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Clinical Research in Cardiology
https://doi.org/10.1007/s00392-018-1282-7
ORIGINAL PAPER
Sleep-disordered breathing in patients with cardiovascular diseases
cannot be detected by ESS, STOP-BANG, and Berlin questionnaires
Hannes Reuter
1,4
· Simon Herkenrath
2,3
· Marcel Treml
2
· Marcel Halbach
1
· Daniel Steven
1
· Konrad Frank
1
·
Alessandra Castrogiovanni
3
· Ilona Kietzmann
2
· Stephan Baldus
1
· Winfried J. Randerath
2,3
Received: 19 March 2018 / Accepted: 15 May 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract
Sleep-disordered breathing (SDB) is highly prevalent in patients with cardiovascular diseases (CVD) and associated with
poor outcome. At least 50% of heart failure (HF) patients present with SDB, equally divided in obstructive sleep apnea (OSA)
and central sleep apnea (CSA). CVD patients with SDB do not always present with typical SDB symptoms. Therefore, we
asked whether established questionnaires allow for the reliable detection of SDB. In this prospective cohort study, 89 CVD
patients (54 male, 59 ± 15 years, BMI 30 ± 6 kg/m
2
) in stable clinical state underwent an ambulatory polygraphy. SDB was
defined as an apnea-hypopnea index (AHI) ≥ 15/h. We evaluated the Epworth Sleepiness Scale (ESS), STOP-BANG and
Berlin questionnaires as well as anthropometric data and comorbidities regarding their ability to predict SDB. The ESS
showed no correlation with SDB. The sensitivity of the Berlin Questionnaire to detect SDB was 73%, specificity was 42%.
The STOP-BANG questionnaire showed a sensitivity of 97% while specificity was 13%. Coronary heart disease and/or
history of myocardial infarction, hyperuricemia and age significantly contributed to a logistic regression model predicting
presence of SDB. However, our regression model explains only 36% of the variance regarding the presence or absence of
SDB. The approach to find variables, which would allow an early and reliable differentiation between patients with CVD
and coexistence or absence of SDB, failed. Thus, as CVD patients show a high SDB prevalence and poor outcome, only a
systematic screening based on measures of respiration-related parameters (i.e., respiratory flow, blood oxygen saturation,
etc.) allows for a reliable SDB assessment.
Keywords Sleep-disordered breathing · Cardiovascular disease · Screening · Questionnaires · Sleep apnea
Introduction
A coexistence of cardiovascular diseases (CVD) and sleep-
disordered breathing (SDB) is highly prevalent. Several
studies have shown that at least 50% of heart failure (HF)
patients present with SDB, equally divided in obstructive
sleep apnea (OSA) and central sleep apnea (CSA) [1–3].
OSA presents with an overall prevalence of 6–13% and is
an independent risk factor for arterial hypertension, chronic
systolic heart failure, cerebrovascular diseases and atrial
fibrillation [4–11]. Recurring desaturations and associated
arousals are known to induce catecholamine release, sys-
temic inflammation, oxidative stress, insulin resistance and a
release of fatty acids [12, 13]. Thus, OSA is associated with
left ventricular hypertrophy and adverse cardiac remodeling
as well as atherosclerosis and vascular thrombosis [14–16].
Furthermore, large prospective population-based cohort
studies suggest, that OSA is one of the most important risk
factors of arterial hypertension, especially resistant hyper-
tension [17–20].
CSA is known to be associated with systolic heart fail-
ure (HFrEF) and its prevalence is estimated 21–37% among
HFrEF patients [21–23]. Due to chronic hyperventilation and
increased peripheral and central chemosensitivity, respiratory
loop gain is elevated. This phenomenon induces overshooting
* Winfried J. Randerath
randerath@klinik-bethanien.de
1
Clinic III for Internal Medicine, Heart Center, University
of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
2
Institute for Pneumology at the University of Cologne,
Aufderhöher Str. 169-175, 42699 Solingen, Germany
3
Bethanien Hospital gGmbH, Solingen, Aufderhöher
Str. 169-175, 42699 Solingen, Germany
4
Evangelisches Klinikum Köln-Weyertal, Weyertal 76,
50931 Cologne, Germany
@Phil_Robichaud
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