Pneumologie 2017; 71(04): 233-244
DOI: 10.1055/s-0037-1600155
Abstracts
Georg Thieme Verlag KG Stuttgart · New York

Impact of Hypopneas on Classification of Obstructive and Central Sleep Apnea in Patients with Atrial Fibrillation

J Strotmann
1   Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
,
H Fox
1   Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
,
T Bitter
1   Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
,
F Schindhelm
1   Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
,
KJ Gutleben
1   Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
,
T Schütte
1   Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
,
D Horstkotte
1   Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
,
O Oldenburg
1   Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen
› Author Affiliations
Further Information

Publication History

Publication Date:
13 April 2017 (online)

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Sleep-disordered breathing (SDB) represents a highly prevalent co-morbidity in patients with atrial fibrillation (Afib). Previous studies differentiate OSA from central sleep apnea (CSA) by classification of apneas only. Hence, hypopneas usually represent a great proportion of nocturnal respiratory events. This study investigates the impact of differentiating apneas and hypopneas instead of apneas only on differentiation of predominant OSA vs. CSA.

Retrospective analysis of consecutive patients (07/2007 to 03/2016) with preserved LV-EF (> 55%), documented Afib at hospital admission and high-quality 6-channel cardiorespiratory polygraphy (PG) recording. Detailed re-analysis (single analyser) of PG recordings in respect to central and obstructive apneas and hypopneas, and determination of apnea-hypopnea-index (AHI).

A total of 211 patient met strict inclusion criteria (146 men, age 68.7 ± 8.5y). Of those only 6.6% showed no SDB (AHI< 5/h). Considering only apneas, predominant OSA was present in 46.0%, and CSA in 44.1% of patients. In moderate to severe SDB (AHI ≥15/h), predominant OSA was classified in 44.8%, CSA in 55.2%. In contrast, while taking apneas and hypopneas into account, 55.9% of patients had OSA and 36.5% CSA, moderate to severe SDB was predominant obstructive in 57.9% and central in 42.1% (figure).

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Fig. 1: comparison of distribution of predominant type of SDB depending on classification according to apneas only or apneas and hypopneas
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Fig. 2: comparison of distribution of predominant type in moderate to severe SDB depending on classification according to apneas only or apneas and hypopneas

To date, ESC guidelines recommend screening for SDB in patients with Afib as well as treatment of OSA. Since the role of CSA in these patients needs to be determined and treatment usually differs, clear differentiation of obstructive from central respiratory events, apneas and hypopneas, seems to be mandatory.