Heart failure and sleep related breathing disorders: Data from PROMISES (Progetto Multicentrico Italiano Sonno e Scompenso Cardiaco) study Carolina Lombardi a,b, ⁎, Andrea Faini a , MariaTeresa La Rovere c , Francesco Fanfulla d , Paola Mattaliano a , Sergio Caravita a , Mauro Contini e , Piergiuseppe Agostoni e,f , Pasquale Perrone-Filardi g , Gianfranco Parati a,b , on behalf of PROMISES Investigators a Sleep Disorders Center, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy b Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy c Istituti Clinici Scientifici Maugeri – IRCCS Montescano, Italy d Istituti Clinici Scientifici Maugeri – IRCCS Pavia, Italy e Centro Cardiologico Monzino, IRCCS, Milan, Italy f Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy g Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy abstract article info Article history: Received 20 October 2017 Received in revised form 26 April 2018 Accepted 2 May 2018 Background: In heart failure (HF) sleep problems and sleep-related breathing disorders are frequently reported and are associated with poor prognosis. However, only few large clinical studies have investigated this issue in heart failure through breathing pattern analysis by polysomnography. Methods and results: 370 HF patients, with either moderate-severe reduced ejection fraction or with clinical decompensation, consecutively referred to 10 participating cardiology centers, have been enrolled in the PROMISES Study, an Italian project aimed at generating a large, multidisciplinary database of anthropometric, clinical, echocardiographic and sleep data, the last derived from overnight unattended cardio-respiratory polysomnography in HF patients. Obstructive sleep apnea was the most frequent form of sleep related breathing disorders observed in our cohort (35.4% with an AHI cutoff of 15). The possible determinants of sleep related breathing disorders were analyzed through stepwise logistic regression analysis and two multivariate models showing that a markedly reduced left ventricular ejection fraction was the most important factor associated with central sleep apneas (OR = 7.7 for AHI cutoff = 15 and LVEF ≤ 35%) together with male gender and increasing age. Conventional risk factors for obstructive sleep apnea did not identify HF patients affected by this condition. Conversely, a greater neck circumference was associated with an increased risk for central apneas. Conclusions: Our paper offers a deeper insight into the features of SRBD and its determinants in HF patients, leading in turn to a better clinical management of these comorbid patients. © 2018 Elsevier B.V. All rights reserved. Keywords: Sleep apnea Heart failure Sleep related breathing disorders 1. Introduction In the last twenty years several studies have demonstrated that im- portant mechanisms contributing to the pathophysiology or progression of heart failure (HF) might be expressed at night during sleep [1]. Additionally HF patients frequently report a reduced sleep duration and a low sleep quality [1], which could be markers of the presence and severity of sleep related breathing disorders (SRBD). There are two main types of SRBD: obstructive sleep apnea (OSA) and central sleep apnea (CSA) [1]. The clinical importance of CSA and OSA in HF is mainly related to their reported association with increased morbidity and mortality [2–5]. However, while evidence is available that such SRBDs are associated with a worse prognosis, whether and how they need to be treated it is still a debated issue [6–8]. The changing profile of HF patients who are of increasing age and with growing prevalence of co-morbidities, may influence the response to SRBD treatment. Moreover, the uncertainty on the benefits of ventila- tion treatment in HF patients with SRBD is also due to the fact that until recently we have still controversial data from the epidemiological International Journal of Cardiology 271 (2018) 140–145 ⁎ Corresponding author at: Sleep Disorders Center, Department of Cardiovascular, Neural, and Metabolic Sciences and Sleep Disorders Centre, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149 Milan, Italy. E-mail address: c.lombardi@auxologico.it (C. Lombardi). https://doi.org/10.1016/j.ijcard.2018.05.001 0167-5273/© 2018 Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard