Abstract
BackgroundModerate-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.ObjectivesThe 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 VO2), percent-predicted peak VO2 and oxygen uptake at anaerobic threshold (VO2-AT).MethodsThis 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.Results76 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 VO2 in comparison to control (67 ± 17 to 73 ± 19%; p = 0.01). Additional primary endpoints peak VO2 and VO2-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).ConclusionAPAP intervention was shown to significantly improve outcome compared to control group, represented in percent-predicted peak VO2, an established surrogate marker for cardiovascular prognosis in HFrEF. APAP has additional beneficial effects on hypoxemia, cardiac function and quality of life.
Highlights
Sleep-disordered breathing (SDB), obstructive sleep apnea (OSA) in particular, is highly prevalent in patients with heart failure (HF) [1, 2]
Epidemiological studies suggest that OSA is an independent risk factor for HF development and has a negative effect on prognosis in patients with HF [3,4,5]
A total of 941 HFrEF patients were screened (81.6% male, mean age 65.5 ± 12 years); 106 were referred for PSG of whom 30 did not have moderate-to-severe OSA, leaving 76 patients who were enrolled in the study and randomized to the automatic positive airway pressure (APAP) or control group (Fig. 2)
Summary
Sleep-disordered breathing (SDB), obstructive sleep apnea (OSA) in particular, is highly prevalent in patients with heart failure (HF) [1, 2]. Obstructive respiratory events result in negative intrathoracic pressure swings, which influence venous return and preload for the right ventricle, and trigger cardiac arrhythmias [8]. Another mechanism by which OSA might contribute to the pathophysiology of HF is by increasing sympathetic activation [9]. 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. Conclusion APAP intervention was shown to significantly improve outcome compared to control group, represented in percent-predicted peak VO2, an established surrogate marker for cardiovascular prognosis in HFrEF. APAP has additional beneficial effects on hypoxemia, cardiac function and quality of life
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