Schlafqualität und -architektur bei herzinsuffizienten Patienten mit schlafbezogener Atmungsstörung

In dieser retrospektiven Studie wurden 250 kardiorespiratorische Polysomnografien von herzinsuffizienten Patienten mit reduzierter Pumpfunktion (LVEF $\leq$ 4%, NYHA $\geq$ II) und einer schlafbezogenen Atmungsstörung hinsichtlich der Schlafparameter ausgewertet. Insgesamt hatten alle Patienten im Durchschnitt eine Schlafeffizienz von nur 69,3%, der Leichtschlafanteil (N1 und N2) war erhöht, der Tiefschlafanteil N3 mit nur 4,1% deutlich erniedrigt. In der Analyse der Subgruppen - prädominant obstruktive (OSA) versus prädominant zentrale schlafbezogene Atmungsstörung (ZSA) - zeigte sich eine signifikant schlechtere Schlafeffizienz hervorgerufen durch eine signifikante Zunahme der nächtlichen Wachphasen in der ZSA-Gruppe, die insgesamt aber auch eine schlechtere kardiale Funktion im Vergleich zur OSA-Gruppe hatte. Signifikante Unterschiede in der Verteilung der Schlafstadien ließen sich bis auf ein längeres N1-Stadium in der ZSA-Gruppe im Vergleich der beiden Subgruppen nicht darstellen

Sleep duration and quality in heart failure patients

Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure and reduced left ventricular ejection fraction (HF-REF). SDB is classified as predominant obstructive (OSA) or central (CSA) and may alter sleep duration, sleep quality, and quality of life. This study describes sleep quality and duration in well-characterized cohorts of these patients. Two hundred fifty consecutive patients with HF-REF (NYHA class ≥II, ejection fraction ≤45%) underwent cardiac and pulmonary examination, plus full attended in-hospital overnight polysomnography (PSG). PSG recordings were performed according to current recommendations and underwent independent, blinded analysis at a core laboratory. Patients with HF-REF and CSA were older and had more impaired cardiac function compared to those with OSA. With respect to sleep parameters, patients with CSA spent more time in bed than those with OSA (468 ± 52 vs 454 ± 46 min, p = 0.021) while sleep efficiency was lower (67 ± 14 vs 72 ± 13% of total sleep time (TST), p = 0.008). In addition, CSA patients spent more time awake after sleep onset (101 ± 61 vs 71 ± 46 min, p = 0.001) and had more stage N1 (light) sleep (33 ± 19 vs 28 ± 16% of TST, p = 0.017). Overall, the proportion of sleep spent in N3 (slow-wave/deep) sleep in HF-REF patients with SDB was low (4.1 ± 6.3% of TST) compared with healthy adults. HF-REF patients with CSA compared to OSA have worse sleep efficiency and quality. This could result in less restorative sleep, changes in sympathovagal balance, and impaired resetting of important reflexes, which might contribute to worse cardiovascular outcomes in HF-REF patients with SDB

Impact of SERVE-HF on management of sleep disordered breathing in heart failure: a call for further studies

Sleep disordered breathing (SDB) (obstructive sleep apnea, central sleep apnea/Cheyne-Stokes respiration or the combination of both) is highly prevalent in patients with a wide variety of cardiovascular diseases including hypertension, arrhythmia, coronary artery disease, myocardial infarction and stroke (reviewed previously in the September issue of this journal). Its close association with outcomes in chronic heart failure with reduced ejection fraction (HF-REF) suggests that it may be a potential treatment target. Herein, we provide an update on SDB and its treatment in HF-REF