In-hospital treatment of obstructive sleep apnea during decompensation of heart failure

Abstract

Background: Treatment of obstructive sleep apnea (OSA) in outpatients with systolic heart failure improves cardiac function. We evaluated the impact of immediate inpatient diagnosis and treatment of OSA in hospitalized patients with acutely decompensated heart failure (ADHF) on in-hospital cardiac outcomes.

Methods: A pilot randomized controlled trial was conducted in an academic heart hospital. Patients with ADHF underwent an attended in-hospital sleep study within 2 days of hospital admission to establish the diagnosis of sleep-disordered breathing. The participants were 46 consecutive patients with ADHF who had OSA (apnea-hypopnea index [AHI], >or= 15 events per hour). Participants were randomly assigned to either the intervention arm (n = 23), with in-hospital treatment of OSA using auto-adjusting positive airway pressure along with standard treatment of ADHF, or to the control arm (n = 23), in which they received only standard treatment for ADHF. The primary outcome was the change in left ventricular ejection fraction (LVEF) 3 nights postrandomization.

Results: The change in LVEF from baseline to 3 days postrandomization in the intervention arm was significantly superior to that of the control group. The difference in LVEF improvement was 4.6% (p = 0.03). LVEF increased in the intervention group by 4.5% (SE, 1.7%). The LVEF change in the control arm was--0.3% (SE, 1.5%). The difference in LVEF improvement between the two groups persisted after adjustment for baseline LVEF, type of cardiomyopathy, BMI, AHI, and sex.

Conclusions: An approach of early identification and in-hospital treatment of OSA in patients with ADHF is feasible and resulted in improvement in systolic function. The impact of this approach on out-of-hospital outcomes requires further investigation.

Trial registration: ClinicalTrials.gov Identifier: NCT00701038.

Figures

Figure 1

Disposition of participants. The most common reasons for exclusion (64%) were LVEF > 45% and projected length of stay

Figure 2

Individual change of LVEF in control and intervention arms. Dotted lines represent the average change for each group. Note that the patient in the treatment group with a 35% change in LVEF was removed in the sensitivity analysis, and the significance of the treatment advantage persisted (LVEF difference, 3.3%; p = 0.03).