Prevalence and Clinical Correlates of Sleep-Disordered Breathing in Patients Hospitalized With Acute Decompensated Heart Failure

Suda, Shoko; Kasai, Takatoshi; Matsumoto, Hiroki; Shiroshita, Nanako; Kato, Megumi; Kawana, Fusae; Yatsu, Shoichiro; Murata, Azusa; Kato, Takao; Hiki, Masaru; Chiang, Shuo-Ju; Miyazaki, Sakiko; Daida, Hiroyuki

doi:10.1016/j.cjca.2018.03.006

Cited by 15 publications

(11 citation statements)

References 30 publications

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“…However, the detection of SDB by cardiorespiratory polygraphy has not yet been established in patients with HF [20]. In addition, in patients with AHF, OSA is prevalent in a study, where SDB was identified by cardiorespiratory polygraphy, whereas CSA is prevalent in studies, where SDB was identified by full polysomnography [3]. Indeed, in the present study, predominant OSA was less frequent in other studies, where SDB was identified by cardiorespiratory polygraphy [10,11].…”

Section: Discussioncontrasting

confidence: 48%

“…In recent studies, sleep-disordered breathing (SDB) was often observed in patients with AHF (about 75% cases), who develop either obstructive sleep apnea (OSA) or central sleep apnea (CSA) [3]. OSA is a risk factor for hypertension [4], coronary artery disease [5], and atrial fibrillation (AF) [6], all of which contribute to AHF pathogenesis.…”

Section: Introductionmentioning

confidence: 99%

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Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure

et al. 2021

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Background Identifying patients at risk for poor clinical outcomes following acute heart failure (AHF) is essential. However, data regarding the prognostic effect of sleep-disordered breathing (SDB) and treatment with positive airway pressure (PAP) on clinical outcomes of hospitalized patients following AHF is lacking. Objectives This study investigated the prognostic effect of SDB, PAP treatment, and compliance with PAP treatment on patient clinical outcomes. Polysomnography was performed in hospitalized patients whose left ventricular ejection fraction was < 50%. Patients were divided into groups based on whether SDB was defined as an apnea-hypopnea index ≥ 15 and if they had received PAP treatment. Furthermore, patients with SDB and PAP were subdivided into more and less compliant groups. We assessed the incidences of deaths and rehospitalizations due to heart failure. Results Overall, 241 patients were enrolled; 73% had SDB and 29% were initiated on PAP treatment. At a median follow-up of 1.7 years, 74 clinical events (32 deaths, 42 rehospitalizations) occurred. In the multivariable analysis, compared with the non-SDB group, SDB without PAP treatment was associated with an increased risk of clinical outcomes (hazard ratio [HR] 1.79, P = 0.049), whereas SDB with PAP treatment was not (HR 0.78, P = 0.582). Among patients with PAP treatment, a more compliant group was also inversely associated with clinical events (HR 0.11, P = 0.012). Conclusions In hospitalized patients with AHF, untreated SDB was associated with worse clinical outcomes that might be reversible by PAP treatment. However, this potential may be suppressed in less compliant patients.

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Section: Discussioncontrasting

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure

et al. 2021

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“…Compared with those studies, BMI in the present study was lower. As AHI is correlated with BMI, the relatively lower BMI might partly explain the lower prevalence of sleep apnea. Another important factor contributing to the lower prevalence of sleep apnea was that the patients received intensive therapy of heart failure before sleep studies.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Compared with those studies, BMI in the present study was lower. As AHI is correlated with BMI, 18,19 the relatively lower BMI might partly explain the lower prev- AHI might not be the best metric to determine the severity of sleep apnea in heart failure. As mainly reflecting the frequency of apneas and hypopneas during sleep on its own definition, AHI does not consider the durations of apneas and hypopneas.…”

Section: Discussionmentioning

confidence: 99%

Prognostic value of sleep apnea and nocturnal hypoxemia in patients with decompensated heart failure

