Impact of Sleep-Disordered Breathing on Heart Rate Turbulence in Heart Failure PatientsReportar como inadecuado




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Background

Sleep-disordered breathing SDB is associated with adverse outcomes in patients with chronic heart failure CHF. Additionally, heart rate turbulence HRT reflects changes in the sinus cycle length of baroreceptor in response to hemodynamic fluctuations after ventricular premature beat. Recent studies have suggested that HRT as a marker of vagal activity has a predictive value of poor prognosis in CHF patients. However, little is known about the relationship between SDB and HRT in CHF patients.

Methods and Results

In this study, 75 patients with CHF were enrolled. We simultaneously performed Holter ECG during a 24-hr period and portable sleep monitoring at nighttime, and determined the respiratory disturbance index RDI, HRT turbulence onset TO and turbulence slope TS during that 24-hr period. These patients were divided into two groups based on the presence of severe SDB: Group A RDI≥30, n = 17 and Group B RDI<30, n = 58. TS was significantly lower in Group A than in Group B across the 24-hr period nighttime: 3.6±1.1 vs. 6.9±1.3; daytime: 3.7±0.8 vs. 7.0±1.1; all-day: 3.5±0.7 vs. 6.7±0.9% ms-RR, P<0.05, respectively. TO did not differ between the two groups. Furthermore, there was a significant negative correlation between all-day TS and RDI R = –0.257, P = 0.027. Moreover, in the multiple regression analysis, RDI was an independent factor to determine all-day TS.

Conclusions

In patients with severe SDB, blunted TS was observed across 24 hours. These results suggest that SDB induce impairment of vagal activity across a 24-hour period and may be associated with poor prognosis in CHF patients.



Autor: Akiomi Yoshihisa , Satoshi Suzuki, Mai Takiguchi, Takeshi Shimizu, Satoshi Abe, Takamasa Sato, Takayoshi Yamaki, Koichi Sugimoto,

Fuente: http://plos.srce.hr/



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