Author + information
- Thomas Bitter,
- Natalie Prib,
- Andrea Zwenke,
- Christian Prinz,
- Zisis Dimitriadis,
- Dieter Horstkotte and
- Olaf Oldenburg
Previous studies confirmed Cheyne-Stokes respiration (CSA) and obstructive sleep apnea (OSA) to be independently associated with adequate implanted cardioverter-defibrillator (ICD) therapies in patients with chronic heart failure (CHF) to prevent sudden cardiac death. This study aims to clarify the impact of CSA and OSA on the circadian pattern of malignant arrhythmic events.
146 patients with CHF (LVEF ≤45%, NYHA-class ≥2) and ICD were screened for the coexistence of OSA or CSA (Apnea-Hypopnea Index ≥10/h) by cardiorespiratory polygraphy. During follow-up (median 48 months) time of day of adequate ICD-shocks and overall ICD-therapies (antitachycardia pacing and shocks) were recorded by device logs. If repetitive events or VT-storms occurred, the index event time was used for analysis.
Sleep studies revealed 37 patients (25.3%) as having OSA, 43 (29.5%) having CSA, and 66 (45.2%) having no sleep-disordered breathing (noSDB). In total 171 appropriate ICD-therapies including 57 shocks were delivered. From midnight to 6 a.m., ICD-shocks occurred in 50% of people with OSA, 16% of patients with CSA, and 11% of those with noSDB (OSA vs. noSDB: P=0.02; CSA vs. noSDB: P=0.68). ICD therapies from midnight to 6 a.m. were delivered in 35% of patients with OSA, 23% of patients with CSA, and 20% with noSDB (OSA vs. noSDB: P=0.13; CSA vs. noSDB: P=0.86). For patients with OSA, the relative risk (RR) of ICD-shocks from midnight to 6 a.m. was 3.00 (95% confidence interval (CI) 1.28 to 7.06, P=0.03) and of ICD therapies 1.60 (95%CI0.96 to 2.66, P=0.12) respectively. For CSA patients the RR of ICD shocks from midnight to 6 a.m. was 0.60 (95% CI 0.22 to 1.58, P=0.41) and of ICD therapies 0.91(95% CI 0.53-1.45, P=0.74), respectively.
In patients with CHF coexistence of OSA is associated with an enhanced risk for malignant tachyaarrhythmic events requiring ICD-shocks during sleeping hours. In contrast, in CSA patients no altered circadian variation was seen. As underlying respiratory instability and neurohumoral disorders are not exclusively been found during sleep, nocturnal treatment of CSA might be insufficient to completely prevent adverse effects.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Ventricular Arrhythmias in Cardiomyopathy
Abstract Category: 7. Arrhythmias: VT
Presentation Number: 1104-34
- 2013 American College of Cardiology Foundation