ABSTRACT
Os distúrbios respiratórios do sono, incluindo a apneia obstrutiva do sono e a respiração de Cheyne-Stokes, são extremamente comuns em pacientes com insuficiência cardíaca congestiva, com prevalência estimada de 50 por cento. Ambos os distúrbios estão associados à piora da qualidade de vida e ao aumento da mortalidade em pacientes com insuficiência cardíaca congestiva. Nesta revisão abordaremos tanto a etiologia da respiração de Cheyne-Stokes em pacientes com insuficiência cardíaca congestiva, suas consequências e seu tratamento, como o impacto cardiovascular da apneia obstrutiva do sono nos pacientes com insuficiência cardíaca congestiva.
Subject(s)
Humans , Sleep Apnea, Obstructive/therapy , Heart Failure/complications , Heart Failure/mortality , Cheyne-Stokes Respiration/etiology , Quality of Life/psychology , Risk FactorsABSTRACT
We investigated the relationship between sleep-disordered breathing (SDB) and Cheyne-Stokes respiration (CSR) while awake as well as mortality. Eighty-nine consecutive outpatients (29 females) with congestive heart failure (CHF; left ventricular ejection fraction, LVEF <45 percent) were prospectively evaluated. The presence of SDB and of CSR while awake before sleep onset was investigated by polysomnography. SDB prevalence was 81 and 56 percent, using apnea-hypopnea index cutoffs >5 and >15, respectively. CHF etiologies were similar according to the prevalence of SDB and sleep pattern. Males and females were similar in age, body mass index, and LVEF. Males presented more SDB (P = 0.01), higher apnea-hypopnea index (P = 0.04), more light sleep (stages 1 and 2; P < 0.05), and less deep sleep (P < 0.001) than females. During follow-up (25 ± 10 months), 27 percent of the population died. Non-survivors had lower LVEF (P = 0.01), worse New York Heart Association (NYHA) functional classification (P = 0.03), and higher CSR while awake (P < 0.001) than survivors. As determined by Cox proportional model, NYHA class IV (RR = 3.95, 95 percentCI = 1.37-11.38, P = 0.011) and CSR while awake with a marginal significance (RR = 2.96, 95 percentCI = 0.94-9.33, P = 0.064) were associated with mortality. In conclusion, the prevalence of SDB and sleep pattern of patients with Chagas' disease were similar to that of patients with CHF due to other etiologies. Males presented more frequent and more severe SDB and worse sleep quality than females. The presence of CSR while awake, but not during sleep, may be associated with a poor prognosis in patients with CHF.