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Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure

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Abstract

Background

Identifying patients at risk for poor clinical outcomes following acute heart failure (AHF) is essential. However, data regarding the prognostic effect of sleep-disordered breathing (SDB) and treatment with positive airway pressure (PAP) on clinical outcomes of hospitalized patients following AHF is lacking.

Objectives

This study investigated the prognostic effect of SDB, PAP treatment, and compliance with PAP treatment on patient clinical outcomes. Polysomnography was performed in hospitalized patients whose left ventricular ejection fraction was < 50%. Patients were divided into groups based on whether SDB was defined as an apnea–hypopnea index ≥ 15 and if they had received PAP treatment. Furthermore, patients with SDB and PAP were subdivided into more and less compliant groups. We assessed the incidences of deaths and rehospitalizations due to heart failure.

Results

Overall, 241 patients were enrolled; 73% had SDB and 29% were initiated on PAP treatment. At a median follow-up of 1.7 years, 74 clinical events (32 deaths, 42 rehospitalizations) occurred. In the multivariable analysis, compared with the non-SDB group, SDB without PAP treatment was associated with an increased risk of clinical outcomes (hazard ratio [HR] 1.79, P = 0.049), whereas SDB with PAP treatment was not (HR 0.78, P = 0.582). Among patients with PAP treatment, a more compliant group was also inversely associated with clinical events (HR 0.11, P = 0.012).

Conclusions

In hospitalized patients with AHF, untreated SDB was associated with worse clinical outcomes that might be reversible by PAP treatment. However, this potential may be suppressed in less compliant patients.

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Acknowledgements

We are indebted to Nanako Shiroshita, Mitsue Kato and Fusae Kawana for scientific advice.

Funding

This study is partly supported by a Grant-in-Aid for Scientific Research (Grant Number, 26507010); JSPS KAKENHI (Grant Number, JP17K09527); JSPS KAKENHI (Grant Number, JP18K15904); a grant to The Intractable Respiratory Diseases and Pulmonary Hypertension Research Group from the Ministry of Health, Labor and Welfare (20FC1027); a grant from the Ministry of Education, Culture, Sports, Science and Technology (MEXT) Program for the Strategic Research Foundation at Private Universities, 2014–2018, Japanese Center for Research on Women in Sport, Juntendo University, Project for Fostering, Survey Research for the Strategic Strengthening of Female Athletes 2017–2018 by the Japan Sports Agency. These funding sources did not play any other role in this study.

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Authors and Affiliations

  1. Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan

    Sayaki Ishiwata, Takatoshi Kasai, Akihiro Sato, Shoko Suda, Hiroki Matsumoto, Jun Shitara, Shoichiro Yatsu, Azusa Murata, Megumi Shimizu, Takao Kato, Masaru Hiki, Yuya Matsue, Ryo Naito, Hiroyuki Daida & Tohru Minamino

  2. Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan

    Sayaki Ishiwata, Takatoshi Kasai, Akihiro Sato, Yuya Matsue & Ryo Naito

  3. Sleep and Sleep-Disordered Breathing Center, Juntendo University Hospital, Tokyo, 113-8421, Japan

    Sayaki Ishiwata, Takatoshi Kasai, Shoko Suda & Ryo Naito

  4. Department of Cardiovascular Management and Remote Monitoring, Juntendo University Graduate School of Medicine, Tokyo, 113-8421, Japan

    Takatoshi Kasai

  5. Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development, Tokyo, Japan

    Tohru Minamino

  6. Faculty of Health Science, Juntendo University, Tokyo, Japan

    Hiroyuki Daida

Authors
  1. Sayaki Ishiwata
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  2. Takatoshi Kasai
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  3. Akihiro Sato
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  4. Shoko Suda
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  6. Jun Shitara
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  7. Shoichiro Yatsu
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  8. Azusa Murata
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  9. Megumi Shimizu
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  10. Takao Kato
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  11. Masaru Hiki
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  15. Tohru Minamino
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Contributions

SI contributed to this manuscript. Study design: SI and TK. Data collection: authors. Data analysis and statistical analysis: SI and TK. Manuscript draft: SI and TK. Critical revision, editing, and approval of the final manuscript: all authors. SI, TK, HD, and TM are responsible for the overall content as guarantors.

Corresponding author

Correspondence to Takatoshi Kasai.

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Conflict of interest

Dr. S. Ishiwata, Dr. T. Kasai, Dr. A. Sato, Dr. Y. Matsue, and Dr. R. Naito are affiliated with a department endowed by Philips, ResMed, and Fukuda Denshi. Dr. T. Kasai is affiliated with an endowed department by Paramount Bed. Dr. Y. Matsue received an honorarium from Otsuka Pharmaceutical Co. and Novartis Japan, and received research funds from Otsuka Pharmaceutical Co. and Pfizer Japan Inc. Dr. H. Daida reports research grants from CANON MEDICAL SYSTEMS CORPORATION, Philips Japan, Ltd., TOHO HOLDINGS CO., LTD., ASAHI KASEI CORPORATION, Inter Reha Co., Ltd., scholarship grants from Nippon Boehringer Ingelheim Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Sanofi K.K., MSD K.K., Daiichi-Sankyo Company, Limited, Pfizer Co., Ltd., Mitsubishi Tanabe Pharma Corp., Astellas Pharma Inc., Takeda Pharmaceutical Co. Ltd., TEIJIN PHARMA LTD., Shionogi & Co. Ltd., Actelion Pharmaceuticals Ltd., Actelion Ltd., KOWA Pharmaceutical Company Ltd., Bayer Yakuhin, Ltd, lecture fees from Amgen Inc., Daiichi-Sankyo Company, Ltd., KOWA Pharmaceutical LTD., MSD K.K.

Ethics approval

The Institutional Review Board of the Juntendo University Hospital approved the study protocol (871).

Informed consent

The study complied with the Declaration of Helsinki. Informed consent was obtained from all patients.

Consent to publish

Consent to publish was obtained.

Consent to participate

All study participants provided informed consent.

Supplementary Information

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Supplementary file1 (DOCX 306 KB)

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Ishiwata, S., Kasai, T., Sato, A. et al. Prognostic effect of sleep-disordered breathing on hospitalized patients following acute heart failure. Clin Res Cardiol 111, 663–672 (2022). https://doi.org/10.1007/s00392-021-01969-x

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  • DOI: https://doi.org/10.1007/s00392-021-01969-x

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