Prevalence and Persistence of Breathing Disorders in Chronic Heart Failure Patients: Preliminary Results from Home Telemonitoring in the HHH Study

In this paper we present preliminary results of the European Community multicountry trial HHH (Home or Hospital in Heart Failure), which assessed the prevalence and persistence of nocturnal breathing disorders in mild-to-moderate CHF patients. All subjects (465) carried out a baseline respiratory recording in the hospital, followed by 12 recordings (one per month) at home. The latter were totally self-managed by the patients, and data were transmitted to the referring hospital through telephone lines. We found that 43 % of the patients had a periodic breathing pattern (PB, waxing and waning of ventilation with or without apneas) during the night lasting ≥ 1 hour, and the apnea-hypopnea index (AHI) was ≥ 5 events/hour in 51 % of them. During the 1-year follow-up, a PB ≥ 1 hour and an AHI ≥ 5 events/hour were persistent (i.e., occurred in> 50 % of the recordings) in 43 % and 52 % of the patients. These findings confirm the high prevalence of nocturnal breathing disorders in CHF patients and show that in a large proportion of patients they tend to persist over time. 1

Nocturnal periodic breathing is an independent predictor of cardiac death and multiple hospital admissions in heart failure

We assessed the association of periodic breathing (PB) with mortality and hospital re-admissions in a large sample of patients enrolled in the European Community study HHH (Home or Hospital in Heart failure). A 24-hour cardiorespiratory recording was carried out in 443 clinically stable heart failure (HF) subjects (age: 60±11 years, NYHA class 2.4±0.6, LVEF 29±7%). We computed the apnoea/hypopnea index (AHI, events/hour) and the duration of PB (hours) during night-time and tested their association with total cardiac death (Cox regression) and hospitalization for worsening HF (logistic regression). All analysis were multivariate adjusting for known clinical/functional risk factors. AHI and PB duration were independent predictors of cardiac death (p<0.02 both) and of recurrent (> 2) hospital readmissions (p=0.04 and 0.003 respectively). This study confirms the independent predictive value of PB and provides evidence that PB is associated with a higher risk of multiple hospital re-admissions. 1