P2901No impact of atrial fibrillation on sleep quality and sleep duration in patients with sleep-disordered breathing and preserved ejection fraction

Heart failure (HF) with preserved ejection fraction (HFpEF) represents nearly half of HF cases and is increasingly being recognized as a cause of morbidity and mortality. Hypertension (essential or secondary) is an important risk factor of HFpEF, owing to permanent structural changes in heart. A common cause of secondary hypertension is obstructive sleep apnea (OSA). In the present study, we have attempted to seek the frequency and characteristics of sleep disordered breathing (SDB) in HFpEF. Also, we tried to investigate if any correlation exists between the severity of SDB and the severity of diastolic dysfunction. This was a prospective, cross-sectional, case-control study in which 25 case patients with HFpEF and 25 control subjects were included. All the case patients and control subjects went through a detailed clinical, biochemical, echocardiography evaluation and overnight polysomnography. SDB was seen in 64% of the case patients having HFpEF and in 12% of control group with [odds ratio (OR)= 12.2, 95% confidence interval (CI) = 2.83-52.74; p<0.001]. A significant correlation of apnea-hypopnea index (AHI) severity was observed with degree of diastolic dysfunction (r = 0.67; p<0.001). Among HFpEF patients with SDB (16/25), 13 had OSA and only 3 had central sleep apnea (CSA). CSA was present in patients with severe diastolic dysfunction. There were no clinical or sleep quality differences among the OSA and the CSA group. To conclude, a higher frequency of SDB is observed in HFpEF patients. AHI severity correlates with degree of diastolic dysfunction. The underlying mechanisms of correlation between SDB and diastolic dysfunction either through uncontrolled hypertension or direct causation warrant further evaluation.

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Characteristics of sleep-disordered breathing in patients with atrial fibrillation and preserved left ventricular ejection fraction

Clinical Research in Cardiology ◽

10.1007/s00392-017-1163-5 ◽

2017 ◽

Vol 107 (2) ◽

pp. 120-129 ◽

Cited By ~ 13

Author(s):

Johanna Strotmann ◽

Henrik Fox ◽

Thomas Bitter ◽

Odile Sauzet ◽

Dieter Horstkotte ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Sleep Disordered Breathing ◽

Left Ventricular ◽

Ventricular Ejection ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Disordered Breathing

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Sleep disordered breathing in older adults with heart failure with preserved ejection fraction

Geriatric Nursing ◽

10.1016/j.gerinurse.2017.07.001 ◽

2018 ◽

Vol 39 (1) ◽

pp. 77-83

Author(s):

Lynn M. Baniak ◽

Eileen R. Chasens

Keyword(s):

Heart Failure ◽

Older Adults ◽

Ejection Fraction ◽

Sleep Disordered Breathing ◽

Preserved Ejection Fraction ◽

Disordered Breathing

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Prevalence and Impact of Sleep Disordered Breathing (SDB) in Hospitalized Patients with Heart Failure with Preserved Ejection Fraction (HFpEF)

10.1183/13993003.congress-2020.2520 ◽

2020 ◽

Author(s):

Nihal Patel ◽

Kyle Porter ◽

Joshua Englert ◽

Rami Khayat

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Sleep Disordered Breathing ◽

Hospitalized Patients ◽

Preserved Ejection Fraction ◽

Patients With Heart Failure ◽

Disordered Breathing

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Female Patients With Sleep-Disordered Breathing Display More Frequently Heart Failure With Preserved Ejection Fraction

Frontiers in Medicine ◽

10.3389/fmed.2021.675987 ◽

2021 ◽

Vol 8 ◽

Author(s):

Simon Lebek ◽

Philipp Hegner ◽

Maria Tafelmeier ◽

Leopold Rupprecht ◽

Christof Schmid ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Oxygen Saturation ◽

