Effect of Sleep-Disordered Breathing on Appropriate Implantable Cardioverter-Defibrillator Therapy in Patients With Heart Failure

Heart failure (HF) imposes a major public health burden in the United States with a prevalence of 5.1 million and accounts for >30 billion dollars in total costs each year. Sudden arrhythmic death constitutes an important cause of mortality in patients with HF. In randomized controlled trials, implantable cardioverter-defibrillator (ICD) therapy was associated with a reduction in all-cause mortality in patients with a previous cardiac arrest and in some patients with HF and reduced ejection fraction (≤ 35%) who never had cardiac arrest. Sleep-disordered breathing (SDB), presenting as either obstructive sleep apnea (OSA) or central sleep apnea syndrome (CSA with Cheyne–Stokes breathing) is highly prevalent in patients with HF and is associated with increased cardiovascular mortality. The pathophysiological consequences of SDB, including intermittent hypoxia, autonomic dysfunction, and repetitive intrathoracic pressure changes in the case of OSA, may play a role in adverse outcomes in this population. Several investigations have examined the impact of SDB on the incidence of malignant ventricular arrhythmias in higher risk HF patients, using data from their ICD. These studies, derived from single-center experiences, had various study designs and yielded mixed results. Therefore, we sought to perform a systematic review and meta-analysis of the published data to evaluate the association of underlying untreated SDB with the incidence of appropriate ICD therapy in patients with HF.