Huang

Wang

Huang

et al. 2020

Clinical Cardiology

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Background Nocturnal hypoxemia is an important factor underlying the impact of sleep apnea on heart failure. It remains unclear whether nocturnal hypoxemia has a greater prognostic value in acute decompensated heart failure (ADHF) compared with the frequency of sleep apnea. Hypothesis Nocturnal hypoxemia might be better than the frequency of sleep apnea in predicting the outcomes in ADHF. Methods Sleep studies were prospectively performed during an ADHF hospitalization from January 2015 to December 2017. Sleep apnea was defined as the apnea‐hypopnea index (AHI) ≥15/h. The severity of nocturnal hypoxemia was determined by the percentage of time with saturation below 90% (T90%). The endpoint was the first event of all‐cause death, heart transplantation, implantation of left ventricular assist device, unplanned hospitalization for worsening heart failure, acute coronary syndrome, significant arrhythmias, or stroke. Results Of 382 patients, 189 (49.5%) had sleep apnea. The endpoint incidence did not differ between AHI categories (≥15/h vs <15/h: 52.4% vs 44.6%, log rank P = .353), but did between T90% categories (≥3.6% vs <3.6%: 54.5% vs 42.4%, log rank P = .023). Multivariate Cox regression analysis showed that T90% was independently associated with the endpoint (hazard ratio [HR] 1.008, 95% confidence interval [CI] 1.001‐1.016, P = .033), whereas AHI was not; the risk of the endpoint increased by 40.8% in patients with T90% ≥3.6% (HR 1.408, 95%CI 1.030‐1.925, P = .032). Conclusion Nocturnal hypoxemia had a greater prognostic value in ADHF than the frequency of sleep apnea.

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“…Multiple comorbidities are a well-known condition in the elderly population [4] and are generally associated with a greater risk of death and longer length of hospital stay. Certainly, in Japan, hospitalized patients with acute decompensated HF have multiple comorbidities [5][6][7]; an in-hospital mortality rate of approximately 5%, which remains substantial; and a median length of hospital stay of 14-21 days [5], which is substantially longer than that in any Western and Asian countries in association with a different socialized medical system in Japan [8]. HF with preserved ejection fraction (EF) (HFpEF) is prevalent in elderly HF patients and remains a major concern considering its limited treatment options [9].…”

Section: Introductionmentioning

confidence: 99%

Impact of the Geriatric Nutritional Risk Index on In-Hospital Mortality and Length of Hospitalization in Patients with Acute Decompensated Heart Failure with Preserved or Reduced Ejection Fraction

Hirose

Miyazaki

Yatsu

et al. 2020

JCM

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In patients with heart failure (HF), the impact of the Geriatric Nutritional Risk Index (GNRI) on in-hospital mortality and length of hospital stay remains unclear. We aimed to identify the factors associated with increased in-hospital mortality and longer length of hospital stay considering the GNRI in acute decompensated HF with reduced and preserved ejection fraction (HFrEF and HFpEF, respectively). Patients with acute decompensated HF who were admitted to our institution between 2007 and 2011 were investigated. A total of 451 (201, HFrEF; 250, HFpEF) patients were divided into the following: patients with GNRI < 92 and ≥92. In HFrEF, there were no significant differences in in-hospital mortality and length of hospital stay between patients with GNRI < 92 and ≥92 (median (interquartile range), 24.0 (23.8) days and 20.0 (15.0) days, respectively, p = 0.32). In HFpEF, despite no differences in in-hospital mortality, patients with GNRI < 92 had significantly longer length of hospital stay than those with GNRI ≥ 92 (median (interquartile range), 20.0 (22.3) days and 17.0 (16.0) days, respectively, p = 0.04). In HFpEF, GNRI < 92, along with lower hemoglobin, higher B-type natriuretic peptide, and elevated C-reactive protein levels, were the independent factors for longer length of hospital stay. Among patients with acute decompensated HF, assessment of nutritional status with GNRI is useful for stratifying patients at high risk for longer length of hospital stay in HFpEF but not in HFrEF. These observations are particularly important when considering the increasing elderly population and prevalence of HFpEF.

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Prevalence and Clinical Correlates of Sleep-Disordered Breathing in Patients Hospitalized With Acute Decompensated Heart Failure

Cited by 15 publications

References 30 publications

Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure

Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure

Prognostic value of sleep apnea and nocturnal hypoxemia in patients with decompensated heart failure

Impact of the Geriatric Nutritional Risk Index on In-Hospital Mortality and Length of Hospitalization in Patients with Acute Decompensated Heart Failure with Preserved or Reduced Ejection Fraction

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