Prognostic impact of sleep disordered breathing and its treatment in heart failure: an observational study

Abstract

AimsSleep disordered breathing (SDB) may contribute to disease progression in patients with chronic heart failure (CHF). The objective of this observational study was to evaluate whether SDB is a risk factor for mortality in CHF patients and whether this risk can be attenuated by treatment with positive airway pressure (PAP). ) and (ii) evaluated the impact of PAP treatment on mortality in those with severe SDB. After accounting for significant confounding factors (age, NYHA class, cause of CHF, diabetes, and PAP treatment), patients with severe SDB (n ¼ 176) had a 2.0-fold increased hazard ratio for death compared with those without severe SDB [95% confidence interval (CI) 1.1 -3.5, P ¼ 0.023]. In an adjusted on-treatment analysis of the group with severe SDB, mortality was significantly less in patients using PAP (18%) compared with those with untreated SDB (52%; hazard ratio 0.4, 95% CI 0.2-0.6, P ¼ 0.001). Mortality in the PAP-treated group was lower compared with the untreated group at any time-point of the follow-up period. Methods and results We ConclusionThe presence of severe SDB in CHF patients constitutes a significantly increased risk for death, independent of established risk factors. In CHF patients with SDB, use of PAP therapy was associated with a decreased mortality rate at any time point of the follow-up, suggesting that PAP can be safely used in such patients.--

Natural course of sleep-disordered breathing after acute myocardial infarction

“…Thus the prevalence of CSA and OSA in the AMI patients of our study is comparable with that reported in samples of patients with chronic HF and with a similar degree of cardiac impairment [1,3]. In such samples of chronic HF, CSA, as well as OSA, is associated with impaired prognosis [8,9].…”

“…Polysomnography PSG was performed in all subjects using standard polysomnographic techniques (Alice System; Respironics, Pittsburgh, PA, USA) [8]. Respiratory efforts were measured with the use of respiratory inductance plethysmography and airflow by nasal pressure.…”

“…For example, in a previous observational study the presence of sleep apnoea early after AMI was linked to impaired recovery of cardiac function [6]. Ultimately, both OSA and CSA confer an increased mortality risk in patients with chronic HF [7][8][9]. 2) Conversely, there is epidemiological [10] and clinical evidence [11][12][13][14][15] that cardiovascular disease and especially HF can contribute to the development or worsening of sleep apnoea.…”

Sleep disordered breathing in patients with heart failure

“…In a meta-analysis of multiple studies using ASV as a contrast group (O 2 , CPAP, or continued medical therapy), will show that ASV improves AHI and LVEF signifi cantly [63]. Two observational long-term studies [8,10] have demonstrated improved survival in those who used the ASV device compared to those who refused. Currently, 2 large prospective trials are ongoing -SERVE-HF and ADVENT-HF.…”

“…It leads to further deterioration of cardiac function and worsens prognosis [3][4][5][6]. SDB may be a potential therapeutic target as its effective treatment improves quality of life, exercise tolerance and, possibly, long term prognosis [5][6][7][8][9][10]. However, the importance of SDB remains unrecognized and the disorder itself is diagnosed rarely and remains untreated [5].…”