Table 1:
Epidemiologic studies exploring sleepiness in heart failure (HFreF) and obstructive sleep apnea
| Authors | Subjects | Definition of Heart Failure (HF) | Method of Sleepiness Assessment | Control for medications in main analyses | Results |
|---|---|---|---|---|---|
| Arzt et al 2006 1 | n=48 patients with HF and obstructive sleep apnea (OSA) (Apnea hypopnea index (AHI) > 5) n=1139 community controls (328 subjects had OSA with AHI > 5) |
Ischemic, non-ischemic, or hypertensive cardiomyopathy with systolic dysfunction (left ventricular ejection fraction (LVEF) ≤ 45%) | Epworth sleepiness scale (ESS) | No control for medications 81% of HF patients were on B-blockers |
HF patients at any severity of OSA had significantly lower mean ESS (AHI < 5: 7.1±0.4 vs 8.3±0.2 [p=.005]; AHI 5–14: 6.7±0.7 vs 9.2±0.3 [p<.001]; and AHI >=15:7.8±0.7 vs 9.8±0.4 [p=.01]), despite sleeping less than community controls (p<.001). |
| Dolliner et al 20132 | n = 26 HF patients with OSA (AHI ≥ 15 and >50% obstructive events) n = 88 HF patients without sleep-disordered breathing (SDB) |
Recently hospitalized for heart failure or for heart transplantation evaluation with LVEF ≤ 35% and brain natriuretic peptide > 200 pg/mL | ESS | No control for medications 90.3% of patients in this study were on Beta-blockers |
No statistically significant difference in ESS between patients with HF and OSA (ESS = 8) and patients with HF and no SDB (ESS = 6.5). |
| Herrscher et al (2014)3 | n = 62 HF patients with OSA (AHI > 5 and >50% obstructive events) n = 22 HF patients with no SDB (AHI ≤ 5) |
Clinically stable heart failure patients with fully titrated medications in NYHA class II-IV with preserved or unpreserved ejection fractions | ESS | No control for medications 96% of no SDB (AHI<5) patients were on Beta-blockers 94% of mild SDB (5≤AHI <15) were on Beta-blockers 85% of moderate/severe SDB (AHI≥15) were on Beta -blockers |
No statistically significant difference in ESS between HF patients with OSA (ESS = 5.9+/− 4.3) and HF patients without SDB (ESS = 5.0+/− 3.2). |
| Javaheri et al 1998 4 | n= 9 male HF patients with sleep apnea (AHI ≥ 15) n= 72 male HF patients without sleep apnea (AHI <15) |
Stable HF due to systolic dysfunction (LVEF fraction < 45%) | Non-ESS ^ symptom scoring system | No control for medications | No statistically significant difference in the percent of HF patients with and without sleep disordered breathing who reported excessive daytime sleepiness symptoms (24% vs.15%; p >.05). |
| Kaneko et al 2003 5 | N=24 patients with HF and severe OSA (AHI >20 with > 50% obstructive events) | HF due to ischemic or non-ischemic dilated cardiomyopathy for at least 6 months; LVEF<45% at rest | ESS | No control for medications | Patients with HF and severe OSA did not generally complain of excessive sleepiness (mean ESS between 5.7 ±.9 and 6.8 ±.7). |
| Rao et al 2006 7 | N=84 ambulatory HF patients; n = 64 with AHI <15 and n = 20 with AHI >15 | HF defined using the European Society of Cardiology criteria, i.e. symptoms of HF, objective evidence of LVEF and/or response to treatment directed towards HF. | ESS | No control for medications | No statistically significant difference in ESS scores between HF patients with and without sleep disordered breathing (mean ESS of 7.8 ± 4.7 versus 7.5 ±3.6; p = .87). |
| Redeker et al (2010)8 | n = 37 HF patients with OSA (apnea index ≥ 5, < 50% central apneas) n = 27 HF patients without SDB (apnea index < 5) |
