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Sleep-disordered breathing in ischemic cardiomyopathy and hypertensive heart failure patients



The aims of this study are to (a) detect the effect of different types of heart diseases [ischemic, cardiomyopathy, hypertensive heart failure (HF)] on the association with sleep disorders, and to (b) identify the relationship between Cheyne–Stokes respiration (CSR) and left ventricular dysfunction.

Materials and methods

In a cross-sectional study involving 100 HF patients, we performed echocardiography and a fullnight attended polysomnography for all patients.


In all, 47.9% of patients with ischemic heart disease had obstructive sleep apnea (OSA), whereas 37.5% had central sleep apnea (CSA). OSA was highly prevalent in patients with hypertensive heart disease (79.2%). On the other hand, 50.0% patients with dilated cardiomyopathy (DCM) had CSA, whereas 39.3% had OSA. Patients with DCM had a significant increase in the central apnea index (11.05±9.19 events/h), as well cycle length of CSR (68.14 ±13.26 s), as compared with other groups. There was an inverse increase of cycle length with reduction in left ventricular ejection fraction (LVEF) (LVEF≥50% had a cycle length of 41.55±10.84 s, whereas those with LVEF≤30% had a longer mean cycle length of 69.23±18.09 s).


Sleep-disordered breathing is a common disorder in different groups of HF. OSA was prevalent in ischemic and hypertensive heart disease, whereas CSA was prevalent in DCM. There was a significant increase in cycle length of CSR with a reduction in LVEF.


  1. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993; 328:1230–1235.

    Article  CAS  Google Scholar 

  2. Khayat R, Small R, Rathman L, Steven K, Becky G, Linda C, et al. Sleepdisordered breathing in heart failure: identifying and treating an important but often unrecognized comorbidity in heart failure patients. J Card Fail 2013; 19:431–444.

    Article  Google Scholar 

  3. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:1–39.

    Article  Google Scholar 

  4. Sciomer S, Badagliacca R, Fedele F. Pulmonary hypertension: echocardiographic assessment. Heart J 2005; 6:840–845.

    Google Scholar 

  5. Devereux R, Roman M. Evaluation of cardiac and vascular structure by echocardiography and other noninvasive techniques. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis, treatment. 2nd ed. New York: Raven Press; 1995. 1969–1985.

  6. Hoey ET, Pakala V, Teoh JK, Simpson H. The role of imaging in hypertensive heart disease. Int J Angiol 2014; 23:85–92.

    Article  Google Scholar 

  7. Richardson P, McKenna W, Bristow M. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation 1996; 93:841–842.

    Article  CAS  Google Scholar 

  8. Berry R, Brooks R, Gamaldo C. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specification, version 2.1. Darien, IL: American Academy of Sleep; 2014.

  9. Wali SO, Alsharif MA, Albanji MH, Baabbad MS, Almotary HM, Alama N, et al. Prevalence of obstructive sleep apnea among patients with coronary artery disease in Saudi Arabia. J Saudi Heart Assoc 2015; 27:227–233.

    Article  Google Scholar 

  10. Prinz C, Bitter T, Piper C, Horstkotte D, Faber L, Oldenburg O. Sleep apnea is common in patients with coronary artery disease. Wien Med Wochenschr 2010; 160:349–355.

    Article  Google Scholar 

  11. Yumino D, Wang H, Floras JS, Newton GE, Mak S, Ruttanaumpawan P, et al. Relationship between sleep apnea and mortality in patients with ischemic heart failure. Heart 2009; 95:819–824.

    Article  CAS  Google Scholar 

  12. Banno K, Shiomi T, Sasanabe R, Otake K, Hasegawa R, Maekawa M, et al. Sleep-disordered breathing in patients with idiopathic cardiomyopathy. Circ J 2004; 68:338–342.

    Article  Google Scholar 

  13. Javaheri S, Parker T, Liming J. Sleep apnea in 81 ambulatory male patients with stable heart failure: types and their prevalence, consequences, and presentations. Circulation 1998; 97:2154–2159.

    Article  CAS  Google Scholar 

  14. Wilcox I, McNamara S, Willson G. Is sleep apnea a new prognostic marker in heart failure? Circulation 1995; 92:1–274.

    Article  Google Scholar 

  15. Tkacova R, Hall MJ, Liu PP. Left ventricular volume in patients with heart failure and Cheyne-Stokes respiration during sleep. Am J Respir Crit Care Med 1997; 156:1549–1555.

    Article  CAS  Google Scholar 

  16. Solin P, Bergin P, Richardson M. Influence of pulmonary capillary wedge pressure on central apnea in heart failure. Circulation 1999; 99:1574–1579.

    Article  CAS  Google Scholar 

  17. Oldenburg O, Lamp B, Töpfer V. Prevalence of sleep-related breathing disorders in ischemic and non-ischemic heart failure. Dtsch Med Wochenschr 2007; 132:661–666.

    Article  CAS  Google Scholar 

  18. Paulino A, Damy T, Margarit L. Prevalence of sleep-disordered breathing in a 316-patient French cohort of stable congestive heart failure. Arch Cardiovasc Dis 2009; 102:169–175.

    Article  Google Scholar 

  19. Logan A, Perlikowski SM, Mente A, Tisler A, Tkacova R, Niroumand M, et al. High prevalence of unrecognized sleep apnoea in drug-resistant hypertension. J Hypertens 2001; 19:2271–2277.

    Article  CAS  Google Scholar 

  20. Labib A, Afifi L, Shamlool R, Nada MM, Amer HA, ElKholy SH, et al. Sleeprelated breathing disorders in stage II essential hypertension. Egypt J Neurol Psychiat Neurosurg 2015; 52:232–237.

    Article  Google Scholar 

  21. Dempsey J, Veasey S, Morgan B. Pathophysiology of sleep apnea. Physiol Rev 2010; 90:47–112.

    Article  CAS  Google Scholar 

  22. Wedewardt J, Bitter T, Prinz C. Cheyne-Stokes respiration in heart failure: cycle length is dependent on left ventricular ejection fraction. Sleep Med 2010; 11:137–142.

    Article  Google Scholar 

  23. Nopmaneejumruslers C, Kaneko Y, Hajek V, Bradley T. Cheyne–Stokes respiration in stroke: relationship to hypocapnia and occult cardiac dysfunction. Am J Respir Crit Care Med 2005; 171:1048–1052.

    Article  Google Scholar 

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Correspondence to Doaa Magdy MD.

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Salama, S., Omar, A., Ahmed, Y. et al. Sleep-disordered breathing in ischemic cardiomyopathy and hypertensive heart failure patients. Egypt J Bronchol 11, 154–160 (2017).

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  • cheyne–stokes respiration
  • heart failure
  • sleep-disordered breathing