Central Apneas Are More Detrimental in Female Than in Male Patients With Heart Failure

Figures

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  Figure 1. Clinical characteristics of the study population according to sex. In the whole study population, compared with men, women were younger, had higher LVEF, lower prevalence of ischemic heart failure and atrial fibrillation, better renal function, and performed worse on cardiopulmonary exercise test. No sex differences were observed as for body‐mass index, NYHA class, and neurohormonal activation. eGFR indicates estimated glomerular filtration rate; LVEF, left ventricular ejection fraction; NT‐proBNP, N‐terminal pro‐B‐type natriuretic peptide; NYHA, New York Heart Association; VE/VCO2, ventilation‐to‐carbon dioxide output; and VO2, oxygen consumption.

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  Figure 2. Sex‐related differences in central apneas burden. AHI indicates apnea‐hypopnea index; and CAI, central apnea index.

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  Figure 3. Sex‐related differences in chemoreflex sensitivity. HCVR indicates hypercapnic ventilatory response; and HVR, hypoxic ventilatory response.

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  Figure 4. Kaplan‐Meier curves for the primary combined end point of cardiac death, appropriate ICD shock, or first hospitalization for HF according to daytime AHI, nighttime AHI, and nighttime CAI in the study population and according to sex. AHI indicates apnea‐hypopnea index; CAI, central apnea index; HF, heart failure; and ICD, implantable cardioverter‐defibrillator.

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  Figure 5. Independent prognostic significance of central apneas in the whole study population and in either women or men with HF. In the whole study population, a daytime AHI ≥15 events/hour and the T‐90 were predictors of the composite end point of cardiac death, appropriate implantable ICD shock, or first hospitalization for HF independently of sex (P for interaction=0.193 and 0.727, respectively). On the other hand, a nighttime AHI ≥15 events/hour and a nighttime CAI ≥10 events/hour were independent predictors of the composite end point in women but not in men (P for interaction=0.013 and 0.030, respectively). AHI indicates apnea‐hypopnea index; CAI, central apnea index; HF, heart failure; ICD, implantable cardioverter‐defibrillator; and T‐90, percentage of time asleep with SaO2 <90%.

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  Figure 6. Sex‐related differences in burden and prognostic significance of central apneas in HF patients. AHI indicates apnea‐hypopnea index; CAI, central apnea index; and HF, heart failure.