Severe sleep disordered breathing (SDB) was associated with elevated arterial stiffness and may be related to the pathophysiology of heart failure (HF), especially in patients with HF with preserved ejection fraction (HFpEF) according to the results of a study published in ESC Heart Failure.

Satoshi Suzuki, MD, PhD, from the Department of Cardiovascular Medicine, Fukushima Medical University in Fukushima, Japan, and colleagues conducted a cross-sectional study of 221 patients with HF and measured the apnea-hypopnea index (AHI) by polysomnography, echocardiographic parameters, and pulse wave velocity (PWV). Patients with HFpEF (n=70) were older and had higher blood pressure and PWV than those with reduced ejection fraction HF (HFrEF; n=151).

The investigators divided the patients with HF into 3 groups based on AHI: none-to-mild SDB (AHI <15 times/h, n=77), moderate SDB (15 < AHI <30 times/h, n=59), and severe SDB (AHI >30 times/h, n=85). They found that blood pressure and echocardiographic parameters did not differ among the 3 groups, but PWV was significantly higher in the severe SDB group than in the none-to-mild and moderate SDB groups (P =.002).

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When HFrEF and HFpEF groups were considered separately, PWV was significantly higher in the HFpEF group with severe SDB than in the other 2 SDB groups (P =.002), but this was not true for those with HFrEF (P= .068). Furthermore, in the multiple regression analysis, severe SDB was an independent predictor of high PWV in HFpEF (β =0.234; P =.005), but not in HFrEF.

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There were several study limitations, including the small sample size, and that the study was conducted in a single center. Another limitation was that the cutoff line between reduced ejection fraction and preserved ejection fraction is controversial — some place it at 40% and others at 50%. This study used a cutoff for HFpEF of >50% and diagnosed HF according to the Framingham criteria rather than the European Society of Cardiology guidelines. 


Suzuki S, Yoshihisa A, Sato Y, et al. Association between sleep-disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction [published February 20, 2018]. ESC Heart Fail. 2018. doi:10.1002/ehf2.12273