Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jun 14;36(23):1463-9.
doi: 10.1093/eurheartj/ehu522. Epub 2015 Jan 29.

Sleep disordered breathing and post-discharge mortality in patients with acute heart failure

Rami Khayat  1 , David Jarjoura  2 , Kyle Porter  2 , Angela Sow  3 , Jacob Wannemacher  3 , Robert Dohar  3 , Adam Pleister  4 , William T Abraham  4
Affiliations

Sleep disordered breathing and post-discharge mortality in patients with acute heart failure

Rami Khayat et al. Eur Heart J. .

Abstract

Background: Hospitalizations for heart failure are associated with a high post-discharge risk for mortality. Identification of modifiable predictors of post-discharge mortality during hospitalization may improve outcome. Sleep disordered breathing (SDB) is the most common co-morbidity in heart failure patients.

Design, setting, and participants: Prospective cohort study of patients hospitalized with acute heart failure (AHF) in a single academic heart hospital. Between January 2007 and December 2010, all patients hospitalized with AHF who have left ventricular ejection fraction (LVEF) ≤ 45% and were not already diagnosed with SDB were the target population.

Main outcomes and measures: Patients underwent in-hospital attended polygraphy testing for SDB and were followed for a median of 3 years post-discharge. Mortality was recorded using national and state vital statistics databases.

Results: During the study period, 1117 hospitalized AHF patients underwent successful sleep testing. Three hundred and forty-four patients (31%) had central sleep apnoea (CSA), 525(47%) patients had obstructive sleep apnoea (OSA), and 248 had no or minimal SDB (nmSDB). Of those, 1096 patients survived to discharge and were included in the mortality analysis. Central sleep apnoea was independently associated with mortality. The multivariable hazard ratio (HR) for time to death for CSA vs. nmSDB was 1.61 (95% CI: 1.1, 2.4, P = 0.02). Obstructive sleep apnoea was also independently associated with mortality with a multivariable HR vs. nmSDB of 1.53 (CI: 1.1, 2.2, P = 0.02). The Cox proportional hazards model adjusted for the following covariates: LVEF, age, BMI, sex, race, creatinine, diabetes, type of cardiomyopathy, coronary artery disease, chronic kidney disease, discharge systolic blood pressure <110, hypertension, discharge medications, initial length of stay, admission sodium, haemoglobin, and BUN.

Conclusions: This is the largest study to date to evaluate the effect of SDB on post-discharge mortality in patients with AHF. Newly diagnosed CSA and OSA during AHF hospitalization are independently associated with post-discharge mortality.

Keywords: Heart failure; Post-discharge mortality; Sleep apnoea; Sleep disordered breathing.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of the screening process and disposition of participants. AHF, acute heart failure; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; in-hospital mortality on patients with completed sleep studies was 21 patients (6 CSA, 12 OSA, 3 negatives); 1096 survived the hospitalization.
Figure 2
Figure 2
Kaplan–Meier post-discharge survival plot of acute heart failure patients by sleep disordered breathing status. OSA, obstructive sleep apnoea. CSA, central sleep apnoea. nmSDB, no or minimal sleep disordered breathing.
Figure 3
Figure 3
Kaplan–Meier post-discharge survival plot of acute heart failure patients by treatment status. The plot includes acute heart failure patients who survived 6 months post-discharge and had their treatment status verified.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. From AM, Leibson CL, Bursi F, Redfield MM, Weston SA, Jacobsen SJ, Rodeheffer RJ, Roger VL. Diabetes in heart failure: prevalence and impact on outcome in the population. Am J Med 2006;119:591–599. - PubMed
    1. Barker WH, Mullooly JP, Getchell W. Changing incidence and survival for heart failure in a well-defined older population, 1970–1974 and 1990–1994. Circulation 2006;113:799–805. - PubMed
    1. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, Ferguson TB, Ford E, Furie K, Gillespie C, Go A, Greenlund K, Haase N, Hailpern S, Ho PM, Howard V, Kissela B, Kittner S, Lackland D, Lisabeth L, Marelli A, McDermott MM, Meigs J, Mozaffarian D, Mussolino M, Nichol G, Roger VL, Rosamond W, Sacco R, Sorlie P, Thom T, Wasserthiel-Smoller S, Wong ND, Wylie-Rosett J. Heart disease and stroke statistics – 2010 update: a report from the American Heart Association. Circulation 2010;121:e46–e215. - PubMed
    1. Bueno H, Ross JS, Wang Y, Chen J, Vidan MT, Normand SL, Curtis JP, Drye EE, Lichtman JH, Keenan PS, Kosiborod M, Krumholz HM. Trends in length of stay and short-term outcomes among Medicare patients hospitalized for heart failure, 1993–2006. JAMA 2010;303:2141–2147. - PMC - PubMed
    1. Muzzarelli S, Leibundgut G, Maeder MT, Rickli H, Handschin R, Gutmann M, Jeker U, Buser P, Pfisterer M, Brunner-La Rocca HP. Predictors of early readmission or death in elderly patients with heart failure. Am Heart J 2010;160:308–314. - PubMed

Publication types