Sleep Apnea Type Impacts Prognosis in Chronic Heart Failure Patients

Chronic heart failure patients with predominant central sleep apnea (CSA) have a higher risk of death or hospitalization than individuals with coexisting obstructive sleep apnea (OSA) and CSA, regardless of whether or not they receive adaptive servo-ventilation therapy (ASV), according to results from the ongoing FACE Multicenter National Cohort Study.

CSA affects roughly 30% of individuals with chronic heart failure and is associated with worse prognosis. ASV has been shown to more effectively treat CSA in chronic heart failure patients than continuous positive airway pressure (CPAP).
________________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Obstructive Sleep Apnea Linked to Diabetes
Can Sleep Apnea Lead to Dementia?
________________________________________________________________________________________________________________________________________________________________________

To examine how the type of sleep apnea affects prognosis, and to examine the effects of ASV therapy in these patients, the researchers analyzed 301 chronic heart failure patients (87% in New York Heart Association functional class II/III) participating in the FACE Multicentre National Cohort Study.

Participants had an Epworth Sleepiness Scale score of 7.5±5.0 (75% with no severe sleepiness). Major comorbidities included hypertension (72%), dyslipidemia (60%), atrial fibrillation (44%), diabetes (39%), or cerebrovascular event (29%).

Although predominant CSA and CSA-OSA patients exhibited similar cardiac disease severity and medical treatments, all-cause mortality and unplanned hospitalization at 3- month follow-up were significantly increased in chronic heart failure patients with predominant CSA (HR=3.0, p=0.04) and the most severe New York Heart Association class irrespective of ASV therapy, compared with those with coexisting CSA-OSA.

“Ventilation with ASV should be differentiated depending on heart failure type, since [chronic heart failure with reduced ejection fraction] and [chronic heart failure with preserved ejection fraction] may have different prognosis and care,” said lead study author Renaud Tamisier, MD, PhD, from Grenoble Alpes University in France. “Plus, depending on diagnosis, association with the obstructive event may change the prognosis of chronic heart failure on ASV.”

For this ongoing study, Tamisier said they next plan to analyze the 12-month follow-up data.

—Mike Bederka

Reference:

Tamisier R, Damy T, Davy J-M, et al. Morbidity and mortality of chronic heart failure (CHF) patients treated by adaptive servo-ventilation (ASV): interim data of the FACE Multicentre National Cohort Study. Presented at: ATS 2016 International Conference; May 18, 2016; San Francisco, California. http://www.thoracic.org/about/newsroom/press-releases/conference/2016/resources/6864-csa-chf-and-asv.pdf.