Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure,Clinical Research in Cardiology

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Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure
Clinical Research in Cardiology ( IF 5 ) Pub Date : 2021-11-11 , DOI: 10.1007/s00392-021-01969-x
Sayaki Ishiwata _{1,

2,

3} , Takatoshi Kasai _{1,

2,

3,

4} , Akihiro Sato _{1,

2} , Shoko Suda _{1,

3} , Hiroki Matsumoto ₁ , Jun Shitara ₁ , Shoichiro Yatsu ₁ , Azusa Murata ₁ , Megumi Shimizu ₁ , Takao Kato ₁ , Masaru Hiki ₁ , Yuya Matsue _{1,

2} , Ryo Naito _{1,

2,

3} , Hiroyuki Daida _{1,

5} , Tohru Minamino _{1,

6}

Affiliation

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.

中文翻译：

睡眠呼吸障碍对急性心力衰竭住院患者预后的影响

背景

识别有急性心力衰竭 (AHF) 后临床结果不佳风险的患者至关重要。然而，缺乏关于睡眠呼吸障碍 (SDB) 和气道正压通气 (PAP) 治疗对 AHF 后住院患者临床结果的预后影响的数据。

目标

本研究调查了 SDB、PAP 治疗和 PAP 治疗依从性对患者临床结果的预后影响。对左心室射血分数 < 50% 的住院患者进行了多导睡眠监测。根据 SDB 是否定义为呼吸暂停低通气指数 ≥ 15 以及是否接受过 PAP 治疗，将患者分组。此外，SDB 和 PAP 患者被细分为依从性较高和依从性较低的组。我们评估了因心力衰竭而死亡和再住院的发生率。

结果

总共招募了 241 名患者；73% 患有 SDB，29% 开始接受 PAP 治疗。中位随访 1.7 年，发生了 74 起临床事件（32 人死亡，42 人再次住院）。在多变量分析中，与非 SDB 组相比，未接受 PAP 治疗的 SDB 与临床结果风险增加相关（风险比 [HR] 1.79，P = 0.049），而接受 PAP 治疗的 SDB 则不然（HR 0.78，P = 0.582）。在接受 PAP 治疗的患者中，依从性更高的组也与临床事件呈负相关（HR 0.11，P = 0.012）。