Automatic positive airway pressure for obstructive sleep apnea in heart failure with reduced ejection fraction

Abstract

Background Moderate-to-severe obstructive sleep apnea (OSA) is highly prevalent in heart failure patients with reduced left ventricular ejection fraction (HFrEF), and is associated with worsening cardiac function and increased mortality. Objectives The automatic positive airway pressure (APAP) trial tested the impact of APAP treatment on changes for the pre-specified endpoints: changes in peak oxygen uptake (peak VO 2 ), percent-predicted peak VO 2 and oxygen uptake at anaerobic threshold (VO 2 -AT). Methods This randomized, controlled pilot study included patients with chronic, stable HFrEF who had moderate-to-severe OSA. Patients were randomized 1:1 to either APAP (AutoSet™, ResMed) or nasal strips (control) for 6 months. Results 76 patients have been randomized and 58 had complete data for final analysis. There was a statistically significant change in the APAP intervention arm for the primary endpoint percent-predicted peak VO 2 in comparison to control (67 ± 17 to 73 ± 19%; p = 0.01). Additional primary endpoints peak VO 2 and VO 2 -AT showed a trend in increase in the APAP group. Moreover, there were significant improvements within the APAP group for hypoxemia, left ventricular function and quality of life from baseline to 6 months, but not within the control group (p = 0.001 and p = 0.037, respectively). Conclusion APAP intervention was shown to significantly improve outcome compared to control group, represented in percent-predicted peak VO 2 , an established surrogate marker for cardiovascular prognosis in HFrEF. APAP has additional beneficial effects on hypoxemia, cardiac function and quality of life.

Relação da apneia obstrutiva do sono com consumo de oxigênio, atividade fí­sica e alimentação

“…The low PAL observed in groups with OSA is mainly due to obesity and the low quality of sleep that causes daytime sleepiness [1,15]. It has also been described, in the literature, that individuals with reduced VO 2max tend to have less physical and functional capacity [1,3,17]. This will directly impact the ADLs of these individuals, as VO 2max is an indicator of cardiorespiratory resistance capacity and an important predictive parameter of morbidities associated with OSA, such as heart failure, stroke, among others that have been reported in similar studies [18].…”

“…Low PAL is associated with a higher degree of obesity that provides the accumulation of fat in the cervical region and narrows the upper airways, worsening OSA [15]. Therefore, the reduced values of the AT in the groups with OSA are explained both by the reduced PAL itself and by the cardiovascular comorbidities of these patients, mainly heart failure [17]. The low PAL observed in groups with OSA is mainly due to obesity and the low quality of sleep that causes daytime sleepiness [1,15].…”

Positionspapier „Schlafmedizin in der Kardiologie“, Update 2021

“…OSA bei HFrEF: Bei HFrEF kann eine CPAP-Therapie der OSA zur Verbesserung der linksventrikulären Funktion, aber auch der Lebensqualität und Leistungsfähigkeit führen [ 56 , 86 , 109 ]. Prospektiv randomisierte Studien zu harten Endpunkten sind nicht vorhanden und außerhalb der ADVENT HF-Studie nicht zu erwarten, welche sowohl OSA und ZSA einschließt [ 106 ].…”

“…Eine automatische CPAP-Therapie (APAP) führt zu einer Verbesserung der kardiopulmonalen Leistungsfähigkeit in der Spiroergometrie, verbunden mit einer verbesserten Lebensqualität und LVEF [ 56 ].…”

Three-Stage Breathing Effort Quantification for Obstructive Sleep Apnea Detection Based on Thoracic and Abdominal Movement Signals

“…Therefore, we argue that the detection cue should be raised after the transition from either S1 or S2 to S3 is observed (without imposing a 10 s wait time to determine if it as an apnea, which can help prevent further drops in oxygen desaturation) to initiate a therapeutic device (i.e., early intervention). For example, one device that utilizes the early detection of abnormal physiological changes during sleep is the auto-adjusting positive airways pressure (APAP) device [31], [32]. Therefore, the transition S3→S3 is not evaluated assuming the intervention cue raised previously succeeds in preventing continuous UA collapse.…”