Is ventilatory therapy combined with exercise training effective in patients with heart failure and sleep-disordered breathing? Results of a randomized trial during a cardiac rehabilitation programme (SATELIT-HF)

Abstract

Sleep-related disordered breathing is common in patients with chronic heart failure. To assess the efficacy of short-term nocturnal ventilatory therapy combined with exercise training (V+ET) compared with exercise training alone (ET) in patients with chronic heart failure with sleep-disordered breathing. Patients in New York Heart Association functional class II-IIIb, with an apnoea-hypopnoea index (AHI)>15/h, and enrolled in a cardiac rehabilitation programme, were centrally randomized to V+ET or ET. Subjects were classified as having obstructive sleep apnoea (OSA) (n=49) or central sleep apnoea (CSA)/mixed (n=69). The primary outcome was the change in the 10-second average oxygen consumption at maximum exercise (VO2peak) at the end of the cardiac rehabilitation programme. Fifty-eight patients were randomized to V+ET and 60 patients to ET. The median increase in VO2peak was 15% [interquartile range 6-36%] in the V+ET group and 16% [0-31%] in the ET group (P=0.34). AHI decreased in both groups, but significantly more in the V+ET group (P=0.006). The decrease in the ventilatory efficiency (VE/VCO2) slope was not statistically different between the two-randomization groups (P=0.10). In subjects with CSA, the VE/VCO2 slope decreased significantly more in the V+ET group (P=0.03), while there was no difference between the two-randomization groups in subjects with OSA (P=0.75). Six cardiovascular events occurred in patients with OSA (all randomized to the ET group); in subjects with CSA, two events occurred in the V+ET group and three in the ET group. Short-term nocturnal ventilation combined with exercise training does not increase the exercise capacity of patients with chronic heart failure.