ORLANDO, FL — Sleep-disordered breathing (SDB) identified during acute decompensated heart failure (ADHF) hospitalization, especially central sleep apnea (CSA), predicted elevated cardiac readmission risk at three and six months and a two-thirds increase in mortality at three years in a prospective cohort study[1,2].
Its authors propose that routine screening and treatment for central or obstructive sleep apnea (OSA) in hospitalized heart-failure patients might be a useful strategy for bringing down ADHF readmission rates and associated late mortality.
Sleep-disordered breathing is one of the most common heart-failure comorbidities, identified in >70% of patients admitted with ADHF, the study's senior author Dr Rami N Khayat (Ohio State University, Columbus) told heartwire here at the Heart Failure Society of America 2013 Scientific Meeting . Although sleep studies aren't typically performed after admissions for HF, he recommends that they be routinely included for patients without a prior diagnosis of SDB "early on in the hospitalization."
Khayat presented the single-center study of 1117 patients admitted for ADHF from 2007 to 2010 with lead author Angela Sow (Ohio State University). All had an LVEF <45% and had never been diagnosed with SDB. Their sleep studies conducted on the second night of admission used type 3 monitors (with a minimum of four physiologic monitoring channels). SDB was defined as an apnea-hypopnea index of >15 events per hour (usually considered moderate apnea).
Features of 1117 Patients With Central or Obstructive Sleep Apnea or No Sleep Disordered Breathing
| End points | CSA, n=344 | OSA, n=525 | No SDB, n=248 | p |
| Age (y) | 60.3 | 60.3 | 54.6 | <0.05 vs CSA and OSA |
| LVEF (%) | 23.1 | 26.3 | 29.5 | <0.05 vs CSA and OSA |
| BMI | 29.4 | 31.7 | 29.0 | <0.05 vs OSA |
| LOS (d) | 9.5 | 9.0 | 7.2 | <0.05 vs CSA and OSA |
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CSA=Central sleep apnea |
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CSA and OSA showed comparable significant, independent effects on late mortality. Both were independent predictors of six-month cardiac readmission, the risk doubling for CSA, in particular. CSA was an independent predictor of cardiac readmission at one, three, and six months.
Hazard Ratio (95% CI) for Mortality and Rate Ratio (95% CI) for Cardiac Readmission in 1117 Patients With CSA, OSA, or No SDB
| Outcome | CSA vs No SDB | CSA vs OSA | OSA vs No SDB |
| 36-mo mortality | 1.71 (1.2–2.5), p=0.007 | 1.03 (0.8–1.3), p=0.81 | 1.66 (1.1–2.4), p=0.007 |
| 1-mo cardiac readmission | 1.92 (1.2–3.1), p=0.009 | 1.29 (0.9–1.8), p=0.14 | 1.48 (0.9–2.3), p=0.10 |
| 3-mo cardiac readmission | 1.66 (1.2–2.4), p=0.005 | 1.33 (1.0–1.7), p=0.03 | 1.25 (0.9–1.7), p=0.20 |
| 6-mo cardiac readmission | 1.97 (1.4–2.7), p<0.001 | 1.42 (1.1–1.8), p=0.004 | 1.39 (1.0–1.9), p=0.03 |
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Adjusted for age, sex, LVEF, BMI, creatinine, diabetes, type of cardiomyopathy, CAD, chronic kidney disease, discharge SBP <110, hypertension, discharge ACE inhibitors or angiotensin-receptor blocker, discharge beta-blocker, index length of stay, admission Na and hemoglobin. |
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Khayat acknowledged that SDB in many patients could represent a facet of the acute heart-failure syndrome, rather than a distinct disorder; he said if so, it remains an independent measure of worsened HF "not explained away by LVEF, LV end-diastolic dimensions, natriuretic peptides, or anything else."
He added, "We've done validation studies on a similar [cohort, suggesting that] sleep-disordered breathing doesn't go away or change much after they're discharged."
Neither Khayat nor Sow had disclosures; Khayat has elsewhere disclosed previously consulting for Respicardia and receiving research grants from Respironics.
Heartwire from Medscape © 2013
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Cite this: Sleep Apnea Worsens Acute HF Outcomes; Testing for It at HF Admission Proposed - Medscape - Oct 04, 2013.
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