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Original Research |

Short-term Effects of Cardiac Resynchronization Therapy on Sleep-Disordered Breathing in Patients With Systolic Heart Failure*

Tomas Kara, MD, PhD; Miroslav Novak, MD, PhD; Jiri Nykodym, MS; Kevin A. Bybee, MD; Jaroslav Meluzin, MD, PhD; Marek Orban, MD; Zuzana Novakova, MD, PhD; Jolana Lipoldova, MD; David L. Hayes, MD; Miroslav Soucek, MD, PhD; Jiri Vitovec, MD, PhD; Virend K. Somers, MD, PhD, FCCP
Author and Funding Information

*From the International Clinical Research Center Brno (Drs. Kara, Novak, Nykodym, Meluzin, Orban, Lipoldova, Soucek, and Vitovec), St. Anne’s University Hospital Brno, Brno, Czech Republic; the Division of Cardiovascular Disease (Drs. Bybee, Hayes, and Somers), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Physiology (Dr. Novakova), Faculty of Medicine, Masaryk University, Brno, Czech Republic.

Correspondence to: Tomas Kara, MD, PhD, International Clinical Research Center Brno, St. Anne’s University Hospital Brno, Pekarska 53, 65691 Brno, Czech Republic; e-mail: kara.tomas@mayo.edu


Chest. 2008;134(1):87-93. doi:10.1378/chest.07-2832
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Objectives: We evaluated the short-term effect of cardiac resynchronization therapy (CRT) on sleep apnea in patients with systolic heart failure.

Background: Sleep-disordered breathing is common in patients with left ventricular systolic dysfunction.

Methods: Twelve patients (mean [± SE] age, 59.6 ± 7.8 years; mean left ventricular ejection fraction, 28.0 ± 2.8%) with an implanted atrial-synchronized biventricular pacemaker for the treatment of left ventricular systolic dysfunction were selected and studied. Each subject underwent polysomnography on 3 consecutive nights with CRT on the first night, CRT off the second night, and CRT on the third night. Echocardiography was performed prior to each polysomnogram.

Results: The central sleep event index (ie, the number of central sleep apneas [CSAs] and hypopneas per hour of sleep) score was lower with CRT compared to that without CRT (mean central sleep event index score with CRT on, 6.9 ± 1.7 events per hour of sleep; mean central sleep event index score with CRT off, 14.3 ± 2.9 events per hour of sleep; mean central sleep event index score with CRT on, 8.1 ± 1.5 events per hour of sleep; p < 0.001). Similarly, the cumulative duration of central sleep events (the number of minutes per hour of sleep during CRT) was one half that observed without CRT (CRT on, 2.8 ± 0.7 min per hour of sleep; CRT OFF 6.2 ± 1.2 min per hour of sleep; CRT ON 3.1 ± 0.7 min per hour of sleep; p < 0.001). There was a significant correlation between mitral regurgitant volume and central sleep event index on all three nights (r ≥ 0.77; p < 0.01).

Conclusions: CRT reduces CSA severity in the short term. This reduction correlated significantly with the CRT-mediated reduction of mitral regurgitation.

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