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(Chest. 2003;124:1400-1405.)
© 2003 American College of Chest Physicians

The Relationship Between Congestive Heart Failure, Sleep Apnea, and Mortality in Older Men*

Sonia Ancoli-Israel, PhD; Einat R. DuHamel, MD; Carl Stepnowsky, PhD; Robert Engler, MD; Mairav Cohen-Zion, MA and Matthew Marler, PhD

* From the Departments of Psychiatry (Drs. Ancoli-Israel and Marler, and Ms. Cohen-Zion), Reproductive Medicine (Dr. DuHamel), and Medicine (Dr. Engler), University of California, San Diego; and Veterans Affairs San Diego Healthcare System (Dr. Stepnowsky), San Diego, CA.

Correspondence to: Sonia Ancoli-Israel, PhD, Department of Psychiatry 116A, VASDHS, 3350 La Jolla Village Dr, San Diego, CA 92161; e-mail: sancoliisrael{at}ucsd.edu

Study objectives: To examine the association of sleep apnea with heart disease.

Design: Prospective study.

Setting: Medical wards at the Veterans Affairs San Diego Healthcare System.

Patients: Three hundred fifty-three randomly selected inpatient men.

Measurements and results: Sleep was recorded for 2 nights in the hospital. Medical conditions were obtained from hospital medical records. Cox proportional hazards analyses indicated that patients with congestive heart failure (CHF) plus central sleep apnea (CSA) had shorter survival than those with just CHF, just sleep apnea (obstructive or central), or neither. Survival for those with obstructive sleep apnea (OSA) or CSA and no CHF was no different than for those with neither disorder. Follow-up analysis showed that for those with no CHF, neither CSA nor OSA shortened survival (p > 0.80). For those with CHF, having CSA shortened the life span with a hazard ratio of 1.66 (p = 0.012), but having OSA had no effect. Patients with CHF had more severe sleep apnea than those with no heart disease.

Conclusions: This study does not clarify the issues of cause and effect, but does reinforce the strong associations between sleep apnea and heart disease in elderly men. These data suggest that people with coronary disease should be regarded as a risk group for sleep apnea.

Key Words: central sleep apnea • congestive heart failure • mortality




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