Naito Ryo, Kasai Takatoshi, Tomita Yasuhiro, Kasagi Satoshi, Narui Koji, Momomura Shin-Ichi
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Front Cardiovasc Med. 2023 Jun 16;10:1156353. doi: 10.3389/fcvm.2023.1156353. eCollection 2023.
Heart failure (HF) is an advanced stage of cardiac disease and is associated with a high rate of mortality. Previous studies have shown that sleep apnea (SA) is associated with a poor prognosis in HF patients. Beneficial effects of PAP therapy that is effective on reducing SA on cardiovascular events, were not yet established. However, a large-scale clinical trial reported that patients with central SA (CSA) which was not effectively suppressed by continuous positive airway pressure (CPAP) revealed poor prognosis. We hypothesize that unsuppressed SA by CPAP is associated with negative consequences in patients with HF and SA, including either obstructive SA (OSA) or CSA.
This was a retrospective observational study. Patients with stable HF, defined as left ventricular ejection fraction of ≤50%; New York Heart Association class ≥ II; and SA [apnea-hypopnea index (AHI) of ≥15/h on overnight polysomnography], treated with CPAP therapy for 1 month and performed sleep study with CPAP were enrolled. The patients were classified into two groups according to AHI on CPAP (suppressed group: residual AHI ≥ 15/h; and unsuppressed group: residual AHI < 15/h). The primary endpoint was a composite of all-cause death and hospitalization for HF.
Overall, data of 111 patients including 27 patients with unsuppressed SA, were analyzed. The cumulative event-free survival rates were lower in the unsuppressed group during a period of 36.6 months. A multivariate Cox proportional hazard model showed that the unsuppressed group was associated with an increased risk for clinical outcomes (hazard ratio 2.30, 95% confidence interval 1.21-4.38, = 0.011).
Our study suggested that in patients with HF and SA including either OSA or CSA, presence of unsuppressed SA even on CPAP was associated with worse prognosis as compared to those with suppressed SA by CPAP.
心力衰竭（HF）是心脏病的晚期阶段，与高死亡率相关。先前的研究表明，睡眠呼吸暂停（SA）与HF患者的不良预后相关。持续气道正压通气（PAP）治疗对减少SA有效，但对心血管事件的有益作用尚未得到证实。然而，一项大规模临床试验报告称，持续气道正压通气（CPAP）不能有效抑制的中枢性SA（CSA）患者预后较差。我们假设，CPAP不能抑制的SA与HF和SA患者的不良后果相关，包括阻塞性SA（OSA）或CSA。
这是一项回顾性观察研究。纳入了稳定HF患者，定义为左心室射血分数≤50%；纽约心脏协会分级≥II级；以及SA[夜间多导睡眠图呼吸暂停低通气指数（AHI）≥15次/小时]，接受CPAP治疗1个月并使用CPAP进行睡眠研究。根据CPAP上的AHI将患者分为两组（抑制组：残余AHI≥15次/小时；未抑制组：残余AHI<15次/小时）。主要终点是全因死亡和HF住院的复合终点。
总体而言，分析了111例患者的数据，其中包括27例SA未得到抑制的患者。在36.6个月的时间里，未抑制组的累积无事件生存率较低。多变量Cox比例风险模型显示，未抑制组与临床结局风险增加相关（风险比2.30，9%置信区间1.21-4.38，P=0.011）。
我们的研究表明，在患有HF和SA（包括OSA或CSA）的患者中，即使使用CPAP，SA未得到抑制与SA得到CPAP抑制的患者相比，预后更差。
