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Prevalence and risk factors of sleep apnoea in adult patients with CHD

Published online by Cambridge University Press:  29 November 2018

Gen Harada ,
Daiji Takeuchi ,
Kei Inai ,
Tokuko Shinohara  and
Toshio Nakanishi
Gen Harada
Affiliation:
Department of Pediatric Cardiology, Tokyo Women’s Medical University, Tokyo, Japan Division of Adult Congenital Heart Disease Life-long Care, Tokyo Women’s Medical University, Tokyo, Japan
Daiji Takeuchi*
Affiliation:
Department of Pediatric Cardiology, Tokyo Women’s Medical University, Tokyo, Japan Division of Adult Congenital Heart Disease Life-long Care, Tokyo Women’s Medical University, Tokyo, Japan
Kei Inai
Affiliation:
Department of Pediatric Cardiology, Tokyo Women’s Medical University, Tokyo, Japan Division of Adult Congenital Heart Disease Life-long Care, Tokyo Women’s Medical University, Tokyo, Japan
Tokuko Shinohara
Affiliation:
Department of Pediatric Cardiology, Tokyo Women’s Medical University, Tokyo, Japan Division of Adult Congenital Heart Disease Life-long Care, Tokyo Women’s Medical University, Tokyo, Japan
Toshio Nakanishi
Affiliation:
Department of Pediatric Cardiology, Tokyo Women’s Medical University, Tokyo, Japan Division of Adult Congenital Heart Disease Life-long Care, Tokyo Women’s Medical University, Tokyo, Japan
*
Author for correspondence: D. Takeuchi, MD, PhD, Department of Pediatric Cardiology, Tokyo Women’s Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. Tel: 81-3-3353-8111; Fax: 81-3-3356-0441; E-mail: [email protected]
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Abstract

Background

Although sleep apnoea is an important disorder associated with cardiac events, data regarding its prevalence and risk factors in adult patients with CHD are limited.

Methods

In this study, patients underwent a sleep study in the hospital. Indications for admission were classified as heart failure, diagnostic catheterisation, interventional catheterisation, or arrhythmia. The prevalence, characteristics, and risk factors of sleep apnoea using a type 3 portable overnight polygraph in adult patients with CHD were evaluated.

Results

This study comprised 104 patients of median age 36 years with interquartile range of 28–48 years, admitted for heart failure 34% (n = 36), diagnostic catheterisation 26% (n = 27), interventional catheterisation 18% (n = 19), or arrhythmia 22% (n = 23). The prevalence of sleep apnoea, defined as a respiratory disturbance index ≥5, was 63% (n = 63), with a distribution of 37, 16, and 10% for mild (5≤ respiratory disturbance index <15), moderate (15⩽ respiratory disturbance index <30), and severe (respiratory disturbance index ≥30) sleep apnoea, respectively. A large majority of the sleep apnoea cases were categorised as obstructive sleep apnoea (92%, n = 58). The respiratory disturbance index ≥15 group had a significantly higher proportion of male patients and higher body mass index, noradrenaline level, and aortic blood pressure than the group without sleep apnoea (respiratory disturbance index <5). Multi-variable analysis showed that NYHA class ≥II, whose odds ratio 4.36, 95% confidence interval 1.09–20.87, and body mass index ≥25, whose odds ratio 4.29, 95% confidence interval 1.32–15.23, were independent risk factors for a respiratory disturbance index ≥15.

Conclusion

Our results showed a high prevalence of sleep apnoea in adult patients with CHD. Its unique haemodynamics may be associated with a high prevalence of sleep apnoea. Congestive heart failure and being overweight are important risk factors for sleep apnoea. Management of heart failure and general lifestyle improvements are important for controlling sleep apnoea symptoms in these patients.

Keywords

Sleep apnoeaadult CHDprevalencerisk factorsheart failure
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 1 , January 2019 , pp. 71 - 77
Copyright
© Cambridge University Press 2018 

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Footnotes

Cite this article: Harada G, Takeuchi D, Inai K, Shinohara T, Nakanishi T. (2018) Prevalence and risk factors of sleep apnoea in adult patients with CHD. Cardiology in the Young29: 71–77. doi: 10.1017/S1047951118001853

