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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Sleep apnea screening in heart failure: An exploratory analysis
Session:
Posters 5 - Écran 5 - Insuficiência Cardíaca
Speaker:
Gonçalo José Lopes Da Cunha
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.3 Acute Heart Failure – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Gonçalo Lopes Da Cunha; Bruno M. Rocha; Rita Ventura Gomes; Joana A. Duarte; Rui Morais; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background: </strong></p> <p>Sleep Apnea (SA) is increasingly recognized in patients with Heart Failure (HF). Nocturnal polysomnography (PSG) is the gold-standard to diagnose SA. Portable devices have also been validated in HF cohorts either in chronic or acute settings. The main goals of this investigation were to determine the correlation between clinical, laboratory and respiratory measurements with the presence of SA, defined as apnea-hypopnea index (AHI) >15/h, and with desaturation time with SpO<sub>2</sub> <90% (T90) =22 minutes, a strong mortality predictor in HF with reduced ejection fraction (HFrEF).</p> <p> </p> <p><strong>Methods: </strong></p> <p>This work is based on a single-center retrospective cohort of consecutive patients hospitalized for decompensated HF from 2013 to 2018. All patients were assessed with ApneaLink<sup>TM</sup> screening portable device the day before discharge. HF was defined as recommended by the European Society of Cardiology guidelines. Similar to SERVE-HF trial, HFrEF and HF with preserved ejection fraction (HFpEF) were defined by a left ventricular ejection fraction (LVEF) =45% or >45%, respectively.</p> <p> </p> <p><strong>Results:</strong></p> <p>A total of 228 patients were included in the analysis. SA was present in 135 (59,2%) patients. Mean age was 75,3 ± 10,5 years, 51,1% were female, and 58,8% had HFpEF. Hypertension (81,8%), atrial fibrillation (57,7%) and diabetes <em>mellitus</em> (45,8%) were the most frequently observed comorbidities. Median NT-proBNP was 2093 ± 3037pg/mL, mean AHI was 24,5 ± 19,2/h, mean O<sub>2</sub> 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 etiology of HF were predictors of AHI >15/h (R<sup>2</sup> 65,8%), with ODI being the strongest predictor (standardized coefficient 64,8%). The cutoff of ODI=14,50/h had sensitivity of 90,5% and specificity of 83,8% to predict AHI>15/h (area under the curve (AUC) 0,933, p<0,001). Similarly, mean SpO2 was the only predictor of T90 =22minutes (R<sup>2</sup> 65,8%). The cut-off of mean SpO2=92,50% had sensitivity of 94,7% and specificity of 84,4% to predict T90 =22 minutes (AUC 0,944, p<0,001).</p> <p> </p> <p><strong>Conclusions:</strong></p> <p>SA was strongly predicted by ODI in a cohort of patients with recently compensated HF. Likewise, T90 =22minutes was highly predicted by mean SpO<sub>2</sub>. One may wonder whether simple pulse oximetry ODI and mean SpO<sub>2</sub> measurements can be routinely used for SA screening, since PSG and portable devices are not widely available. This hypothesis is worth being prospectively assessed.</p>
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