Abstract
ObjectiveWe conducted a retrospective case control study to examine whether remote monitoring of Cheyne-Stokes breathing (CSB) was useful for predicting the onset of heart failure (HF) in patients with obstructive sleep apnea (OSA) on continuous positive airway pressure (CPAP).MethodsAmong patients with OSA treated at our hospital, 33 patients with HF that occurred between July 2014 and May 2021 [11 patients with acute HF (AHF); 22 patients with chronic HF (CHF) exacerbation] were included in the HF group. Of the 618 stable patients, 149 patients with a 30-days average CSB rate (CSB%) ≧1% were included in the non-HF control group. The chronologic change of CSB% were compared among the AHF, CHF and Control groups. Furthermore, of the 149 patients in the non-HF control group, 44 patients were matched for CSB%, body mass index, and sex in a ratio of 1:2 to 22 patients with CHF. The average cycle length (CL) of CSB was compared among three groups: CHF in stable period (CHF-stable group), CHF in exacerbation period (CHF-exacerbation group), and control group. In addition, according to the status of HF, receiver operating characteristic (ROC) curves were generated to determine the optimal cut-off points for variation of CSB% and CL.ResultsChronological change in CSB% among the three groups was significantly different. Standard deviation of CSB% (SD CSB%) before onset HF was significantly higher in both the AHF and CHF groups than in the control group. The CL of CSB was significantly longer in the CHF group than in the control group and was longer during the exacerbation period than during the stable period. The optimal cut-off value of CL that could differentiate patients with and without the onset of HF was 68.9 s.ConclusionThe HF group demonstrated greater CSB variations and longer CL than the non-HF control group. Furthermore, the CL was longer during the exacerbation period of HF even in the same patient. These results suggest that remote monitoring of CPAP device data for CSB variations and CL might allow early prediction of the onset and exacerbation of HF.
Highlights
The respiratory status has been reported to reflect hemodynamics
As for the sleep indices obtained by the continuous positive airway pressure (CPAP) device during the stable period, apnea-hypopnea index (AHI) was not significantly different (7.9 ± 6.5 vs. 6.3 ± 4.8, P = 0.210), whereas the standard Cheyne-Stokes breaking (CSB)% was significantly higher in the heart failure (HF) group (8.4 ± 9.2 vs. 4.4 ± 6.1, P = 0.013)
The comorbidity rates of atrial fibrillation (Af) and stage 3b or higher nephropathy were significantly higher in the HF group (78.8 vs. 30.2%, P < 0.001 and 27.3 vs. 8.1%, P < 0.001, respectively)
Summary
The respiratory status has been reported to reflect hemodynamics. In a prospective study on patients with heart failure (HF) and New York Heart Association functional class II to IV, Kumagai et al quantitatively measured diurnal respiratory instability in patients during bed rest while awake, and reported that the diurnal respiratory instability was an independent predictive indicator of outcomes such as unscheduled hospitalization due to exacerbation of HF [1]. Sleep-disordered breathing that occurs in association with HF, such as obstructive sleep apnea (OSA) and central sleep apnea (CSA) with Cheyne-Stokes breaking (CSB) (CSA-CSB), have been targeted for treatment. Since publication of the results of the Treatment of Predominant Central Sleep Apnea by Adaptive Servo Ventilation in Patients with Heart Failure (SAVE-HF) trial [2], and a study demonstrating that adaptive servo ventilation (ASV) does not alleviate nocturnal cardiovascular stress in patients with systolic heart failure and predominant CSA [3], as well as other studies, the importance of CSA-CSB as a treatment target, in patients with impaired left ventricular function, has been reduced. In real-world clinical practice, it is often observed that remote monitoring of CSB may allow much earlier detection of new onset as well as exacerbation of pathological conditions, especially cardiovascular disease, in OSA patients [5,6,7]
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