Assessment of Sleep Structure in Patients with Chronic Heart Failure Using Polysomnographic

Öz

Awareness of the significance of sleep-related disorders in cardiovascular diseases is increasing. Sleep disorders are common in heart failure, involving insomnia, disruptions in sleep architecture, periodic leg movements, and periodic breathing. Difficulties in initiating or maintaining sleep, early awakening, difficulty returning to sleep, and daytime sleepiness are frequently observed. In our study, we aimed to investigate polysomnographic differences in sleep architecture in patients with chronic, compensated, and stable heart failure and to reveal the relationship between these changes and left ventricular systolic function through polysomnography and transthoracic echocardiography. Patients between the ages of 18-75 with complaints of sleep disturbances, evaluated through Transthoracic Echocardiography, will be included in the study. A prerequisite for inclusion will be receiving optimal Heart Failure treatment for at least four weeks. Exclusion criteria will include chronic heart failure due to valvular heart diseases, listing for heart transplantation, known life-threatening diseases, current treatment with oxygen or positive airway pressure, and a history of unstable angina pectoris, acute myocardial infarction, and cardiac surgery within the last 3 months. In heart failure patients, the percentage of stage N1, total AHI, total RDI, total RERA, total obstructive apnea events, total desaturation duration, total arousal index, AHI, RERA, and RDI independent of position during NREM sleep, RDI independent of position during REM, and AHI in the supine position were higher compared to the control group. Heart failure, even in its early stages, warrants attention regarding sleep disorders. Emphasizing the timely and accurate identification, treatment of sleep and respiratory disorders in heart failure patients, considering the potential positive impact on long-term outcomes, is crucial.

Anahtar Kelimeler

• Heart failure
• polysomnography
• echocardiography
• sleep disorders

Kronik Kalp Yetmezliği Hastalarında Uyku Yapısının Polisomnografik Verilerle Değerlendirilmesi

Öz

Kardiyovasküler hastalıklarda uyku ile ilgili bozuklukların önemine dair farkındalık artmaktadır. Uyku bozuklukları kalp yetmezliğinde yaygındır ve uykusuzluk, uyku mimarisinde bozulma, periyodik bacak hareketleri ve periyodik solunumu içerir. Uykuyu başlatma veya sürdürmede zorluk, çok erken uyanma ve tekrar uykuya dalamama ve gün içi uykululuk sıklıkla görülür. Biz çalışmamızda kronik, kompanse ve stabil seyirli kalp yetmezliği hastalarında polisomnografik olarak uyku mimarisi farklılıkları ve bu değişimlerin sol ventrikül sistolik fonksiyonu ile ilişkisinin polisomnografi (PSG) ve transtorasik ekokardiyografi ile ortaya çıkarılması amaçlandı. Transtorasik Ekokardiyografi ile değerlendirilmiş uyku şikayetleri olan 18-75 yaş hastalar dahil dahil edildi. En az dört hafta optimal Kalp Yetmezlik tedavisi alıyor olmak şartı arandı. Kalp kapak hastalıklarına bağlı kronik kalp yetmezliği, kalp nakli için listeleye alınma, yaşamı tehdit eden bilinen hastalıklar, oksijen veya pozitif hava yolu basıncı ile mevcut tedavi alıyor olmak, son 3 ay içinde kararsız anjina pektoris, akut myokard enfarktüsü ve kardiyak cerrahi öyküsü dışlama kriteri olarak belirlendi. Kalp yetmezlikli hastalarda N1 evre yüzdesi, total AHI, total RDI, total RERA, toplam obstrüktif apne sayısı, toplam desaturasyon süresi, total aurosal indeks, NREM evresinde poziyondan bağımsız olarak AHI, RERA ve RDI, REM evresinde poziyondan bağımsız olarak RDI, supin pozisyonda ise AHI kontrol grubuna göre daha yüksekti. Kalp yetmezliği erken evrede bile olsa uyku bozuklukları açısından dikkat edilmesi, uzun vadeli sonuçlar üzerinde muhtemel olumlu etkisi göz önüne alınarak kalp yetmezliği hastalarında uyku ve solunum bozukluklarının zamanında doğru tanımlanması ve tedavisi için önemli bir vurgu yapmakta, ayrıca klinik uyku yönetimi ve tedavisi için belirli bir teorik destek sağlamaktadır.

