Prognostische Bedeutung zentraler Schlafapnoen bei Patienten mit chronischer Herzinsuffizienz

The patient registry SAHERZ was founded because of conflicting results regarding the prognosis of patients with chronic heart failure and central sleep apnea. Therefore, 300 patients with chronic heart failure who received a polysomnography between August 2007 and June 2011 were included in the patient registry SAHERZ and evaluated for heart-transplant free survival. After application of predefined inclusion and exclusion criteria, data of 267 patients with heart failure (NYHA class I to III) were available for analysis. 57% of patients had no or only mild central sleep apnea (AHI ≤ 15) while moderate (AHI 15-30) and severe central sleep apnea (AHI> 30) were present in 18% and 25% of patients, respectively. With regard to the frequency of central sleep apnea, our patient cohort was comparable with previous cohorts in the literature with a prevalence of central sleep apnea in about 21% up to 82% of patients with chronic heart failure, depending on the reference [25,26]. The average observation time of our cohort was 43±18 months. During the follow-up, 4 patients underwent a heart transplantation and 67 patients died. Multivariate Cox regression analysis identified a higher patient age, male gender, chronic kidney disease and reduced left ventricular ejection fraction as predictive risk factors for a heart transplant-free survival. In contrast, the presence of central sleep apnea was not an independent risk factor for a heart transplant-free survival. The fact that survival of patients with moderate or severe central sleep apnea did not differ from patients with no or mild central sleep apnea supports the hypothesis that central sleep apnea is not an independent prognostic risk factor, but merely a marker of the severity of heart disease.