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Unravelling the Ugly Truth about Sleep Apnea and Advanced Heart Failure: A Portuguese real-world setting
Session:
SESSÃO DE POSTERS 43 - INSUFICIÊNCIA CARDÍACA E COMORBILIDADES
Speaker:
Patrícia Bernardes
Congress:
CPC 2025
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Patrícia Bernardes; Mariana Marçal; Jéni Quintal; Tatiana Duarte; Hugo Viegas; Ana Sousa; Crisálida Ferreira; Dina Ferreira; Andreia Soares; Vânia Caldeira; Sara Gonçalves; Filipe Seixo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Sleep apnea (SA) is a prevalent sleep-related breathing disorder associated with intermittent hypoxia. Heart failure (HF) has emerged as a significant concern due to shared risk factors.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To estimate the prevalence and impact of sleep apnea on clinical outcomes in patients with advanced heart failure (AHF).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> This retrospective observational study included 74 outpatients with advanced heart failure followed at our HF unit, between September 2020 and September 2024. SA screening was performed in all pts by local protocol. Population was divided in 2 groups according to the presence of SA. Groups were compared according to basal characteristics and events. AHF was defined according to the 2018<em> Position statement from Heart Failure Association of the European Society of Cardiology for AHF.</em></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">This cohort included 74 pts with a mean age of 72 years (SD = 12,4). Mean follow up was 18,5 months ± 9,2. 93% had a current NYHA status of III or IV. Median NtproBNP was 5174 pg/mL.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">45% of pts (n = 33) were diagnosed with sleep apnea; 78% were male. Most pts had ischaemic HF (n=15; 45,5%). Regarding HF subtypes, HFrEF accounted for 70% (n=23), 21% (n=7) had HFmEF and 9% (n=3) had HFpEF. Mean ejection fraction at screening was lower in the SA group (33,7 ± 12,2, p = 0,003). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The majority of AHF pts was classified with severe SA (n=14; 42.4%; mean AHI 29,5 ± 13.2 events/h) and obstructive events (n=28; 84,8%). SA pts came to more urgent visits (7 ± 6,5 vs 4,9 ± 4,1, <em>p</em> = 0,045) and had higher rates of hypertension (88% vs 61%, <em>p</em> = 0,005). <u>The nº of urgent visits showed a moderate positive correlation with the apnea-hypopnea index (AHI) (r=0.453; p=0.027).</u> HF hospitalizations were low in both groups. In HFrEF pts, SA was associated with higher mean NT-proBNP (10432 vs 5902 pg/mL, <em>p</em> = 0,046).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All pts diagnosed with obstructive SA started positive airway pressure therapy; only 1 of them quitted treatment.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Death from any cause occurred in 36 pts (48,6%) traducing pt severity. SA was associated with a significantly higher incidence of death in pts with AHF (p = 0.011). <u>Furthermore, SA emerged as an independent predictor of mortality from any cause (OR = 3.3, 95% CI: 1.15–9.91, p = 0.026).</u></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion<span style="color:#bfbfbf">: </span></strong>Sleep apnea is a high prevalent comorbidity in pts with AHF and is associated with higher rates of decompensation. Early diagnose and tailored therapeutic strategies may contribute to reduce the burden of these interrelated conditions.</span></span></p>
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