The UCI Sleep Disorders Center and the Division of Pulmonary and Critical Care, University of California at Irvine, Irvine, California; The Sleep Heart Program at the Ohio State University, Columbus, Ohio.
Bethesda North Hospital, Cincinnati, Ohio; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio; University of Cincinnati College of Medicine, Cincinnati, Ohio.
J Card Fail. 2020 Aug;26(8):705-712. doi: 10.1016/j.cardfail.2020.06.007. Epub 2020 Jun 24.
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.
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).
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.
阻塞性睡眠呼吸暂停（OSA）与心力衰竭（HF）患者的死亡率和再入院率增加有关。在失代偿性 HF 发作期间，对 OSA 的院内诊断和治疗的影响尚不清楚。
对 150 名住院治疗失代偿性 HF 且在住院期间被诊断为 OSA 的患者进行了一项单中心、随机、对照试验。所有参与者均接受 HF 失代偿的指南指导治疗。参与者被随机分配到干预组（n=75）和对照组（n=75），在住院期间接受正压通气（PAP）治疗。主要结局是出院时左心室射血分数（LVEF）。PAP 组的 LVEF 从基线时的 25.5±10.4 变化到出院时的 27.3±11.9。对照组的 LVEF 基线时为 27.3±11.7，出院时为 28.8±10.5。在意向治疗分析中，与对照组相比，住院期间 PAP 对 LVEF 无显著影响（P=0.84）。干预组的治疗分析显示，夜间使用 PAP≥3 小时的参与者的 LVEF 显著增加（n=36，48%），而使用时间较少的参与者则没有（P=0.01）。使用时间与 LVEF 改善程度呈正相关。出院后 6 个月的随访结果显示，夜间使用 PAP≥3 小时的患者的再入院率较夜间使用 PAP<3 小时的患者（P<0.02）和对照组（P<0.04）下降了>60%。
在失代偿性 HF 合并新诊断的 OSA 患者中，住院期间使用 PAP 治疗是安全的，但不能显著提高出院时的 LVEF。一项探索性分析显示，PAP 的充分使用与更高的出院 LVEF 和降低 6 个月再入院率有关。
