Rami N Khayat1, Shahrokh Javaheri2, Kyle Porter3, Angela Sow4, Roger Holt5, Winfried Randerath6, William T Abraham5, David Jarjoura7. 1. The UCI Sleep Disorders Center and the Division of Pulmonary and Critical Care, University of California at Irvine, Irvine, California; The Sleep Heart Program at the Ohio State University, Columbus, Ohio. Electronic address: rnkhayat@gmail.com. 2. Bethesda North Hospital, Cincinnati, Ohio; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio. 3. The Center for Biostatistics, The Ohio State University, Columbus, Ohio. 4. The Sleep Heart Program at the Ohio State University, Columbus, Ohio; The Center for Clinical and Translational Science, The Ohio State University Columbus, Ohio. 5. Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio. 6. Bethanien Hospital, Institute of Pneumology at the University of Cologne, Solingen, Germany. 7. The Sleep Heart Program at the Ohio State University, Columbus, Ohio; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio; The Center for Biostatistics, The Ohio State University, Columbus, Ohio.
Abstract
BACKGROUND:Obstructive sleep apnea (OSA) is associated with increased mortality and readmissions in patients with heart failure (HF). The effect of in-hospital diagnosis and treatment of OSA during decompensated HF episodes remains unknown. METHODS AND RESULTS: A single-site, randomized, controlled trial of hospitalized patients with decompensated HF (n = 150) who were diagnosed with OSA during the hospitalization was undertaken. All participants received guideline-directed therapy for HF decompensation. Participants were randomized to an intervention arm which received positive airway pressure (PAP) therapy during the hospitalization (n = 75) and a control arm (n = 75). The primary outcome was discharge left ventricular ejection fraction (LVEF). The LVEF changed in the PAP arm from 25.5 ± 10.4 at baseline to 27.3 ± 11.9 at discharge. In the control group, LVEF was 27.3 ± 11.7 at baseline and 28.8 ± 10.5 at conclusion. There was no significant effect on LVEF of in-hospital PAP compared with controls (P = .84) in the intention-to-treat analysis. The on-treatment analysis in the intervention arm showed a significant increase in LVEF in participants who used PAP for ≥3 hours per night (n = 36, 48%) compared with those who used it less (P = .01). There was a dose effect with higher hours of use associated with more improvement in LVEF. Follow-up of readmissions at 6 months after discharge revealed a >60% decrease in readmissions for patients who used PAP ≥3 h/night compared with those who used it <3 h/night (P < .02) and compared with controls (P < .04). CONCLUSIONS: In-hospital treatment with PAP was safe but did not significantly improve discharge LVEF in patients with decompensated HF and newly diagnosed OSA. An exploratory analysis showed that adequate use of PAP was associated with higher discharge LVEF and decreased 6 months readmissions.
RCT Entities:
BACKGROUND:Obstructive sleep apnea (OSA) is associated with increased mortality and readmissions in patients with heart failure (HF). The effect of in-hospital diagnosis and treatment of OSA during decompensated HF episodes remains unknown. METHODS AND RESULTS: A single-site, randomized, controlled trial of hospitalized patients with decompensated HF (n = 150) who were diagnosed with OSA during the hospitalization was undertaken. All participants received guideline-directed therapy for HF decompensation. Participants were randomized to an intervention arm which received positive airway pressure (PAP) therapy during the hospitalization (n = 75) and a control arm (n = 75). The primary outcome was discharge left ventricular ejection fraction (LVEF). The LVEF changed in the PAP arm from 25.5 ± 10.4 at baseline to 27.3 ± 11.9 at discharge. In the control group, LVEF was 27.3 ± 11.7 at baseline and 28.8 ± 10.5 at conclusion. There was no significant effect on LVEF of in-hospital PAP compared with controls (P = .84) in the intention-to-treat analysis. The on-treatment analysis in the intervention arm showed a significant increase in LVEF in participants who used PAP for ≥3 hours per night (n = 36, 48%) compared with those who used it less (P = .01). There was a dose effect with higher hours of use associated with more improvement in LVEF. Follow-up of readmissions at 6 months after discharge revealed a >60% decrease in readmissions for patients who used PAP ≥3 h/night compared with those who used it <3 h/night (P < .02) and compared with controls (P < .04). CONCLUSIONS: In-hospital treatment with PAP was safe but did not significantly improve discharge LVEF in patients with decompensated HF and newly diagnosed OSA. An exploratory analysis showed that adequate use of PAP was associated with higher discharge LVEF and decreased 6 months readmissions.
Authors: Dariush Mozaffarian; Emelia J Benjamin; Alan S Go; Donna K Arnett; Michael J Blaha; Mary Cushman; Sandeep R Das; Sarah de Ferranti; Jean-Pierre Després; Heather J Fullerton; Virginia J Howard; Mark D Huffman; Carmen R Isasi; Monik C Jiménez; Suzanne E Judd; Brett M Kissela; Judith H Lichtman; Lynda D Lisabeth; Simin Liu; Rachel H Mackey; David J Magid; Darren K McGuire; Emile R Mohler; Claudia S Moy; Paul Muntner; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Graham Nichol; Latha Palaniappan; Dilip K Pandey; Mathew J Reeves; Carlos J Rodriguez; Wayne Rosamond; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Daniel Woo; Robert W Yeh; Melanie B Turner Journal: Circulation Date: 2015-12-16 Impact factor: 29.690
Authors: Rami Khayat; Roy Small; Lisa Rathman; Steven Krueger; Becky Gocke; Linda Clark; Laura Yamokoski; William T Abraham Journal: J Card Fail Date: 2013-06 Impact factor: 5.712
Authors: Shahrokh Javaheri; Ferran Barbe; Francisco Campos-Rodriguez; Jerome A Dempsey; Rami Khayat; Sogol Javaheri; Atul Malhotra; Miguel A Martinez-Garcia; Reena Mehra; Allan I Pack; Vsevolod Y Polotsky; Susan Redline; Virend K Somers Journal: J Am Coll Cardiol Date: 2017-02-21 Impact factor: 24.094
Authors: Darren R Mansfield; N Claire Gollogly; David M Kaye; Meroula Richardson; Peter Bergin; Matthew T Naughton Journal: Am J Respir Crit Care Med Date: 2003-11-03 Impact factor: 21.405
Authors: Martin R Cowie; Holger Woehrle; Karl Wegscheider; Christiane Angermann; Marie-Pia d'Ortho; Erland Erdmann; Patrick Levy; Anita K Simonds; Virend K Somers; Faiez Zannad; Helmut Teschler Journal: N Engl J Med Date: 2015-09-01 Impact factor: 91.245
Authors: Andrew P Ambrosy; Gregg C Fonarow; Javed Butler; Ovidiu Chioncel; Stephen J Greene; Muthiah Vaduganathan; Savina Nodari; Carolyn S P Lam; Naoki Sato; Ami N Shah; Mihai Gheorghiade Journal: J Am Coll Cardiol Date: 2014-02-05 Impact factor: 24.094
Authors: Cinthya Pena Orbea; Hussam Jenad; Lena Lea Kassab; Erik K St Louis; Eric J Olson; Gaja F Shaughnessy; Lillian T Peng; Timothy I Morgenthaler Journal: J Clin Sleep Med Date: 2021-12-01 Impact factor: 4.062