Diastolic Dysfunction ◽

Sleep Disordered Breathing ◽

Left Ventricular ◽

Right Atrial ◽

Preserved Ejection Fraction ◽

Female Patients ◽

Disordered Breathing

Objective: Sleep-disordered breathing (SDB) is a widespread disease that is often associated with heart failure (HF) with preserved ejection fraction (HFpEF). HFpEF is more frequent in women than in men, but detailed pathomechanisms remain unclear. We investigated HFpEF in women and men in a high-risk cohort with SDB monitoring.Methods and Results: Three hundred twenty-seven patients (84.4% men) undergoing elective coronary artery bypass grafting were prospectively subjected to SDB monitoring, and an apnea–hypopnea index (AHI) ≥15/h defined SDB. HF was classified according to current guidelines. HFpEF was significantly more frequent in SDB patients compared to those without SDB (28 vs. 17%, P = 0.016). This distribution was driven by an increased frequency of HFpEF in female SDB patients (48% vs. only 25% in male, P = 0.022). In accordance, female patients with SDB exhibited significantly more impaired diastolic left ventricular filling compared to men (echocardiographic E/e′). In contrast to men, in women, minimum oxygen saturation (O2min, measured by polygraphy, R2 = 0.470, P < 0.001) and time of oxygen saturation <90% (R2 = 0.165, P = 0.044) were significantly correlated with E/e′. Moreover, the correlation between O2min and E/e′ was significantly different in women compared to men (P < 0.001). Intriguingly, this association remained independent of clinical covariates in women [age, body mass index, systolic contractile dysfunction, diabetes mellitus, and glomerular filtration rate (GFR), R2 = 0.534, P = 0.042, multivariate regression analysis]. Since angiotensin II signaling has been mechanistically linked to HF, we measured protein expression of its cleavage enzyme ACE2 in human right atrial appendage biopsies (Western blot). Intriguingly, we found a significantly decreased ACE2 expression preferentially in women with SDB (2.66 ± 0.42 vs. 4.01 ± 2.47 in men with SDB, P = 0.005). In accordance, left ventricular mass index was significantly increased in women with SDB compared to women without SDB.Conclusion: In patients with SDB, HFpEF and diastolic dysfunction were more frequent in women compared to men. In contrast to men, the severity of SDB was associated with the degree of diastolic dysfunction in women. These insights might help to find sex-specific therapies for patients with sleep-disordered breathing and heart failure.Clinical Trial Registration: Unique identifier: NCT02877745, URL: http://www.clinicaltrials.gov.

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472 Sleep Quality in Pregnancy: An Analysis of Cardiopulmonary Coupling in the nuMoM2b Cohort

SLEEP ◽

10.1093/sleep/zsab072.471 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A186-A186

Author(s):

Francis Christian ◽

Hugi Hilmisson ◽

Solveig magnusdottir ◽

Robert Thomas

Keyword(s):

Sleep Quality ◽

Sleep Duration ◽

Sleep Disordered Breathing ◽

Sleep Latency ◽

Sleep Onset ◽

Apnea Hypopnea Index ◽

Cardiopulmonary Coupling ◽

Stability And Instability ◽

The Impact ◽

Disordered Breathing

Abstract Introduction The impact of pregnancy on sleep quality and sleep-breathing is of interest due to concerns of an impact on maternal, intra-uterine and neonatal health. The Sleep Disordered Breathing (SDB) sub-study of the Nulliparous Pregnancy Outcomes Study (NuMoM2b) provided a large cohort of single gestational women who underwent home sleep apnea testing (HSAT) to evaluate for SDB. To evaluate changes in sleep during pregnancy, we utilized publicly available data from http://www.sleepdata.org for cardiopulmonary coupling (CPC) analysis to evaluate SDB, as well as sleep duration and quality. No outcomes data is currently available. Methods Standardized Level 3 HSAT was performed after visit 1 (V1), (6–15 weeks’ gestation) and visit 3 (V3), (22 -31 weeks’ gestation) on 3702 women from the NuMoM2b cohort. CPC-analysis was performed using clinically validated algorithms based on CPC-method using ECG and oxygen saturation data (SpO2) as the input signals. SleepImage Apnea Hypopnea Index (sAHI) was calculated to evaluate for SDB (FDA; 182618). Additional calculations to determine sleep latency, sleep duration, wake after sleep onset, and sleep quality (SQI) were performed. The SQI-metric incorporates measures of sleep stability and instability and is then presented on a scale of 0 – 100 where a higher number is desirable. Results 3,261 & 2,511 participants had data at visits 1 & 3, respectively. A total of 3,012 and 2,332 individuals had ECG data of sufficient quality. The mean age of the analyzed cohort was 27 years old. SDB events were overall low, but significantly increased across visits, sAHI [(1.6 ± 2.5)/hour (V1) vs (2.9 ± 4.1) (V3)], p< 0.001. There was a statistically significant increase in sleep latency [7.4 ± 12.7 (V1) vs 18.7 ± 27.8 (V3)], p< 0.001 and reduction in total sleep time [401.2 ± 85.6 (V1) vs 348.5 ± 79.3 (V3)], p< 0.001. Most notably, there was a >10% reduction in the SQI, indicative of increased unstable, fragmented sleep as pregnancy progressed [72.1 ± 13.8 (V1), 60.5 ± 16.2 (V3)], p < 0.001. Conclusion Using objective measures based on CPC analysis from HSAT derived signals, sleep disordered breathing, sleep duration and sleep quality are all adversely impacted as gestation progresses. Support (if any):

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