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Symptoms of sleep apnoea in chronic heart failure—results from a prospective cohort study in 1,500 patients

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Abstract

Background

In patients with chronic heart failure, sleep-disordered breathing (SDB) is a common co-morbidity worsening prognosis. The aim of this study was to investigate whether assessment of specific symptoms can elucidate presence of SDB in these patients.

Methods

A prospective questionnaire scoring investigation on possible symptoms of sleep apnoea (nocturia, fatigue, daytime sleepiness, snoring, nocturnal sweating, witnessed apnoea’s, nap) was conducted in 1,506 consecutive patients with stable chronic heart failure (LVEF ≤45%, NYHA ≥2). Afterwards, polysomnography or polygraphy, capillary blood gas analysis, echocardiography, and cardiopulmonary exercise testing were performed.

Results

Adjusted for all significant covariates, snoring (p < 0.01) was the only symptom independently associated with OSA, while witnessed apnoeas (p = 0.02) and fatigue (p = 0.03) independently predicted for CSR. As additional parameters, higher BMI (threshold 26.6; p < 0.01) and higher pCO2 (threshold 37.6 mmHg; p < 0.01) were independently associated with OSA and male gender (p < 0.001) and lower pCO2 (threshold 35.0 mmHg; p < 0.001) with CSA. Cumulative questionnaire score results did not sufficiently (OSA—sensitivity 0.40, specificity 0.74; CSA—sensitivity 0.57, specificity 0.59) predict SDB.

Conclusion

Although in chronic heart failure patients with either OSA or CSA specific symptoms are apparent, combining clinical data, demographic data, and capillary blood gas analysis results appears favourable to determine the presence of SDB.

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Acknowledgements

The authors would like to thank all nurses from the sleep lab of the Heart and Diabetes Centre North Rhine-Westphalia for their support. Dr. Bitter was supported by an unrestricted research grant from the Ruhr University, Bochum.

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Authors and Affiliations

  1. Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany

    Thomas Bitter, Sajid Mohammed Hossain, Christian Prinz, Dieter Horstkotte & Olaf Oldenburg

  2. Department of Business Administration and Economics, Chair of Statistics, University of Bielefeld, Bielefeld, Germany

    Nina Westerheide

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  1. Thomas Bitter
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  2. Nina Westerheide
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  3. Sajid Mohammed Hossain
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Correspondence to Thomas Bitter.

Appendix A

Appendix A

Questionnaire on symptoms of sleep apnoea in congestive heart failure

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Bitter, T., Westerheide, N., Hossain, S.M. et al. Symptoms of sleep apnoea in chronic heart failure—results from a prospective cohort study in 1,500 patients. Sleep Breath 16, 781–791 (2012). https://doi.org/10.1007/s11325-011-0575-0

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