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

Abstract

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.

Prognostic Value of Cheyne-Stokes Respiration and Nutritional Status in Acute Decompensated Heart Failure

“…This observational study included data from May 2012 to April 2018 from 241 patients with ADHF who had enrolled in our previous study [ 15 ]. Of these, patients who lacked CONUT score data, including missing albumin and total cholesterol data and raw polysomnography data, were excluded.…”

“…Airflow was measured with a nasal pressure cannula and an oronasal thermal airflow sensor. Oxyhemoglobin saturation was monitored using oximetry as described in our previous study [ 15 ]. Because the presence or absence of CSR is not formally and specifically reported in our clinical report on polysomnography (only focusing on central sleep apnea), we used the raw polysomnography data to re-score the presence or absence of CSR.…”

“…Patients with ADHF usually have increased sympathetic nerve activity [ 13 ] and existing CSR may enhance sympathetic nerve activation [ 14 ] and lead to poor prognosis compared to those without CSR. Indeed, patients with ADHF and sleep apnea, including CSR, have a poor prognosis [ 15 ]. Malnutrition is also a prognostic factor for patients with HF.…”