Sleep-disordered breathing and incident heart failure in older men

Sogol Javaheri, Terri Blackwell, Sonia Ancoli-Israel, Kristine E. Ensrud, Katie L. Stone, Susan Redline

Research output: Contribution to journalArticlepeer-review

57 Scopus citations


Rationale: The directionality of the relationship between sleepdisordered breathing and heart failure is controversial. Objectives: We assessed whether elevations in the obstructive or central sleep apnea index or the presence of Cheyne-Stokes breathing are associated with decompensated and/or incident heart failure. Methods: We conducted a prospective, longitudinal study of 2,865 participants derived from the Osteoporotic Fractures inMen Study, a prospectivemulticenter observational study of community-dwelling older men. Participants underwent baseline polysomnography and were followed for a mean 7.3 years for development of incident or decompensated heart failure. Ourmain exposureswere the obstructive apnea-hypopnea index (AHI), central apnea index (CAI ≥5), and Cheyne-Stokes breathing. Covariates included age, race, clinic site, comorbidities, physical activity, and alcohol and tobacco use. Measurements and Main Results: CAI greater than or equal to five and presence of Cheyne-Stokes breathing but not obstructive AHI were significant predictors of incident heart failure (adjusted hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.16-2.77 for CAI≥5) (HR, 2.23; 95% CI, 1.45-3.43 for Cheyne-Stokes breathing). After excluding those with baseline heart failure, the incident risk of heart failure was attenuated for those with CAI greater than or equal to five (HR, 1.57; 95% CI, 0.92-2.66) but remained significantly elevated for those with Cheyne-Stokes breathing (HR, 1.90; 95% CI, 1.10-3.30). Conclusions:Anelevated CAI/Cheyne-Stokes breathing, but not an elevated obstructive AHI, is significantly associated with increased risk of decompensated heart failure and/or development of clinical heart failure in a community-based cohort of older men.

Original languageEnglish (US)
Pages (from-to)561-568
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Issue number5
StatePublished - Mar 1 2016

Bibliographical note

Funding Information:
The MrOS (Osteoporotic Fractures in Men) Study is supported by National Institutes of Health (NIH) funding. The following institutes provide support: the National Institute on Aging, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Center for Advancing Translational Sciences, and NIH Roadmap for Medical Research under the following grant numbers: U01 AG027810, U01 AG042124, U01 AG042139, U01 AG042140, U01 AG042143, U01 AG042145, U01 AG042168, U01 AR066160, and UL1 TR000128. The NHLBI provided funding for the MrOS Sleep ancillary study "Outcomes of Sleep Disorders in Older Men" under the following grant numbers: R01 HL071194, R01 HL070848, R01 HL070847, R01 HL070842, R01 HL070841, R01 HL070837, R01 HL070838, and R01 HL070839. S.J. was supported by NIH funding under grant number 5T32HL007901


  • Cheyne-Stokes breathing
  • Epidemiology
  • Heart failure
  • Sleep apnea


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