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Complex sleep apnoea in congestive heart failure
  1. Thomas Bitter1,
  2. Nina Westerheide2,
  3. Mohammed Sajid Hossain1,
  4. Roman Lehmann3,
  5. Christian Prinz1,
  6. Astrid Kleemeyer1,
  7. Dieter Horstkotte1,
  8. Olaf Oldenburg1
  1. 1Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
  2. 2Department of Business Administration and Economics, Chair of Statistics, University of Bielefeld, Germany
  3. 3Cardiac Research Unit, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
  1. Correspondence to Thomas Bitter, Department of Cardiology, Heart and Diabetes Centre NRW, Ruhr University Bochum, Georgstrasse 11, D-32545 Bad Oeynhausen, Germany; akleemeyer{at}


Background Sleep disordered breathing is common and of prognostic significance in patients with congestive heart failure (CHF). Complex sleep apnoea (complexSA) is defined as the emergence of central sleep apnoea during continuous positive airway pressure (CPAP) treatment in patients with obstructive sleep apnoea (OSA). This study aims to determine the prevalence and predictors for complexSA in patients with CHF with OSA, and to assess the effects of treatment with adaptive servoventilation.

Methods 192 patients with CHF (left ventricular ejection fraction (LVEF) ≤45%, New York Heart Association (NYHA) class ≥2) and OSA (apnoea–hypopnoea index (AHI) ≥15) were investigated using echocardiography, cardiopulmonary exercise testing, measurement of hyperoxic, hypercapnic ventilatory response, 6 min walk test and measurement of N-terminal pro-brain natriuretic peptide (NT-proBNP) prior to CPAP introduction. If patients demonstrated complexSA (AHI >15/h with <10% obstructive events) during CPAP titration, adaptive servoventilation was introduced and the investigations were repeated at 3 monthly follow-up visits.

Results ComplexSA developed in 34 patients (18%) during CPAP titration. After adjustment for demographic and cardiac parameters, measures of CO2 sensitivity (higher hyperoxic, hypercapnic ventilatory response) were independently associated with complexSA. Patients using adaptive servoventilation had improved AHI, NYHA class, NT-proBNP concentration, LVEF, hyperoxic, hypercapnic ventilatory response, oxygen uptake during cardiopulmonary exercise testing and the relationship between minute ventilation and the rate of CO2 elimination (VE/Vco2 slope) at last individual follow-up (14±4 months).

Conclusion There is a high prevalence of complexSA in patients with OSA and CHF, and those who develop complexSA have evidence of higher respiratory controller gain before application of CPAP. Treatment with adaptive servoventilation effectively suppressed complexSA and had positive effects on cardiac function and respiratory stability.

  • Heart failure
  • complex sleep apnoea
  • adaptive servoventilation
  • sleep disordered breathing
  • cardiac function
  • sleep apnoea

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  • Funding TB was supported by an unrestricted research grant from the Ruhr University, Bochum.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the Ethics Committee of the Ruhr University Bochum, Germany.

  • Provenance and peer review Not commissioned; externally peer reviewed.