Morbidity and mortality of chronic heart failure (CHF) patients with sleep apnoea (SA) treated by adaptive servo-ventilation (ASV): Interim results of FACE cohort study_ UPDATE

Abstract

Sleep disorder breathing is associated with a worse prognosis of CHF. The multicentre cohort study FACE is collecting real-world clinical data of CHF patients with reduced (HF-rEF), mid-range (HF-mrEF) and preserved (HFpEF) left ventricular ejection fraction (LVEF) with predominant CSA or coexisting central and obstructive sleep apnea (CSA-OSA), eligible for ASV therapy. Morbidity and mortality, cardiac function, quality of life are assessed over a period of 2 years depending on whether the patient was compliant (≥ 3 h/night) with ASV therapy (ResMed, AutoSet CS) or not (control). Primary endpoint is all-cause death or unplanned hospitalization for worsening HF. Cumulative incidence will be estimated by Kaplan–Meier method and compared using log-rank test between ASV & control group. An update of the interim 2-year follow-up (FU) data is presented here. Three hundred and ninety-one CHF patients were included in the mITT analysis. Median FU for analysis was 21.6 months. Baseline characteristics were: age 70.7 ± 11.0 y, 87.5% male, body mass index 28.3 ± 5.2 kg/m 2 . Patients with HF-rEF, HF-mrEF and HFpEF were 38.7%, 22.1% and 39.2% respectively. Patients with an ischemic etiology were 55.2%. Sixty-nine percent had predominant CSA and 31% had CSA-OSA. Patients with severe sleep apnoea (AHI >30/h) were 76.2%. Sixty-six percent of patients were compliant to ASV therapy. In the global population, ASV therapy seemed to be beneficial in inpatients who had the highest level of nocturnal oxygen desaturation (T90, ODI) at baseline ( P = 0.013), in obese ( P = 0.009) & non-ischemic patientss ( P = 0.014) compared to control group. However, the subgroup analysis identified significant improvement of prognosis with ASV only in HFpEF but not in HF-rEF or HF-mrEF. ASV therapy is associated with a better prognosis in CHF patients with high level of oxygen desaturation during sleep, non-ischemic HF aetiology and with preserved LVEF. FACE study is a useful tool to better understand which CHF populations with CSA can benefit of ASV therapy.