Abstract
BackgroundSleep-disordered breathing (SDB) is associated with adverse outcomes in patients with chronic heart failure (CHF). Additionally, heart rate turbulence (HRT) reflects changes in the sinus cycle length of baroreceptor in response to hemodynamic fluctuations after ventricular premature beat. Recent studies have suggested that HRT as a marker of vagal activity has a predictive value of poor prognosis in CHF patients. However, little is known about the relationship between SDB and HRT in CHF patients.Methods and ResultsIn this study, 75 patients with CHF were enrolled. We simultaneously performed Holter ECG during a 24-hr period and portable sleep monitoring at nighttime, and determined the respiratory disturbance index (RDI), HRT (turbulence onset (TO) and turbulence slope (TS)) during that 24-hr period. These patients were divided into two groups based on the presence of severe SDB: Group A (RDI≥30, n = 17) and Group B (RDI<30, n = 58). TS was significantly lower in Group A than in Group B across the 24-hr period (nighttime: 3.6±1.1 vs. 6.9±1.3; daytime: 3.7±0.8 vs. 7.0±1.1; all-day: 3.5±0.7 vs. 6.7±0.9% ms/RR, P<0.05, respectively). TO did not differ between the two groups. Furthermore, there was a significant negative correlation between all-day TS and RDI (R = –0.257, P = 0.027). Moreover, in the multiple regression analysis, RDI was an independent factor to determine all-day TS.ConclusionsIn patients with severe SDB, blunted TS was observed across 24 hours. These results suggest that SDB induce impairment of vagal activity across a 24-hour period and may be associated with poor prognosis in CHF patients.
Highlights
Despite recent advances in its medical management, chronic heart failure (CHF) still leads to high mortality and morbidity
In patients with severe Sleep-disordered breathing (SDB), blunted Turbulence slope (TS) was observed across 24 hours
These results suggest that SDB induce impairment of vagal activity across a 24-hour period and may be associated with poor prognosis in CHF patients
Summary
Despite recent advances in its medical management, chronic heart failure (CHF) still leads to high mortality and morbidity. Some studies have demonstrated that SDB is associated with occurrence of ventricular arrhythmias [8,9] and an adverse prognosis in CHF patients [10,11]. Heart rate turbulence (HRT), which presents baroreceptor responses and is a marker of vagal function, is an independent predictor of mortality in CHF patients [12,13,14,15]. We sought to clarify the relationship between the severity of SDB and vagal function (HRT) in CHF patients. Sleep-disordered breathing (SDB) is associated with adverse outcomes in patients with chronic heart failure (CHF). Recent studies have suggested that HRT as a marker of vagal activity has a predictive value of poor prognosis in CHF patients. Little is known about the relationship between SDB and HRT in CHF patients
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