November 27, 2024Journal of Clinical MedicineOpen Access

Sleep-Disordered Breathing in Patients with Chronic Heart Failure and Its Implications on Real-Time Hemodynamic Regulation, Baroreceptor Reflex Sensitivity, and Survival

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Why the study?

Autonomic impairment predicts outcomes in HF and may be involved in cardiovascular complications of OSAS and CSR, but the implications of SDB on hemodynamic regulation and autonomic activity in chronic HF needed investigation.

Does sleep-disordered breathing impair hemodynamic regulation, autonomic activity, and survival in patients with chronic heart failure?

Structured PICO

Does sleep-disordered breathing impair hemodynamic regulation, autonomic activity, and survival in patients with chronic heart failure?

Population

58 chronic heart failure patients with reduced ejection fraction (≤35%), median age 61, 41 males.

Intervention

Sleep-disordered breathing (obstructive sleep apnea syndrome or Cheyne-Stokes respiration)

Comparator

Patients without sleep-disordered breathing

Outcome

Real-time hemodynamic regulation, heart rate variability, baroreceptor reflex sensitivity, and overall survivalsurrogate

Severe sleep-disordered breathing in chronic heart failure patients may be associated with impaired cardiovascular autonomic function and lower baroreceptor reflex sensitivity.

Implication

Moderate-to-severe SDB was associated with shorter survival in CHF; leaves open whether autonomic changes mediate risk or merit intervention.

Abstract

Background: Impairment in autonomic activity is a prognostic marker in patients with heart failure (HF), and its involvement has been suggested in cardiovascular complications of obstructive sleep apnea syndrome (OSAS) and Cheyne–Stokes respiration (CSR). This prospective observational study aims to investigate the implications of sleep-disordered breathing (SDB) on hemodynamic regulation and autonomic activity in chronic HF patients. Methods: Chronic HF patients, providing confirmation of reduced ejection fraction (≤35%), underwent polysomnography, real-time hemodynamic, heart rate variability (HRV), and baroreceptor reflex sensitivity (BRS) assessments using the Task Force Monitor. BRS was assessed using the sequencing method during resting conditions and stress testing. Results: Our study population (n = 58) was predominantly male (41 vs. 17), with a median age of 61 (±11) yrs and a median BMI of 30 (±5) kg/m2. Patients diagnosed with CSR were 13.8% (8/58) and 50.0% (29/58) with OSAS. No differences in the real-time assessment of hemodynamic regulation, heart rate variability, or baroreceptor reflex function were found between patients with OSAS, CSR, and patients without SDB. A subgroup analysis of BRS and HRV in patients with severe SDB (AHI > 30/h) and without SDB (AHI < 5) revealed numerically reduced BRS and increased LF/HF-RRI values under resting conditions, as well as during mental testing in patients with severe SDB. Patients with moderate-to-severe SDB had a shorter overall survival, which was, however, dependent upon age. Conclusions: Chronic HF patients with severe SDB may exhibit lower baroreceptor function and impaired cardiovascular autonomic function in comparison with HF patients without SDB.