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1 From the Services de Physiologie-Explorations Fonctionnelles et de Cardiologie and Institut National de la Santé et de la Recherche Médicale, INSERM U 296, Hôpital Henri Mondor, Créteil, France
We investigated the prevalence of sleep-disordered breathing in 20 outpatients on a heart transplant waiting list. All were younger than 60 years and had severe stable cardiac failure with a cardiac index below 2.5 L/min/m2 and a left ventricular ejection fraction below 25%. Nine patients (45%) exhibited ten or more apneas and hypopneas per hour of sleep (apneic group). In all patients but one, apneas and hypopneas were predominantly of the central type and occurred during Cheyne- Stokes respiration. There were no statistically significant differences between the apneic and nonapneic groups of patients in terms of age (51±5 years vs 49±11), body mass index (24±4 kg/m2 vs 22±3), cardiac index (1.87±0.35 L/min/m2 vs 1.84±0.40), isotopic left ventricular ejection fraction (13±5 vs 12±3%), arterial blood gas, or pulmonary function tests. Hypnogram characteristics showed poorer sleep quality in the apneic group than in the nonapneic group, with a larger number of arousals; this difference was found both for arousals lasting more than 30 s (8±5/h vs 4±2) and for arousals lasting less than 30 s (18±16/h vs 5±6) and was associated with increased wakefulness after sleep onset in the apneic group (138±82 min vs 84±45). Arousals were strongly associated with hyperpneic phases of Cheyne-Stokes respiration. We conclude that sleep-disordered breathing is common in patients with end-stage heart disease and adversely affects the quality of sleep.
Key Words: arousals • cardiac failure • Cheyne-Stokes respiration
Submitted on September 29, 1993
Accepted on May 5, 1994
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