Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure

Bitter T, Westerheide N, Prinz C, Hossain MS, Vogt J, Langer C, Horstkotte D, Oldenburg O (2011)
European Heart Journal 32(1): 61-74.

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Aims The aim of this first large-scale long-term study was to investigate whether obstructive sleep apnoea (OSA) and/or central sleep apnoea (CSA) are associated with an increased risk of malignant cardiac arrhythmias in patients with congestive heart failure (CHF). Methods and results Of 472 CHF patients who were screened for sleep disordered breathing (SDB) 6 months after implantation of a cardiac resynchronization device with cardioverter-defibrillator, 283 remained untreated [170 with mild or no sleep disordered breathing (mnSDB) and 113 patients declined ventilation therapy] and were included into this study. During follow-up (48 months), data on appropriately monitored ventricular arrhythmias as well as appropriate cardioverter-defibrillator therapies were obtained from 255 of these patients (90.1%). Time period to first monitored ventricular arrhythmias and to first appropriate cardioverter-defibrillator therapy were significantly shorter in patients with either CSA or OSA. Forward stepwise Cox models revealed an independent correlation for CSA and OSA regarding monitored ventricular arrhythmias [apnoea-hypopnoea index (AHI) >= 5 h(-1): CSA HR 2.15, 95% CI 1.40-3.30, P < 0.001; OSA HR 1.69, 95% CI 1.64-1.75, P = 0.001; AHI >= 15 h(-1): CSA HR 2.06, 95% CI 1.40-3.05, P < 0.001; OSA HR 1.69, 95% CI 1.14-2.51, P = 0.02] and appropriate cardioverter-defibrillator therapies (AHI >= 5 h(-1): CSA HR 3.24, 95% CI 1.86-5.64, P < 0.001; OSA HR 2.07, 95% CI 1.14-3.77, P = 0.02; AHI >= 15 h(-1): CSA HR 3.41, 95% CI 2.10-5.54, P < 0.001; OSA HR 2.10, 95% CI 1.17-3.78, P = 0.01). Conclusion In patients with CHF, CSA and OSA are independently associated with an increased risk for ventricular arrhythmias and appropriate cardioverter-defibrillator therapies.
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Bitter T, Westerheide N, Prinz C, et al. Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. European Heart Journal. 2011;32(1):61-74.
Bitter, T., Westerheide, N., Prinz, C., Hossain, M. S., Vogt, J., Langer, C., Horstkotte, D., et al. (2011). Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. European Heart Journal, 32(1), 61-74.
Bitter, T., Westerheide, N., Prinz, C., Hossain, M. S., Vogt, J., Langer, C., Horstkotte, D., and Oldenburg, O. (2011). Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. European Heart Journal 32, 61-74.
Bitter, T., et al., 2011. Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. European Heart Journal, 32(1), p 61-74.
T. Bitter, et al., “Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure”, European Heart Journal, vol. 32, 2011, pp. 61-74.
Bitter, T., Westerheide, N., Prinz, C., Hossain, M.S., Vogt, J., Langer, C., Horstkotte, D., Oldenburg, O.: Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure. European Heart Journal. 32, 61-74 (2011).
Bitter, Thomas, Westerheide, Nina, Prinz, Christian, Hossain, Mohamed Sajid, Vogt, Juergen, Langer, Christoph, Horstkotte, Dieter, and Oldenburg, Olaf. “Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure”. European Heart Journal 32.1 (2011): 61-74.
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Koehler U, Apelt S, Cassel W, Hildebrandt O, Nell C, Ranft S, Grimm W., Wien. Klin. Wochenschr. 124(3-4), 2012
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