Sayaki Ishiwata1,2,3, Takatoshi Kasai4,5,6,7, Akihiro Sato1,2, Shoko Suda1,3, Hiroki Matsumoto1, Jun Shitara1, Shoichiro Yatsu1, Azusa Murata1, Megumi Shimizu1, Takao Kato1, Masaru Hiki1, Yuya Matsue1,2, Ryo Naito1,2,3, Hiroyuki Daida1,8, Tohru Minamino1,9. 1. Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. 2. Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan. 3. Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, 113-8421, Japan. 4. Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan. kasai-t@mx6.nisiq.net. 5. Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan. kasai-t@mx6.nisiq.net. 6. Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, 113-8421, Japan. kasai-t@mx6.nisiq.net. 7. Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan. kasai-t@mx6.nisiq.net. 8. Faculty of Health Science, Juntendo University, Tokyo, Japan. 9. Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan.
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.
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.
Authors: Emer Van Ryswyk; Craig S Anderson; Nicholas A Antic; Ferran Barbe; Lia Bittencourt; Ruth Freed; Emma Heeley; Zhihong Liu; Kelly A Loffler; Geraldo Lorenzi-Filho; Yuanming Luo; Maria J Masdeu Margalef; R Doug McEvoy; Olga Mediano; Sutapa Mukherjee; Qiong Ou; Richard Woodman; Xilong Zhang; Ching Li Chai-Coetzer Journal: Sleep Date: 2019-10-09 Impact factor: 5.849