Acute Effects of Cardiac Resynchronization Therapy on Sleep Disordered Breathing in Patients with Chronic Heart Failure

doi:10.1378/chest.07-2832

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First published online on April 10, 2008
Chest, doi:10.1378/chest.07-2832
A more recent version of this article appeared on July 1, 2008

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	Articles by Kara, T.
	Articles by Somers, V. K.

Acute Effects of Cardiac Resynchronization Therapy on Sleep Disordered Breathing in Patients with Chronic Heart Failure

Tomas Kara, MD, PhD^a^,b; Miroslav Novak, MD, PhD^a; Jiri Nykodym^a^,b; Kevin A. Bybee, MD^b; Jaroslav Meluzin, MD, PhD^a; Marek Orban, MD^a^,b; Zuzana Novakova, MD, PhD^c; Jolana Lipoldova, MD^a; David L. Hayes, MD^b; Miroslav Soucek, MD, PhD^a^,d; Jiri Vitovec, MD, PhD^a and Virend K. Somers, MD, PhD^b

^aInternational Clinical Research Center Brno & I^st Department of Internal Medicine – Cardioangiology, St. Anne's University Hospital, Brno, Czech Republic ^bDivision of Cardiovascular Disease, Mayo Clinic and Mayo Foundation, Rochester, MN, USA ^cDepartment of Physiology, Faculty of Medicine, Masaryk University Brno, Czech Republic ^dII^nd Department of Internal Medicine, St. Anne's University Hospital, Brno, Czech Republic

kara.tomas{at}mayo.edu

Abstract

Objectives: We evaluated the acute effect of cardiac resynchronization therapy(CRT) on sleep apnea in patients with systolic heart failure.

Background: Sleep-disordered breathing is common in patients with left ventricularsystolic dysfunction.

Methods: Twelve patients (age 59.6 +/- 7.8 years, left ventricular ejectionfraction, 28.0 +/- 2.8 percent) with an implanted atrial-synchronizedbiventricular pacemaker for treatment of left ventricular systolicdysfunction were selected and studied. Each subject underwentpolysomnography on three consecutive nights with CRT ON thefirst night, CRT OFF the second night, and CRT ON the thirdnight. Echocardiography was performed prior to each polysomnogram.

Results: Central sleep event index (central sleep apneas and hypopneasper hour of sleep) was lower during CRT compared with no CRT(CRT ON 6.9 +/- 1.7; CRT OFF 14.3 +/-2.9; CRT ON 8.1 +/- 1.5events/hour of sleep; p<0.001). Similarly, cumulative durationof central sleep events in minutes per hour of sleep duringCRT was one-half that observed without CRT (CRT ON 2.8 +/- 0.7;CRT OFF 6.2 +/- 1.2; CRT ON 3.1 +/- 0.7; p<0.001). Therewas a significant correlation between mitral regurgitant volumeand central sleep event index on all three nights (r $≥$ 0.77; p<0.01).

Conclusions: CRT acutely reduces central sleep apnea severity. This reductioncorrelated significantly with CRT mediated reduction of mitralregurgitation.

Key Words: cardiac resynchronization • sleep apnea • mitral regurgitation