Beneficial Effects of Positive Airway Pressure Therapy for Sleep‐Disordered Breathing in Heart Failure Patients With Preserved Left Ventricular Ejection Fraction

Abstract

Background: Right-heart dysfunction is associated with poor prognosis in heart failure with preserved left ventricular ejection fraction (HFpEF). It remains unclear whether sleep-disordered breathing (SDB) treatment using positive airway pressure (PAP) improves right-heart and pulmonary function and exercise capacity and reduces mortality rates of HFpEF patients. Hypothesis: PAP may improve right-heart and pulmonary function, exercise capacity and prognosis in HFpEF patients with SDB. Methods: One hundred nine consecutive patients with HFpEF (left ventricular ejection fraction >50%) and moderate to severe SDB (apnea-hypopnea index ≥15/h) treated with medications were divided into 2 groups: 31 patients with PAP (PAP group) and 78 patients without PAP (non-PAP group). Right ventricular fractional area change (RV-FAC), tricuspid valve regurgitation pressure gradient (TR-PG), tricuspid valve E/E , forced expiratory volume in 1 second/forced vital capacity (FEV 1 /FVC), percentage of vital capacity, and peak VO 2 were determined before and 6 months later, and all-cause mortality was followed up for 916 days. Results: All parameters improved in the PAP group (RV-FAC, 36.0% -46.5%; TR-PG, 31.1 mm Hg-22.4 mm Hg; tricuspid valve E/E , 7.8-5.1; FEV 1 /FVC, 83.9%-89.8%; percentage of vital capacity, 83.5%-89.9%; and peak VO 2 , 16.6 mL/kg/min-19.6 mL/kg/min; P <0.05, respectively) but not in the non-PAP group. Importantly, all-cause mortality was significantly lower in the PAP group than in the non-PAP group (0% vs 12.8%; log-rank P = 0.014). Conclusions: Positive airway pressure improves right-heart and pulmonary function and exercise capacity and may reduce all-cause mortality in patients with HFpEF and SDB.

Association between sleep‐disordered breathing and arterial stiffness in heart failure patients with reduced or preserved ejection fraction

“…Additionally, meta‐analysis has demonstrated that continuous positive airway pressure improves aortic stiffness in patients with OSA 40. We previously reported that the reduction of all‐cause mortality in HFpEF patients with SDB after positive airway pressure treatment might be partly due to improvement of aortic stiffness 41, 42. Thus, it is possible to speculate that SDB management using positive airway pressure improves the prognosis of HFpEF patients via a decrease in arterial stiffness, which is one of the important mechanisms underlying HFpEF, as we reported in our previous study.…”

Current Perspectives on Systemic Hypertension in Heart Failure with Preserved Ejection Fraction

“…In a study of 15 patients with HFpEF and severe OSA, diuretic use reduced systolic blood pressures and OSA severity and was associated with increased oropharyngeal junction area, suggesting contributions from resolving upper airway edema [111]. In 109 consecutive patients on HF medical therapy with moderate to severe sleep-disordered breathing, non-invasive positive pressure ventilation (NIPPV) has been shown to provide an improvement in right heart function and pulmonary function as well as a reduction in all-cause mortality [112]. However, in a study of 101 patients newly diagnosed with HFpEF on hospital admission, 58 patients underwent screening for sleep apnea which confirmed a diagnosis in 39 patients [113].…”

Sleep disordered breathing in older adults with heart failure with preserved ejection fraction

“…The six studies that examined the effect of treatment of sleep apnea in adults with HFpEF with positive airway pressure are described in Table 1. 39–43 Four of these studies 39,40,42,43 had a prospective observational design 39,40,42 and two were randomized controlled trials with a control group that received usual care (i.e. cardiac medications).…”