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Randomized Controlled Trial
. 2020 Aug;26(8):705-712.
doi: 10.1016/j.cardfail.2020.06.007. Epub 2020 Jun 24.

In-Hospital Management of Sleep Apnea During Heart Failure Hospitalization: A Randomized Controlled Trial

Rami N Khayat  1 , Shahrokh Javaheri  2 , Kyle Porter  3 , Angela Sow  4 , Roger Holt  5 , Winfried Randerath  6 , William T Abraham  5 , David Jarjoura  7
Affiliations
Randomized Controlled Trial

In-Hospital Management of Sleep Apnea During Heart Failure Hospitalization: A Randomized Controlled Trial

Rami N Khayat et al. J Card Fail. 2020 Aug.

Abstract

Background: Obstructive sleep apnea (OSA) is associated with increased mortality and readmissions in patients with heart failure (HF). The effect of in-hospital diagnosis and treatment of OSA during decompensated HF episodes remains unknown.

Methods and results: A single-site, randomized, controlled trial of hospitalized patients with decompensated HF (n = 150) who were diagnosed with OSA during the hospitalization was undertaken. All participants received guideline-directed therapy for HF decompensation. Participants were randomized to an intervention arm which received positive airway pressure (PAP) therapy during the hospitalization (n = 75) and a control arm (n = 75). The primary outcome was discharge left ventricular ejection fraction (LVEF). The LVEF changed in the PAP arm from 25.5 ± 10.4 at baseline to 27.3 ± 11.9 at discharge. In the control group, LVEF was 27.3 ± 11.7 at baseline and 28.8 ± 10.5 at conclusion. There was no significant effect on LVEF of in-hospital PAP compared with controls (P = .84) in the intention-to-treat analysis. The on-treatment analysis in the intervention arm showed a significant increase in LVEF in participants who used PAP for ≥3 hours per night (n = 36, 48%) compared with those who used it less (P = .01). There was a dose effect with higher hours of use associated with more improvement in LVEF. Follow-up of readmissions at 6 months after discharge revealed a >60% decrease in readmissions for patients who used PAP ≥3 h/night compared with those who used it <3 h/night (P < .02) and compared with controls (P < .04).

Conclusions: In-hospital treatment with PAP was safe but did not significantly improve discharge LVEF in patients with decompensated HF and newly diagnosed OSA. An exploratory analysis showed that adequate use of PAP was associated with higher discharge LVEF and decreased 6 months readmissions.

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Figures

Figure 1:
Figure 1:. Flow Diagram of All Study Participants
ADHF: Acutely decompensated heart failure; CSA: central sleep apnea; ESRD: End stage renal disease; GDMT: Guideline directed medical therapy; HD: Hemodialysis; LVAD: Left ventricular assist device; OSA: Obstructive sleep apnea; SDB: Sleep disordered breathing
Figure 2:
Figure 2:. Effect of Hours of Nightly PAP Use on LVEF Change during Hospitalization
LVEF: Left ventricular ejection fraction; PAP: Positive airway pressure
See this image and copyright information in PMC

References

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    1. Khayat R, Jarjoura D, Porter K, Sow A, Wannemacher J, Dohar R, et al. Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. Eur Heart J. 2015. - PMC - PubMed
    1. Khayat R, Abraham W, Patt B, Brinkman V, Wannemacher J, Porter K, et al. Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure. J Card Fail. 2012;18(7):534–40. - PMC - PubMed

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