The Profile of Romanian Patient with Central Sleep Apnea and Heart Failure
Authors: Borcea Corina-Ioana , Deleanu Oana Claudia , Mihălţan Florin-Dumitru 
Published: November 2021

Sleep-related breathing disorders are highly prevalent in patients with established cardiovascular disease, especially Heart failure (HF). Central sleep apnea (CSAS) share several pathophysiological features with obstructive sleep apnea, but each with a unique pathology and specific treatment. There are considerably fewer published patient profile reports in association with CSAS-HF. The treatment for association CSAS-HF varies and depends on the etiology of respiratory disorder and leaves considerable room for improvement for future investigations. Despite progress over the last 3 decades, HF continues to have high morbidity and mortality rates. At this time, it is also uncertain whether CSAS is a consequence of HF with reduced ejection fraction or it is in fact a risk factor for the evolution of underlying cardiac pathology.

Therefore, this retrospective study highlights the interaction between CSA and HF, with particular attention to age differences, a frequent reported risk factor, in a Romanian large cohort. Were included adults > 18 years old, with sleep apnea syndrome (apnea-hypopnea index-AHI>5 per hour of sleep with at least 50% of central on polygraphy-PG and after on polysomnographic-PSGsleep study) in the presence of sleep symptoms, with known HF with preserved LVEF (>40%) in a previous internal/cardiology department. Were excluded those < 18years old, with other sleep apneas (obstructive, mixed or complex), other sleep disorders (by PSG), inadequate PSG records,or patient refusal. Anthropometric data, clinical findings, vital parameters, comorbidities, treatments and investigations (see below) were analyzed in the population and also in subgroups.

The majority of this study population (12 patients) were male, older, with normal weight, symptomatic and comorbidities. As many as 90% of the patients presented severe CSAS and 77.8% associated Cheyne–Stokes respiration (CSR). The comparative analysis of the subgroups in which according to the literature the associated pathologies manifest differently showed that there have not been noted major differences or statistically significant correlation between these two groups and cardiac outcomes.Still, in the group over 65 years we found that people were more predisposed to suffer from high BP, judging by the elevated level of the systolic blood pressure value, and another relevant comorbidities were atrial fibrillation, had more apneas and hypopneas during sleep and severe CSA were the most common. Following titration, AHI, central apnea index, desaturation index decreased with clinically significant. This study appeals to the importance of sleep health, an even more important aspect for Romania, where this associations underreported and even unrecognized, and thus the general condition of patients can worsen. Further research, based on other criteria of difference, is needed as the evidence is still lacking regarding the long-term consequences of CSA and long-term impact of current strategies in HF population.