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European Heart Journal 1999 20(16):1201-1209; doi:10.1053/euhj.1999.1546
Copyright © 1999 by the European Society of Cardiology.
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High prevalence and persistence of sleep apnoea in patients referred for acute left ventricular failure and medically treated over 2 months

F. Tremela,, J.-L. Pépinb, D. Vealeb, B. Wuyamb, J.-P. Sichéa, J.M. Malliona and P. Lévyb

a Department of Cardiology, University Hospital, Grenoble, France
b Department of Respiratory Medicine and Sleep Laboratory, University Hospital, Grenoble, France

revised January 20, 1999; accepted February 3, 1999 1999

Abstract

Aims Cardiac failure patients were studied systematically using polysomnography 1 month after recovering from acute pulmonary oedema, and again after 2 months of optimal medical treatment for cardiac failure.

Methods and Results This prospective study of consecutive patients was conducted in a cardiac care unit of a university hospital. V o2measurements and left ventricular ejection fraction were recorded. Thirty-four patients, initially recruited with pulmonary oedema, improved after 1 month of medical treatment to NYHA II or III. They were aged less than 75 years and had a left ventricular ejection fraction less than 45% at the time of inclusion. Age was 62 (9) years, body mass index=27 (5)kg.m–2and an ejection fraction=30 (10)%. Eighteen of the 34 patients (53%) had coronary artery disease. Twenty-eight of the 34 had sleep apnoea syndrome with an apnoea+hypopnoea index >15.h–1of sleep. Thus, the prevalence of sleep apnoea in this population was 82%. Twenty-one of 28 (75%) patients had central sleep apnoea and seven of 28 (25%) had obstructive sleep apnoea. Patients with central sleep apnoea had a lower Pa co2than those with obstructive sleep apnoea (33 (5) vs 37 (5) mmHg, P<0·005). Significant correlations were found between apnoea+hypopnoea index and peak exercise oxygen consumption (r=–0·73, P<0·01), and apnoea+hypopnoea index and Pa co2(r=–0·42,P =0·03). When only central sleep apnoea patients were considered, a correlation between apnoea+hypopnoea index and left ventricular ejection fraction was also demonstrated (r=–0·46,P <0·04). After 2 months of optimal medical treatment only two patients (both with central sleep apnoea) showed improvement (apnoea+hypopnoea index <15.h–1).

Conclusions We have demonstrated a high prevalence of sleep apnoea, which persisted after 2 months of medical treatment, in patients referred for acute left ventricular failure. Central sleep apnoea can be considered a marker of the severity of congestive heart failure.

Key Words: Left ventricular failure, sleep apnoea, Cheyne–Stokes respiration

f1 Correspondence: Dr Frédéric Tremel, Département de Cardiologie, CHU de Grenoble, BP 217 X, 38043, Grenoble, France.

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