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Sleep-disordered breathing and inappropriate defibrillator shocks in chronic heart failure

Schlafbezogene Atmungsstörungen und inadäquate Defibrillatorschocks bei chronischer Herzinsuffizienz

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Abstract

Purpose

Supraventricular tachyarrhythmias are a major cause of inappropriate defibrillator shocks. Sleep-disordered breathing (SDB) is a known risk factor for atrial fibrillation (AF). We hypothesized that Cheyne–Stokes respiration (CSA) and obstructive sleep apnea (OSA) have an impact on inappropriate defibrillator discharges in patients witch chronic heart failure (CHF) and cardiac resynchronization therapy with defibrillator (CRT-D).

Methods

In this study, 172 patients with CHF (LVEF ≤ 45 %, NYHA-class ≥ 2) and CRT-D underwent overnight polygraphy; 54 had no SDB (apnea–hypopnea index < 5/h), 59 had OSA, and 59 had CSA. During follow-up (36 months), inappropriate defibrillator shocks were documented.

Results

In all, 17 patients had inappropriate defibrillator shocks (9.9 %; eight oversensing due to lead fractures, five caused by atrial fibrillation, four because of sinus tachycardia). Mean event-free survival time was 33.5 ± 1.2 months in the CSA group, 35.2 ± 0.7 months in the OSA group, and 32.1 ± 1.5 months in the no SDB group, respectively (CSA vs. no SDB p = 0.63; OSA vs. no SDB p = 0.31; CSA vs. OSA p = 0.45). Stepwise Cox proportional hazard regression analysis revealed an independent association for age (per year: hazard ratio 0.90, 95 % confidence interval 0.85–0.96, p < 0.001), but not for any kind of SDB.

Conclusions

SDB was not associated with inappropriate defibrillator shocks. We assume this is due to the low incidenceand low proportion of inappropriate therapies in response to AF.

Zusammenfassung

Hintergrund

Supraventrikuläre Arrhythmien sind eine häufige Ursache für inadäquate Schocks durch implantierbare Kardioverter-Defibrillatoren (ICD). Schlafbezogene Atmungsstörungen (SBAS) gelten als Risikofaktor für das Auftreten von Vorhofflimmern (AF). Ziel dieser Studie war es daher zu untersuchen, ob die Cheyne-Stokes-Atmung (CSA) oder die obstruktive Schlafapnoe (OSA) das Auftreten inadäquater ICD-Schocks bei Patienten mit chronischer Herzinsuffizienz (CHF) und kardialer Resynchronisationstherapie mit Defibrillator (CRT-D) beeinflussen.

Methodik

172 Patienten mit CHF (linksventrikuläre Ejektionsfraktion, LVEF: ≤ 45 %, New-York-Heart-Association(NYHA)-Klasse ≥ 2) und CRT-D durchliefen eine nächtliche Polygraphie. Nachfolgend wurden während des 36-monatigen Follow-up inadäquate ICD-Schocks dokumentiert.

Ergebnisse

Bei 59 Patienten konnte eine OSA, bei 59 Patienten eine CSA und bei 54 Patienten keine SBAS (Apnoe-Hypopnoe-Index < 5/h) dokumentiert werden. 17 Patienten waren von inadäquaten Schocks betroffen (9,9 %); 8 bei Oversensing aufgrund eines Sondendefekts, 5 wegen Vorhofflimmern, 4 aufgrund von Sinustachykardien). Das mittlere ereignisfreie Überleben betrug 33,5 ± 1,2 Monate in der CSA-Gruppe, 35,2 ± 0,7 Monate in der OSA-Gruppe und 32,1 ± 1,5 Monate bei Patienten ohne SBAS (CSA vs. keine SBAS: p = 0,63; OSA vs. keine SBAS: p = 0,31; CSA vs. OSA: p = 0,45). In der Stepwise-Cox-proportional-Hazard-Regressionsanalyse zeigte sich einzig das Patientenalter (pro Jahr: Hazard Ratio 0,90; 95%-Konfidenzintervall: 0,85 bis 0,96; p < 0,001), nicht jedoch die SBAS als ein unabhängiger Risikofaktor.

Schlussfolgerung

Eine Assoziation zwischen SBAS und inadäquaten ICD-Schocks konnte nicht nachgewiesen werden. Dies scheint begründet in einer geringen Inzidenz sowie einem geringen Anteil inadäquater Schocks aufgrund von AF.

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Compliance with ethical guidelines

Conflict of interest

T. Bitter and O. Oldenburg state that they have received travel expenses from ResMed Germany. K.-J. Gutleben has received travel expenses from Biotronik, Sorin, and St. Jude Medical. J. Vogt has received travel expenses from Biotronik, Medtronic Inc., and St. Jude Medical. G. Nölker has received travel expenses from Medtronic and Biotronik. Z. Dimitriadis, C. Prinz, and D. Horstkotte state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

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Authors and Affiliations

  1. Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany

    Thomas Bitter MD, Klaus-Jürgen Gutleben MD, Georg Nölker MD, Zisis Dimitriadis MD, Christian Prinz MD, Jürgen Vogt MD, Dieter Horstkotte MD & Olaf Oldenburg MD

  2. Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany

    Thomas Bitter MD

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  1. Thomas Bitter MD
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  2. Klaus-Jürgen Gutleben MD
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Correspondence to Thomas Bitter MD.

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T. Bitter and K.-J. Gutleben contributed equally to the study and the manuscript.

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Bitter, T., Gutleben, KJ., Nölker, G. et al. Sleep-disordered breathing and inappropriate defibrillator shocks in chronic heart failure. Herzschr Elektrophys 25, 198–205 (2014). https://doi.org/10.1007/s00399-014-0324-8

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