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Sleep Apnea in Heart Failure: in search of a better prognosis predictor..
Session:
Painel 1 - Insuficiencia cardiaca 1
Speaker:
Sérgio Maltês
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Sérgio Maltês; Gonçalo Lopes Da Cunha; Bruno M. Rocha; Joana Duarte; Rita Gomes; Rita Silvério; Carla Maravilha; João Presume; Luis Campos; Célia Henriques; Catarina Rodrigues; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background</strong></p> <p>Sleep apnea (SA) is a burdensome and often underdiagnosed condition in heart failure (HF). Portable devices, such as ApneaLink<sup>TM</sup>, are currently validated as a screening tool for SA. The apnea-hypopnea index (AHI) as been long considered the gold-standard measurement for the diagnosis of SA, also having a prognosis impact. Recently, however, other respiratory variables have been proposed as better prognosis predictors in patients with HF. The main goal of this study was to assess the prognostic value of other respiratory measurements evaluated by ApneaLink<sup>TM</sup> at discharge in a population admitted for HF.</p> <p><strong>Methods</strong></p> <p>This was a single-center retrospective study enrolling consecutive patients admitted in a HF Clinic for acute HF from 2013 and 2018. All stable patients without previously known sleep-disordered breathing underwent ApneaLink<sup>TM </sup>screening the night before discharge in the euvolemic state. Those with a total respiratory evaluation time <180 minutes or in need of supplemental oxygen were excluded. A primary endpoint of long-term HF hospitalizations was evaluated.</p> <p><strong>Results</strong></p> <p>Overall, 231 patients (mean age 74.5 ± 10.6 years; 47% male; 83% hypertension; 41% chronic kidney disease; 44% anemia; 18% with a NYHA>2 at discharge; 43% ischaemic HF; 41% with a left ventricle ejection fraction lower than 50%) were assessed. One-hundred and sixty-nine patients (59.1%) had an AIH >15, with a median of 19 (IQR 7-42); the median number of obstructive apneas and central apneas was 13 (IQR 2-68), and 2 (IQR 0-10), respectively. Two-hundred patients (69.9%) had nocturnal periods of an oxygen saturation below 85% (T85), with a median time under that value of 8 (IQR 0-47) minutes. Over a median follow-up of 34.1 (IQR 18.40-54.37) months, 105 (45.7%) patients died and 128 (55.7%) were readmitted for AHF. After adjustment for cofounders (namely, the presence of anemia) a T85 above the 75<sup>th</sup> percentile was significantly correlated with a higher risk of HF readmission in a multivariate analysis (adjusted HR: 1.58, 95% CI: 1.08-2.30, p=0.017) (figure 1). These results were independent of the apnea-hypopnea index.</p> <p><strong>Conclusion</strong></p> <p>Nocturnal hypoxemia (T85) was an independent predictor of rehospitalization in patients with HF. These results further validate the utility and prognosis impact of other respiratory measurements (other than AHI) evaluated by ApneaLink<sup>TM</sup> screening at discharge in a population of patients admitted for HF.</p>
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