Treating Sleep Apnea May Cut 6-Month Acute-HF Rehospitalization

Marlene Busko

March 16, 2015

SAN DIEGO, CA — Among patients with acute decompensated heart failure found to have sleep apnea soon after they were discharged from the hospital, those who were compliant with continuous positive airway pressure (CPAP) treatment were less likely to return to the emergency room or be readmitted within 6 months, in a small study[1].

At a poster session here at the American College of Cardiology (ACC) 2015 Scientific Sessions, Dr Sunil Sharma (Thomas Jefferson University and Hospitals, Philadelphia, PA) said to heartwire from Medscape that this study adds to the growing body of evidence identifying sleep-disordered breathing in HF patients as a significant risk factor for clinical outcomes in patients with different forms of heart failure.

In the current study of 70 patients with HF and sleep apnea, the mean number of return visits to the hospital decreased by 0.8 visits for the group compliant with sleep-apnea treatment (compliant group) and increased by 1.1 visits in the noncompliant group at 6 months (P=0.03).

The number of emergency-room visits increased by 0.4 visits but decreased by 0.4 visits in the compliant vs noncompliant groups at 6 months (P=0.0001).

"I think it is a very strong signal that there is underlying sleep-disordered breathing in the vast majority of these patients, and it is untreated," Sharma said. "If we were to intervene early and treat these patients, we would substantially lower the amount of readmissions, which would be a huge cost saving."

Researchers identified patients who had been hospitalized for HF and, within 4 weeks of discharge, had a positive screening test for sleep apnea, which was confirmed by overnight polysomnography. Polysomnography is fully covered by Medicare, and CPAP is also covered if the patient has an apnea hypopnea index (AHI) of 5 or more, Sharma explained. Mean AHI of participants was 30, indicating severe disease.

Patients had a mean age of 60.4 years and mean BMI of 38.2 kg/m2. About half (47.5%) were men, and about half (52.5%) were African Americans.

Mean pulmonary artery systolic pressure, measured by echocardiogram, decreased in the compliant group but increased in the noncompliant group.

When asked why patients may not be compliant with treatment, Sharma speculated that patients might not see an immediate benefit and "slack off" in using the device. The noncompliant group tended to be younger and had a slightly higher incidence of type 2 diabetes.

Sharma is a coinvestigator of a large multicenter trial, the Cardiovascular Improvements With Minute Ventilation-Targeted ASV Therapy in Heart Failure (CAT-HF) study, which is investigating whether early diagnosis and intervention in patients hospitalized with decompensated CHF will improve a composite outcome of 6-minute-walk distance, CV hospitalizations, or death.

Asked to comment, Dr Rami Khayat (Ohio State University, Columbus), who was not involved in the study, said "clinicians should be aware that up to 70% of HF patients have sleep apnea and that treatment of sleep apnea can improve outcomes of HF." Clinicians should have a very low index of suspicion regarding sleep apnea and a systemic approach to detect sleep apnea in high-risk patients.

Nonadherence to CPAP may be because of patients' noncompliance, but it may also be also be because of inadequate follow-up by physicians, he noted. Recent changes in insurance and Medicare policies requiring adherence before CPAP is covered are likely to improve adherence, he added.

Sharma reports receiving research grants from Resmed. The coauthors have no relevant financial relationships.

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