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

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

Authors

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.

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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

Keywords

  • Acute heart failure
  • Sleep-disordered breathing
  • Positive airway pressure