References

1. Shamsuzzaman, AS, Gersh, BJ, Somers, VK. Obstructive sleep apnea: implications for cardiac and vascular disease. J Am Med Assoc 2003; 290: 1906–1914.Google Scholar
2. Koshino, Y, Satoh, M, Katayose, Y, et al. Association of sleep-disordered breathing and ventricular arrhythmias in patients without heart failure. Am J Cardiol 2008; 101: 882–886.Google Scholar
3. Oldenburg, O, Lamp, B, Faber, L, et al. Sleep-disordered breathing in patients with symptomatic heart failure: a contemporary study of prevalence in and characteristics of 700 patients. Eur J Heart Fail 2007; 9: 251–257.Google Scholar
4. Herold, SE, Young, TW, Ge, D, Snieder, H, Lovrekovic, GZ. Sleep disordered breathing in pediatric patients with tetralogy of Fallot. Pediatr Cardiol 2006; 27: 243–249.Google Scholar
5. Cotts, T, Smith, KR, Lu, J, Dorfman, AL, Norris, MD. Risk for sleep-disordered breathing in adults after atrial switch repairs for d-looped transposition of the great arteries. Pediatr Cardiol 2014; 35: 888–892.Google Scholar
6. Uesugi, T, Kobayashi, T, Hasebe, D, et al. Effects of orthognathic surgery on pharyngeal airway and respiratory function during sleep in patients with mandibular prognathism. Int J Oral Maxillofac Surg 2014; 43: 1082–1090.Google Scholar
7. Satake, H, Sugimura, K, Fukumoto, Y, et al. Effect of respiratory therapy on the prognosis of chronic heart failure patients complicated with sleep-disordered breathing: a pilot efficacy trial. Circ J 2016; 80: 130–138.Google Scholar
8. Chesson, AL Jr., Berry, RB, Pack, A. Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults. Sleep 2003; 26: 907–913.Google Scholar
9. Medicine AAoS. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 1999; 22: 667–689.Google Scholar
10. JCS JWG. Guidelines for diagnosis and treatment of sleep disordered breathing in cardiovascular disease (JCS 2010): Digest version. Circ J 2010; 74: 963–1084.Google Scholar
11. Warnes, CA, Williams, RG, Bashore, TM, et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults with Congenital Heart Disease). Developed in Collaboration with the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e143–e263.Google Scholar
12. Marelli, AJ, Mackie, AS, Ionescu-Ittu, R, Rahme, E, Pilote, L. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation 2007; 115: 163–172.Google Scholar
13. Khairy, P, Van Hare, GF, Balaji, S, et al. PACES/HRS expert consensus statement on the recognition and management of arrhythmias in adult congenital heart disease: developed in partnership between the Pediatric and Congenital Electrophysiology Society (PACES) and the Heart Rhythm Society (HRS). Endorsed by the governing bodies of PACES, HRS, the American College of Cardiology (ACC), the American Heart Association (AHA), the European Heart Rhythm Association (EHRA), the Canadian Heart Rhythm Society (CHRS), and the International Society for Adult Congenital Heart Disease (ISACHD). Can J Cardiol 2014; 30: e1–e63.Google Scholar
14. Sin, DD, Fitzgerald, F, Parker, JD, et al. Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. Am J Respir Crit Care Med 1999; 160: 1101–1106.Google Scholar
15. Young, T, Palta, M, Dempsey, J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328: 1230–1235.Google Scholar
16. Shepard, JW Jr., Pevernagie, DA, Stanson, AW, Daniels, BK, Sheedy, PF. Effects of changes in central venous pressure on upper airway size in patients with obstructive sleep apnea. Am J Respir Crit Care Med 1996; 153: 250–254.Google Scholar
17. Yumino, D, Redolfi, S, Ruttanaumpawan, P, et al. Nocturnal rostral fluid shift: a unifying concept for the pathogenesis of obstructive and central sleep apnea in men with heart failure. Circulation 2010; 121: 1598–1605.Google Scholar
18. Horner, RL, Mohiaddin, RH, Lowell, DG, et al. Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls. Eur Respir J 1989; 2: 613–622.Google Scholar
19. Mortimore, IL, Marshall, I, Wraith, PK, Sellar, RJ, Douglas, NJ. Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. Am J Respir Crit Care Med 1998; 157: 280–283.Google Scholar
20. Vazir, A, Hastings, PC, Dayer, M, et al. A high prevalence of sleep disordered breathing in men with mild symptomatic chronic heart failure due to left ventricular systolic dysfunction. Eur J Heart Fail 2007; 9: 243–250.Google Scholar
21. Tkacova, R, Niroumand, M, Lorenzi-Filho, G, Bradley, TD. Overnight shift from obstructive to central apneas in patients with heart failure: role of PCO2 and circulatory delay. Circulation 2001; 103: 238–243.Google Scholar
22. Mortara, A, Sleight, P, Pinna, GD, et al. Association between hemodynamic impairment and Cheyne-Stokes respiration and periodic breathing in chronic stable congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol 1999; 84: 900–904.Google Scholar
23. Lui, GK, Fernandes, S, McElhinney, DB. Management of cardiovascular risk factors in adults with congenital heart disease. J Am Heart Assoc 2014; 3: e001076.Google Scholar
24. Nishihata, Y, Takata, Y, Usui, Y, et al. Continuous positive airway pressure treatment improves cardiovascular outcomes in elderly patients with cardiovascular disease and obstructive sleep apnea. Heart Vessels 2015; 30: 61–69.Google Scholar
25. Kapa, S, Sert Kuniyoshi, FH, Somers, VK. Sleep apnea and hypertension: interactions and implications for management. Hypertension 2008; 51: 605–608.Google Scholar
26. Peppard, PE, Young, T, Palta, M, Skatrud, J. Prospective study of the association between sleep-disordered breathing and hypertension. N Engl J Med 2000; 342: 1378–1384.Google Scholar
27. Somers, VK, Dyken, ME, Clary, MP, Abboud, FM. Sympathetic neural mechanisms in obstructive sleep apnea. J Clin Invest 1995; 96: 1897–1904.Google Scholar
28. El Shayeb, M, Topfer, LA, Stafinski, T, Pawluk, L, Menon, D. Diagnostic accuracy of level 3 portable sleep tests versus level 1 polysomnography for sleep-disordered breathing: a systematic review and meta-analysis. CMAJ 2014; 186: E25–E51.Google Scholar
29. de Vries, GE, van der Wal, HH, Kerstjens, HA, et al. Validity and predictive value of a portable two-channel sleep-screening tool in the Identification of sleep apnea in patients with heart failure. J Card Fail 2015; 21: 848–855.Google Scholar