Eiichi Watanabe1, Ken Kiyono2, Shojiro Matsui2, Virend K Somers3, Kan Sano4, Junichiro Hayano5, Tomohide Ichikawa6, Mayumi Kawai6, Masahide Harada6, Yukio Ozaki6. 1. Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan. Electronic address: enwatan@fujita-hu.ac.jp. 2. Division of Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Japan. 3. Mayo Clinic and Mayo Foundation, Rochester, Minnesota. 4. Department of Cardiology, Hekinan City Hospital, Hekinan, Japan. 5. Department of Medical Education, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 6. Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan.
Abstract
BACKGROUND: Sleep-disordered breathing, particularly central sleep apnea (CSA), is highly prevalent in heart failure (HF) and an independent prognostic marker. We assessed the hypothesis that an increased hypoxemic burden during sleep may have greater prognostic value than the frequency of apneic and hypopneic episodes. METHODS AND RESULTS: We prospectively conducted overnight cardiorespiratory polygraphy on consecutive HF patients referred to our hospital from 2008 to 2011. We studied CSA defined by an apnea-hypopnea index (AHI) of ≥5 events/h with >75% of all events being central in origin. We determined the AHI, proportion of the sleep time with SpO2 <90% (T90%), and proportion of the recording time that 4% desaturation events occurred (4%POD). We studied 112 HF patients with either systolic or diastolic dysfunction. During a follow-up period of 37 ± 25 months, 32 patients (29%) died. Nonsurvivors had a higher 4%POD compared with survivors (11 ± 6.4% vs 19 ± 13%; P = .001), but did not differ significantly from survivors regarding AHI and T90%. An adjusted logistic regression analysis revealed that the 4%POD was the best independent predictor of mortality. CONCLUSIONS: The 4%POD, a novel metric for the nocturnal hypoxemic burden, is an independent prognostic marker in HF patients affected by CSA.
BACKGROUND:Sleep-disordered breathing, particularly central sleep apnea (CSA), is highly prevalent in heart failure (HF) and an independent prognostic marker. We assessed the hypothesis that an increased hypoxemic burden during sleep may have greater prognostic value than the frequency of apneic and hypopneic episodes. METHODS AND RESULTS: We prospectively conducted overnight cardiorespiratory polygraphy on consecutive HF patients referred to our hospital from 2008 to 2011. We studied CSA defined by an apnea-hypopnea index (AHI) of ≥5 events/h with >75% of all events being central in origin. We determined the AHI, proportion of the sleep time with SpO2 <90% (T90%), and proportion of the recording time that 4% desaturation events occurred (4%POD). We studied 112 HF patients with either systolic or diastolic dysfunction. During a follow-up period of 37 ± 25 months, 32 patients (29%) died. Nonsurvivors had a higher 4%POD compared with survivors (11 ± 6.4% vs 19 ± 13%; P = .001), but did not differ significantly from survivors regarding AHI and T90%. An adjusted logistic regression analysis revealed that the 4%POD was the best independent predictor of mortality. CONCLUSIONS: The 4%POD, a novel metric for the nocturnal hypoxemic burden, is an independent prognostic marker in HF patients affected by CSA.
Authors: Maria Rosa Costanzo; Rami Khayat; Piotr Ponikowski; Ralph Augostini; Christoph Stellbrink; Marcus Mianulli; William T Abraham Journal: J Am Coll Cardiol Date: 2015-01-06 Impact factor: 24.094
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Authors: Jeremy Levy; Daniel Álvarez; Aviv A Rosenberg; Alexandra Alexandrovich; Félix Del Campo; Joachim A Behar Journal: NPJ Digit Med Date: 2021-01-04