Stable chronic HF patients from structured HF disease management programs. | ESS | No control for medications | No statistically significant difference in ESS score between HF patients with OSA (ESS = 7.9 +/− 4.5) and HF patients without SDB (ESS = 8.4+/− 5.4). |
| Wang et al 20099 | N = 195 HF patients: n = 103 with OSA (AHI >15 with >50% obstructive), n = 39 without SDB | HF defined as LVEF ≤45% | ESS | No control for medications | No statistically significant difference in ESS between HF patients with OSA and HF patients without sleep disordered breathing (N-SDB vs OSA: 6.7 +/− 0.6 vs 7.6 +/− 0.4, p = 0.105). |
| Yumino et al 2009 10 | n = 56 patients with HF and OSA (AHI >=15 with >=50% obstructive events) n = 117 patients with HF and mild or no sleep apnea (AHI < 25) |
Ischemic or no-ischemic dilated cardiomyopathy for >= 6 months, LVEF <=45% and NYHA Class II-IV after optimized medical therapy | ESS | β-blockers were controlled for using a stepwise variable selection in a generalized logistic model. β-blockers had no statistically significant association with sleepiness. | No statistically significant difference in ESS between HF patients with OSA (ESS = 7.5+/−3.5) and those with mild or no sleep apnea (ESS = 7.3+/− 4.0) |
Arzt M, Young T, Finn L, et al. Sleepiness and sleep in patients with both systolic heart failure and obstructive sleep apnea. Archives of internal medicine. 2006;166(16):1716–1722.
Dolliner P, Brammen L, Graf S, et al. Portable recording for detecting sleep disorder breathing in patients under the care of a heart failure clinic. Clinical research in cardiology : official journal of the German Cardiac Society. 2013;102(7):535–542.
Herrscher TE, Akre H, Overland B, Sandvik L, Westheim AS. Clinical predictors of sleep apnoea in heart failure outpatients. International journal of clinical practice. 2014;68(6):725–730.
Javaheri S, Parker TJ, Liming JD, et al. Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998;97(21):2154–2159.
Kaneko Y, Floras JS, Usui K, et al. Cardiovascular effects of continuous positive airway pressure in patients with heart failure and obstructive sleep apnea. The New England journal of medicine. 2003;348(13):1233–1241.
Mansfield DR, Gollogly NC, Kaye DM, Richardson M, Bergin P, Naughton MT. Controlled trial of continuous positive airway pressure in obstructive sleep apnea and heart failure. American journal of respiratory and critical care medicine. 2004;169(3):361–366.
Rao A, Georgiadou P, Francis DP, et al. Sleep-disordered breathing in a general heart failure population: relationships to neurohumoral activation and subjective symptoms. J Sleep Res. 2006;15(1):81–88.
Redeker NS, Muench U, Zucker MJ, et al. Sleep disordered breathing, daytime symptoms, and functional performance in stable heart failure. Sleep. 2010;33(4):551–560.
Wang HQ, Chen G, Li J, et al. Subjective sleepiness in heart failure patients with sleep-related breathing disorder. Chinese medical journal. 2009;122(12):1375–1379.
Yumino D, Wang H, Floras JS, et al. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. Journal of cardiac failure. 2009;15(4):279–285.
Luyster FS, Buysse DJ, Strollo PJ. Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research. Journal of Clinical Sleep Medicine. 2010;6(02):196–204.
Taylor DJ, Mallory LJ, Lichstein KL, Durrence HH, Riedel BW, Bush AJ. Comorbidity of chronic insomnia with medical problems. Sleep. 2007;30(2):213–218.
Oldenburg O, Lamp B, Faber L, Teschler H, Horstkotte D, Töpfer V. Sleep‐disordered breathing in patients with symptomatic heart failure A contemporary study of prevalence in and characteristics of 700 patients. European journal of heart failure. 2007;9(3):251–257.