Impact of Sleep-Disordered Breathing on Life-Threatening Ventricular Arrhythmia in Heart Failure Patients With Implantable Cardioverter-Defibrillator

• Published in: The American journal of cardiology 2008-10, Vol.102 (8), p.1064-1068
• Main Authors: Serizawa, Naoki, MD, Yumino, Dai, MD, Kajimoto, Katsuya, MD, Tagawa, Yoshimi, MD, Takagi, Atsushi, MD, Shoda, Morio, MD, Kasanuki, Hiroshi, MD, Hagiwara, Nobuhisa, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiac arrhythmia; Cardiac dysrhythmias; Cardiology; Cardiology. Vascular system; Cardiovascular; Defibrillators; Defibrillators, Implantable; Electric Countershock - instrumentation; Female; Follow-Up Studies; Heart; Heart failure; Heart Failure - etiology; Heart Failure - physiopathology; Heart Failure - therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Humans; Male; Medical sciences; Middle Aged; Pneumology; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Respiratory system : syndromes and miscellaneous diseases; Sleep disorders; Sleep Wake Disorders - complications; Sleep Wake Disorders - physiopathology; Stroke Volume - physiology; Studies; Tachycardia, Ventricular - complications; Tachycardia, Ventricular - physiopathology; Tachycardia, Ventricular - therapy; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.05.057

It was recognized that sleep-disordered breathing (SDB) is associated with cardiac arrhythmia and sudden cardiac death. However, it was unclear whether the presence of SDB increased the risk of life-threatening ventricular arrhythmia in patients with heart failure (HF) with an implantable cardioverter-defibrillator (ICD). Seventy-one patients with HF and an ICD who were followed up for 180 days after a sleep study were prospectively studied. All patients had an ejection fraction ≤35%. SDB was defined as an apnea-hypopnea index ≥10 events/hour on the sleep study. The frequency of appropriate ICD therapy and the day-night pattern of ICD therapies were compared between patients with and without SDB. SDB was diagnosed in 47 of 71 patients (66%). There were no statistical differences between patients with and without SDB in baseline cardiac function. However, appropriate ICD therapies occurred more frequently in patients with (43%) than without SDB (17%; p = 0.029). On multivariate analysis, the presence of SDB was an independent predictor for appropriate ICD therapy (hazard ratio 4.05, 95% confidence interval 1.20 to 13.65, p = 0.015). Moreover, the rate of total ICD therapy from midnight to 6 a.m . was significantly higher in patients with (34%) than without SDB (13%; p = 0.046). In conclusion, in patients with HF with an ICD, the presence of SDB was common and an independent predictor of life-threatening ventricular arrhythmias that were more likely to occur during sleep.