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Relationship between sleep apnea and mortality in patients with ischemic heart failure
  1. Dai Yumino (yumino{at}
  1. Toronto Rehabilitation Institute, Canada
    1. Hanqiao Wang
    1. Toronto Rehabilitation Institute, Canada
      1. John S Floras (john.floras{at}
      1. University of Toronto, Canada
        1. Gary E Newton
        1. Mount Sinai Hospital, Canada
          1. Susanna Mak
          1. Mount Sinai Hospital, Canada
            1. Pimon Ruttanaumpawan
            1. Toronto Rehabilitation Institute, Canada
              1. John D Parker
              1. Mount Sinai Hospital, Canada
                1. T D Bradley (douglas.bradley{at}
                1. University of Toronto, Canada


                  Objective: To determine whether sleep apnea (SA) influences risk of death differently in patients with ischemic than in those with non-ischemic heart failure (HF).

                  Design: Prospective observational study.

                  Patients: Consecutive HF patients with left ventricular ejection fraction ≤45% newly referred to the HF clinic of our institute between September 1, 1997 and December 1, 2004.

                  Main outcome measures: Patients underwent sleep studies and were divided into those with moderate to severe SA (apnea-hypopnea index ≥15/hr of sleep) and those with mild to no SA (apnea-hypopnea index <15/hr of sleep). They were followed for a mean duration of 32 months to determine all-cause mortality rate.

                  Results: Of 193 patients, 34 (18%) died. In the ischemic group, mortality risk adjusted for confounding factors was significantly higher in those with SA than those without it (18.9 vs. 4.6 deaths/100 patient-years, HR 3.03, 95%CI 1.04-8.84, P=0.043). In contrast, in the non-ischemic HF group, there was no difference in adjusted mortality risk between those with, and those without SA (3.9 vs. 4.0 deaths/100 patient-years, P=0.987).

                  Conclusions: In patients with HF, the presence of SA is independently associated with an increased risk of death in those with ischemic, but not in those with non-ischemic etiology. These findings suggest that patients with ischemic cardiomyopathy are more susceptible to the adverse hemodynamic, autonomic and inflammatory consequences of SA than is those with non-ischemic cardiomyopathy.

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