Central sleep apnea, right ventricular dysfunction, and low diastolic blood pressure are predictors of mortality in systolic heart failure

J Am Coll Cardiol. 2007 May 22;49(20):2028-34. doi: 10.1016/j.jacc.2007.01.084. Epub 2007 May 4.


Objectives: The purpose of this study was to determine whether central sleep apnea (CSA) contributes to mortality in patients with heart failure (HF).

Background: Cheyne-Stokes breathing with CSA commonly occurs in patients with systolic HF. Consequences of CSA, including altered blood gases and neurohormonal activation, could result in further left ventricular dysfunction. Therefore, we hypothesized that CSA might contribute to mortality of patients with HF.

Methods: We followed 88 patients with systolic HF (left ventricular ejection fraction < or =45%) with (n = 56) or without (n = 32) CSA. The median follow-up was 51 months.

Results: The mean (+/-SD) of apnea-hypopnea index was significantly higher in patients with CSA (34 +/- 25/h) than those without CSA (2 +/- 1/h). Most of these events were central apneas. In Cox multiple regression analysis, 3 of 24 confounding variables independently correlated with survival. The median survival of patients with CSA was 45 months compared with 90 months of those without CSA (hazard ratio = 2.14, p = 0.02). The other 2 variables that correlated with poor survival were severity of right ventricular systolic dysfunction and low diastolic blood pressure.

Conclusions: In patients with systolic HF, CSA, severe right ventricular systolic dysfunction, and low diastolic blood pressure might have an adverse effect on survival.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Diastole / physiology
  • Follow-Up Studies
  • Heart Failure / mortality*
  • Heart Failure / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Polysomnography
  • Proportional Hazards Models
  • Prospective Studies
  • Severity of Illness Index
  • Sleep Apnea, Central / physiopathology*
  • Survival Analysis
  • Systole / physiology*
  • United States / epidemiology
  • Ventricular Dysfunction, Right / physiopathology*