Key result
In ICD recipients, central sleep apnea was associated with significantly higher 2-year mortality compared to obstructive sleep apnea or no sleep-related breathing disorder (44% vs 0% vs 12.5%; P<0.05).
Why the study?
Does the presence of sleep-related breathing disorders affect the incidence of ventricular tachyarrhythmias and mortality in patients with ICDs?
Cohort (n=40)
Does the presence of sleep-related breathing disorders affect the incidence of ventricular tachyarrhythmias and mortality in patients with ICDs?
In ICD recipients, central sleep apnea is associated with significantly higher 2-year mortality driven by nonsudden cardiac events, but not with an increased incidence of ICD-treated ventricular tachyarrhythmias.
Answers are grounded in this paper and cite their sources.
Central sleep apnea may flag higher-risk ICD patients for monitoring; leaves open whether treatment improves survival or affects arrhythmias.
The prevalence and clinical significance of sleep-related breathing disorders (SRBDs) in patients with cardiac disease and a history of life-threatening ventricular tachyarrhythmias is unclear. Forty consecutive recipients of implantable cardioverter defibrillators (ICDs) with cardiac disease and a documented history of spontaneous, life-threatening, ventricular tachyarrhythmias underwent full night polysomnography. SRBDs were diagnosed if the apnea/hypopnea index was > 10. SRBD were diagnosed in 16 of 40 patients (40%): central sleep apnea (CSA) was present in 9 of these 16 patients (56%), 8 of whom had associated Cheyne-Stoke respiration. Seven of the 16 patients with SRBD (44%) had obstructive sleep apnea (OSA). Patients with and without SRBDs were comparable with respect to left ventricular ejection fraction, NYHA classification, underlying heart disease, ICD indications, and concomitant antiarrhythmic drug and beta-blocker therapy. Patients were followed prospectively for 2 years. ICD-treated ventricular tachyarrhythmias occurred in 10 of 24 patients (42%) without SRBD, in 4 of 9 patients (44%) with CSA, and in 3 of 7 patients (44%) with OSA (NS). The numbers and circadian distributions of episodes recorded during follow-up in patients without SRBD versus with CSA or OSA were not significantly different (14 +/- 25, median = 4 vs 4 +/- 5, median = 2.5 vs 15 +/- 15, median = 7, respectively). The 2-year mortality, which was entirely attributable to nonsudden cardiac events, was highest in patients with CSA (4/9 [44%], vs 0/7 [0%] with OSA, vs 3/24 patients (12.5%) without SRBD; P < 0.05).
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Fries et al. (1999) conducted a cohort in Cardiac disease and a history of life-threatening ventricular tachyarrhythmias (n=40). Central sleep apnea (CSA) vs. No sleep-related breathing disorder (SRBD) was evaluated on 2-year mortality (p=< 0.05). In ICD recipients, central sleep apnea was associated with significantly higher 2-year mortality compared to obstructive sleep apnea or no sleep-related breathing disorder (44% vs 0% vs 12.5%; P<0.05).
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