S., Naneed S., Zuberi Khokhar. Increased mortality associated with Cheine–Stokes respiration in patients with congestive heart failure. Am. J. Respir. Crit. Care Med. 1996; 153 (1): 272–276. doi: 10.1164/ajrccm.153.1.8542128.
- Sekizuka H., Osada N., Miyake F. Sleep disordered breathing in heart failure patients with reduced versus preserved ejection fraction. Heart Lung Circ. 2013; 22: 104–109. doi: 10.1016/j.hlc.2012.08.006.
- Chami H.A., Baldwin C.M., Silverman A. et al. Sleepiness, quality of life, and sleep maintenance in REM versus non-REM sleep-disordered breathing. Am. J. Respir. Crit. Care Med. 2010; 181: 997–1002. doi: 10.1164/rccm.200908-1304oc.
- Mokhlesi B., Finn L.A., Hagen E.W. Obstructive sleep apnoea during REM sleep and hypertension: results of the Wisconsin Sleep Cohort. Am. J. Respir. Crit. Care Med. 2014; 190: 1158–1167. doi: 10.1164/rccm.201406-1136oc.
- Weitzenblum E., Krieger J., Apprill M. et al. Daytime pulmonary hypertension in patients with obstructive sleep apnea syndrome. Am. Rev. Respir. Dis. 1988; 138: 345–349. doi: 10.1164/ajrccm/138.2.345.
- Gami A.S., Olson E.J., Shen W.K. et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J. Am. Coll. Cardiol. 2013; 62 (7): 610–616. doi: 10.1016/j.jacc./2013.04.080.
