• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (78)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in this journal  Topic Collections  • Otolaryngology/ Head & Neck Surgery  • Sleep Apnea  • Cardiovascular System  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

Michael Arzt, MD; Terry Young, PhD; Laurel Finn, MS; James B. Skatrud, MD; Clodagh M. Ryan, MD; Gary E. Newton, MD; Susanna Mak, MD; John D. Parker, MD; John S. Floras, MD, DPhil; T. Douglas Bradley, MD

Arch Intern Med. 2006;166:1716-1722.

Background  Adverse effects of obstructive sleep apnea (OSA), including sleep deprivation, can contribute to the progression of heart failure. The usual indication to diagnose and treat sleep apnea is subjective sleepiness. Previous studies suggest that patients with both heart failure and obstructive sleep apnea often do not complain of sleepiness, albeit their sleep time may be reduced. Therefore, we tested the hypothesis that patients with heart failure have less sleepiness and sleep less compared with subjects without heart failure for a given severity of OSA.

Methods  Sleepiness assessed with the Epworth Sleepiness Scale and sleep structure measured with polysomnography were compared among 155 consecutive patients with heart failure and from a random community sample (n = 1139) according to categories of the apnea-hypopnea index (<5, no OSA; 5-14, mild OSA; and 15, moderate to severe OSA).

Results  Compared with the community sample, for any given severity of OSA, patients with heart failure had lower mean ± SE Epworth Sleepiness Scale scores (7.1 ± 0.4 vs 8.3 ± 0.2 [P = .005]; 6.7 ± 0.7 vs 9.2 ± 0.3 [P<.001]; and 7.8 ± 0.7 vs 9.8 ± 0.4 [P = .01]), indicating less sleepiness despite sleeping less (total sleep time mean ± SE [in minutes]: 306 ± 7 vs 384 ± 2, 295 ± 19 vs 384 ± 5, and 285 ± 13 vs 359 ± 7 for no, mild, and moderate to severe OSA, respectively; P<.001 for all comparisons).

Conclusions  Patients with heart failure have less subjective daytime sleepiness compared with individuals from a community sample, despite significantly reduced sleep time, whether or not they have OSA. In patients with heart failure, the absence of subjective sleepiness is not a reliable means of ruling out OSA.

Author Affiliations: Sleep Research Laboratory of the Toronto Rehabilitation Institute, the Center for Sleep Medicine and Circadian Biology (Drs Arzt, Ryan, and Bradley) and Division of Cardiology, Department of Medicine, Mount Sinai Hospital (Drs Newton, Mak, Parker and Floras), University of Toronto, Toronto, Ontario; and Departments of Population Health Sciences (Dr Young and Ms Finn) and Medicine (Dr Skatrud), University of Wisconsin School of Medicine and Public Health, Madison.  Deceased.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTER

Decreased Sleep in Heart Failure: Are Medications to Blame?
Frank A. J. L. Scheer, Peter H. Stone, and Steven A. Shea
Arch Intern Med. 2007;167(10):1098-1099.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cheyne-Stokes respiration: friend or foe?
T Naughton
Thorax 2012;0:thoraxjnl-2011-200927v1-thoraxjnl-2011-200927.
ABSTRACT | FULL TEXT  

Rostral overnight fluid shift in end-stage renal disease: relationship with obstructive sleep apnea
Elias et al.
Nephrol Dial Transplant 2011;0:gfr605v1-gfr605.
ABSTRACT | FULL TEXT  

Relationship Between Sodium Intake and Sleep Apnea in Patients With Heart Failure
Kasai et al.
J Am Coll Cardiol 2011;58:1970-1974.
ABSTRACT | FULL TEXT  

Diagnostic Accuracy of the Berlin Questionnaire in Detecting Sleep-Disordered Breathing in Patients With a Recent Myocardial Infarction
Sert Kuniyoshi et al.
Chest 2011;140:1192-1197.
ABSTRACT | FULL TEXT  

Obstructive Sleep Apnea: The Most Common Secondary Cause of Hypertension Associated With Resistant Hypertension
Pedrosa et al.
Hypertension 2011;58:811-817.
ABSTRACT | FULL TEXT  

Sleep Apnea Testing and Outcomes in a Large Cohort of Medicare Beneficiaries with Newly Diagnosed Heart Failure
Javaheri et al.
Am. J. Respir. Crit. Care Med. 2011;183:539-546.
ABSTRACT | FULL TEXT  

Obstructive Sleep Apnea and Heart Failure: Pathophysiologic and Therapeutic Implications
Kasai and Bradley
J Am Coll Cardiol 2011;57:119-127.
ABSTRACT | FULL TEXT  

Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure
Bitter et al.
Eur Heart J 2011;32:61-74.
ABSTRACT | FULL TEXT  

Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study
Jilek et al.
Eur J Heart Fail 2011;13:68-75.
ABSTRACT | FULL TEXT  