Anahtar Kelimeler

• kalp yetmezliği
• polisomnografi
• ekokardiyografi
• uyku bozuklukları

Kaynakça

1. 1. Desai, A.S. and L.W. Stevenson, Rehospitalization for heart failure: predict or prevent? Circulation, 2012. 126(4): p. 501-6.
2. 2. Hayes, D., Jr., et al., Insomnia and chronic heart failure. Heart Fail Rev, 2009. 14(3): p. 171-82.
3. 3. Javaheri, S. and R. Germany, Sleep and breathing disorders in heart failure. Handb Clin Neurol, 2022. 189: p. 295-307.
4. 4. Lesman-Leegte, I., et al., Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls. J Card Fail, 2009. 15(1): p. 17-23.
5. 5. Kato, N., et al., Depressive symptoms are common and associated with adverse clinical outcomes in heart failure with reduced and preserved ejection fraction. J Cardiol, 2012. 60(1): p. 23-30.
6. 6. Coniglio, A.C. and R.J. Mentz, Sleep Breathing Disorders in Heart Failure. Heart Fail Clin, 2020. 16(1): p. 45-51.
7. 7. Luyster, F.S., D.J. Buysse, and P.J. Strollo, Jr., Comorbid insomnia and obstructive sleep apnea: challenges for clinical practice and research. J Clin Sleep Med, 2010. 6(2): p. 196-204.
8. 8. Paulino, A., et al., Prevalence of sleep-disordered breathing in a 316-patient French cohort of stable congestive heart failure. Arch Cardiovasc Dis, 2009. 102(3): p. 169-75.

9. 9. Riegel, B., et al., Excessive daytime sleepiness is associated with poor medication adherence in adults with heart failure. J Card Fail, 2011. 17(4): p. 340-8.
10. 10. Shahar, E., et al., Sleep-disordered breathing and cardiovascular disease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med, 2001. 163(1): p. 19-25.
11. 11. Gottlieb, D.J., et al., Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation, 2010. 122(4): p. 352-60.
12. 12. Grimm, W., et al., Prognostic impact of central sleep apnea in patients with heart failure. J Card Fail, 2015. 21(2): p. 126-33.
13. 13. Lewis, N.D., et al., Circulating monocytes are reduced by sphingosine-1-phosphate receptor modulators independently of S1P3. J Immunol, 2013. 190(7): p. 3533-40.
14. 14. Brostrom, A., et al., Sleep difficulties, daytime sleepiness, and health-related quality of life in patients with chronic heart failure. J Cardiovasc Nurs, 2004. 19(4): p. 234-42.
15. 15. Javaheri, S., Sleep disorders in systolic heart failure: a prospective study of 100 male patients. The final report. Int J Cardiol, 2006. 106(1): p. 21-8.
16. 16. Zhao, B., et al., Increased Rapid Eye Movement Sleep Is Associated With a Reduced Risk of Heart Failure in Middle-Aged and Older Adults. Front Cardiovasc Med, 2022. 9: p. 771280.
17. 17. Yan, B., et al., Sleep fragmentation and incidence of congestive heart failure: the Sleep Heart Health Study. J Clin Sleep Med,2021. 17(8): p. 1619-1625.
18. 18. Huang, Y., et al., Prognostic value of sleep apnea and nocturnal hypoxemia in patients with decompensated heart failure. ClinCardiol, 2020. 43(4): p. 329-337.
19. 19. Khattak, H.K., et al., Obstructive Sleep Apnea in Heart Failure:Review of Prevalence, Treatment with Continuous Positive Airway Pressure, and Prognosis. Tex Heart Inst J, 2018. 45(3):p. 151-161.
20. 20. Fudim, M., et al., Evaluation and Treatment of Central SleepApnea in Patients with Heart Failure. Curr Probl Cardiol, 2022. 47(12): p. 101364.
21. 21. Kwon, Y., et al., Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy inPatients With Heart Failure: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol, 2017. 10(2): p.e004609.
22. 22. Efken, C., et al., Obstructive sleep apnoea: longer respiratoryevent lengths in patients with heart failure. Eur Respir J, 2013. 41(6): p. 1340-6.