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Kwon Y, Koene RJ, Kwon O, Kealhofer JV, Adabag S, Duval S. Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure: A Systematic Review and Meta-Analysis. Circ Arrhythm Electrophysiol 2017; 10:e004609. [PMID: 28213507 DOI: 10.1161/circep.116.004609] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with heart failure and reduced ejection fraction are at increased risk of malignant ventricular arrhythmias. Implantable cardioverter-defibrillator (ICD) is recommended to prevent sudden cardiac death in some of these patients. Sleep-disordered breathing (SDB) is highly prevalent in this population and may impact arrhythmogenicity. We performed a systematic review and meta-analysis of prospective studies that assessed the impact of SDB on ICD therapy. METHODS AND RESULTS Relevant prospective studies were identified in the Ovid MEDLINE, EMBASE, and Google Scholar databases. Weighted risk ratios of the association between SDB and appropriate ICD therapies were estimated using random effects meta-analysis. Nine prospective cohort studies (n=1274) were included in this analysis. SDB was present in 52% of the participants. SDB was associated with a 55% higher risk of appropriate ICD therapies (45% versus 28%; risk ratio, 1.55; 95% confidence interval, 1.32-1.83). In a subgroup analysis based on the subtypes of SDB, the risk was higher in both central (risk ratio, 1.50; 95% confidence interval, 1.11-2.02) and obstructive (risk ratio, 1.43; 95% confidence interval, 1.01-2.03) sleep apnea. CONCLUSIONS SDB is associated with an increased risk of appropriate ICD therapy in patients with heart failure and reduced ejection fraction.
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Affiliation(s)
- Younghoon Kwon
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.).
| | - Ryan J Koene
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Osung Kwon
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Jessica V Kealhofer
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Selcuk Adabag
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
| | - Sue Duval
- From the Cardiovascular Division, Department of Medicine, University of Virginia, Charlottesville (Y.K.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (R.J.K., J.V.K., S.D.); Department of Internal Medicine, Asan Medical Center, Ulsan Medical College, Seoul, Korea (O.K.); and Cardiovascular Division, Minneapolis VA Healthcare System, MN (S.A.)
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Fox H, Bitter T, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Arrhythmia in Heart Failure Patients. Sleep Med Clin 2017; 12:229-241. [PMID: 28477777 DOI: 10.1016/j.jsmc.2017.01.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) treatment remains complex and challenging, with current recommendations aiming at consideration and treatment of comorbidities in patients with HF. Sleep-disordered breathing (SDB) and arrhythmia come into play, as both are associated with quality of life deterioration, and morbidity and mortality increase in patients with HF. Interactions of these diseases are versatile and may appear intransparent in daily practice. Nevertheless, because of their importance for patients' condition and prognosis, SDB and arrhythmia individually, but also through interaction on one another, necessitate attention, following the fact that treatment is requested and desired considering latest research findings and outcomes.
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Affiliation(s)
- Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany.
| | - Thomas Bitter
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, D-32545 Bad Oeynhausen, Germany
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Bitter T, Fox H, Gaddam S, Horstkotte D, Oldenburg O. Sleep-Disordered Breathing and Cardiac Arrhythmias. Can J Cardiol 2015; 31:928-34. [PMID: 26037822 DOI: 10.1016/j.cjca.2015.04.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/27/2015] [Accepted: 04/27/2015] [Indexed: 02/07/2023] Open
Abstract
Over the past few years sleep-disordered breathing has been identified as an important factor in arrhythmogenesis and a potential target of therapy to prevent cardiac arrhythmias in selected patients. In this review we highlight the role of obstructive sleep apnea and Cheyne-Stokes respiration in the pathophysiology of arrhythmias, address their clinical effect in supraventricular and ventricular tachyarrhythmias, and in conduction disturbances, and address the role of current treatment options for sleep-disordered breathing in the primary and secondary prevention of arrhythmic events.
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Affiliation(s)
- Thomas Bitter
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
| | - Henrik Fox
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - SaiPrassad Gaddam
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Olaf Oldenburg
- Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
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