Sleep duration and quality in heart failure patients

Anke Türoff, Ulrich Thiem, Henrik Fox, Jens Spießhöfer, Thomas Bitter, Renaud Tamisier, Naresh M. Punjabi, Dieter Horstkotte, Olaf Oldenburg

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Purpose: Sleep-disordered breathing (SDB) is highly prevalent in patients with heart failure and reduced left ventricular ejection fraction (HF-REF). SDB is classified as predominant obstructive (OSA) or central (CSA) and may alter sleep duration, sleep quality, and quality of life. This study describes sleep quality and duration in well-characterized cohorts of these patients. Methods: Two hundred fifty consecutive patients with HF-REF (NYHA class ≥II, ejection fraction ≤45%) underwent cardiac and pulmonary examination, plus full attended in-hospital overnight polysomnography (PSG). PSG recordings were performed according to current recommendations and underwent independent, blinded analysis at a core laboratory. Results: Patients with HF-REF and CSA were older and had more impaired cardiac function compared to those with OSA. With respect to sleep parameters, patients with CSA spent more time in bed than those with OSA (468 ± 52 vs 454 ± 46 min, p = 0.021) while sleep efficiency was lower (67 ± 14 vs 72 ± 13% of total sleep time (TST), p = 0.008). In addition, CSA patients spent more time awake after sleep onset (101 ± 61 vs 71 ± 46 min, p = 0.001) and had more stage N1 (light) sleep (33 ± 19 vs 28 ± 16% of TST, p = 0.017). Overall, the proportion of sleep spent in N3 (slow-wave/deep) sleep in HF-REF patients with SDB was low (4.1 ± 6.3% of TST) compared with healthy adults. Conclusions: HF-REF patients with CSA compared to OSA have worse sleep efficiency and quality. This could result in less restorative sleep, changes in sympathovagal balance, and impaired resetting of important reflexes, which might contribute to worse cardiovascular outcomes in HF-REF patients with SDB.

Original languageEnglish (US)
Pages (from-to)919-927
Number of pages9
JournalSleep and Breathing
Issue number4
StatePublished - Dec 1 2017
Externally publishedYes


  • Central sleep apnea
  • Heart failure
  • Obstructive sleep apnea
  • Sleep
  • Sleep-disordered breathing

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology


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