Epidemiology of OSA
Lindberg
Sleep Apnoea 2010;1:51-68.
ABSTRACT  

Clinical presentations of OSA in adults
Tkacova and Dorkova
Sleep Apnoea 2010;1:86-103.
ABSTRACT  

Continuous positive airway pressure treatment in patients with OSA
Montserrat et al.
Sleep Apnoea 2010;1:244-266.
ABSTRACT  

Sleep apnoea in chronic heart failure
Naughton and Andreas
Sleep Apnoea 2010;1:396-420.
ABSTRACT  

Comparison of Continuous Positive Airway Pressure and Valsartan in Hypertensive Patients with Sleep Apnea
Pepin et al.
Am. J. Respir. Crit. Care Med. 2010;182:954-960.
ABSTRACT | FULL TEXT  

Comprehensive Overview of Nursing and Interdisciplinary Rehabilitation Care of the Stroke Patient: A Scientific Statement From the American Heart Association
Miller et al.
Stroke 2010;41:2402-2448.
FULL TEXT  

Sleep-disordered breathing in the elderly
Bonsignore and McNicholas
Respiratory Diseases in the Elderly 2010;1:179-204.
ABSTRACT  

Obstructive Sleep Apnea Is Common and Independently Associated With Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy
Pedrosa et al.
Chest 2010;137:1078-1084.
ABSTRACT | FULL TEXT  

Nocturnal Rostral Fluid Shift: A Unifying Concept for the Pathogenesis of Obstructive and Central Sleep Apnea in Men With Heart Failure
Yumino et al.
Circulation 2010;121:1598-1605.
ABSTRACT | FULL TEXT  

Dissociation of Obstructive Sleep Apnea From Hypersomnolence and Obesity in Patients With Stroke
Arzt et al.
Stroke 2010;41:e129-e134.
ABSTRACT | FULL TEXT  

Poor sleep and impaired self-care: Towards a comprehensive model linking sleep, cognition, and heart failure outcomes
Riegel and Weaver
Eur J Cardiovasc Nurs 2009;8:337-344.
ABSTRACT | FULL TEXT  

Sympathetic Nervous System Activation in Human Heart Failure: Clinical Implications of an Updated Model
Floras
J Am Coll Cardiol 2009;54:375-385.
ABSTRACT | FULL TEXT  

Should sleep apnoea be a specific target of therapy in chronic heart failure?
Floras
Heart 2009;95:1041-1046.
ABSTRACT | FULL TEXT  

Relationship between Overnight Rostral Fluid Shift and Obstructive Sleep Apnea in Nonobese Men
Redolfi et al.
Am. J. Respir. Crit. Care Med. 2009;179:241-246.
ABSTRACT | FULL TEXT  

Is the Cardiovascular System the Primary Target of Obstructive Sleep Apnea?
Lorenzi-Filho and Drager
Am. J. Respir. Crit. Care Med. 2008;178:892-893.
FULL TEXT  

Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)
Somers et al.
Circulation 2008;118:1080-1111.
FULL TEXT  

Sleep Apnea and Cardiovascular Disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement From the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing In Collaboration With the National Heart, Lung, and Blood Institute National Center on Sleep Disorders Research (National Institutes of Health)
Somers et al.
J Am Coll Cardiol 2008;52:686-717.
FULL TEXT  

Effect of Neurologic Complications on Outcome After Heart Transplant
van de Beek et al.
Arch Neurol 2008;65:226-231.
ABSTRACT | FULL TEXT  

Alterations in upper airway cross-sectional area in response to lower body positive pressure in healthy subjects
Shiota et al.
Thorax 2007;62:868-872.
ABSTRACT | FULL TEXT  

Diagnostic and Therapeutic Approach to Nonsleepy Apnea
Montserrat et al.
Am. J. Respir. Crit. Care Med. 2007;176:6-9.
ABSTRACT | FULL TEXT  

Sleep apnoea screening in heart failure? Not until benefit is proven!
Franklin
Eur Respir J 2007;29:1073-1074.
FULL TEXT  

Decreased Sleep in Heart Failure: Are Medications to Blame?
Scheer et al.
Arch Intern Med 2007;167:1098-1099.
FULL TEXT  

Influence of Obstructive Sleep Apnea on Mortality in Patients With Heart Failure
Wang et al.
J Am Coll Cardiol 2007;49:1625-1631.
ABSTRACT | FULL TEXT  

Update in Sleep and Control of Ventilation 2006
Horner and Bradley
Am. J. Respir. Crit. Care Med. 2007;175:426-431.
FULL TEXT  

Fluid Shift by Lower Body Positive Pressure Increases Pharyngeal Resistance in Healthy Subjects
Chiu et al.
Am. J. Respir. Crit. Care Med. 2006;174:1378-1383.
ABSTRACT | FULL TEXT  

Sleep and health: everywhere and in both directions.
Zee and Turek
Arch Intern Med 2006;166:1686-1688.
FULL TEXT