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Sleep apnea screening in heart failure: an exploratory analysis

Session Poster Session 3

Speaker Rita Ventura Gomes

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Comorbidities
  • Session type : Poster Session

Authors : R Ventura Gomes (Vila Franca de Xira,PT), B Rocha (Lisbon,PT), G Cunha (Lisbon,PT), R Morais (Lisbon,PT), L Fernandes (Lisbon,PT), L Campos (Lisbon,PT), I Araujo (Lisbon,PT), C Fonseca (Lisbon,PT)

R Ventura Gomes1 , B Rocha2 , G Cunha2 , R Morais3 , L Fernandes3 , L Campos4 , I Araujo3 , C Fonseca3 , 1Hospital de Vila Franca de Xira, Cardiology - Vila Franca de Xira - Portugal , 2Hospital de Santa Cruz, Cardiology - Lisbon - Portugal , 3Hospital São Francisco Xavier, CHLO, Clínica de Insuficiência Cardíaca - Lisbon - Portugal , 4Hospital de Sao Francisco Xavier, Medicine - Lisbon - Portugal ,


Sleep Apnea (SA) is increasingly recognized in patients (pts) with Heart Failure (HF). Nocturnal polysomnography (PSG) is the gold-standard to diagnose SA. Currently, portable devices have been thoroughly validated in HF cohorts.

To determine the correlation between clinical, laboratory and respiratory measurements with the presence of SA (defined as apnea-hypopnea index (AHI) >15/h) and desaturation time with SpO2 <90% (T90) =22 minutes, a strong mortality predictor in HF with reduced ejection fraction (HFrEF); and to compare the features of pts with HFrEF vs HF with preserved ejection fraction (HFpEF).

Our work is based on a single-center retrospective cohort of pts hospitalized for decompensated HF during 2013-2018. All pts were screened for SA with ApneaLinkTMafter compensation the night preceding discharge. HF was defined as recommended by the European Society of Cardiology guidelines. A left ventricular ejection fraction =45% and >45% was used to define HFrEF and HFpEF, respectively, as per SERVE-HF trial. 

A total of 228 pts were included in the analysis (mean age 75.3 ± 10.5 years, 48.9% male). SA was present in 135 (59.2%) pts and 41.2% had HFrEF. Mean AHI was 24.5 ± 19.2/h, mean O2 desaturation index (ODI) was 24.4 ± 21.0/h and mean T90 was 169.6 ± 151.2 minutes. In multivariate models, ODI, gender and ischemic HF were predictors of AHI >15/h (R265.8%), with ODI being the strongest predictor (standardized coefficient 64.8%). Similarly, mean SpO2 was the only predictor of T90 =22minutes (R265.8%) (Figure 1). HFrEF pts had more often AHI>15/h (73.4% vs 48.5%, p<0.001), more total apneas (62 ± 148 vs 16 ± 79, p<0.001), obstructive apneas (28 ± 76 vs 8 ± 43, p<0.001) and central apneas (6 ± 20 vs 0 ± 5, p<0.001) than those with HFpEF. In multivariate models, ODI (OR 1.14, CI 1.03-1.26, p=0.013 for HFrEF; OR 1.21, CI 1.11-1.33, p<0.0001 for HFpEF) and mean SpO2 (OR 0.29, CI 0.14-0.60, p=0.001 for HFrEF; OR 0.23, CI 0.10-0.52, p<0.0001 for HFpEF) were the only predictors of AHI >15/h and T90 =22 minutes in both groups, respectively. 

SA was highly prevalent in HFrEF and HFpEF. ODI and mean SpO2 were highly predictive of AHI >15/h and T90 =22minutes, respectively, both prognostic markers validated in a population with HFrEF, and equally so in HFrEF and HFpEF. These findings hypothesize a similar pathophysiology of SA in HF, regardless of left ventricular systolic function. Also, whether simple pulse oximetry can be routinely used for SA screening, since PSG and portable devices are often not widely available, is a finding worth being prospectively assessed.

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