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Sleep Apnea in the spectrum of Heart Failure: a closer look at preserved versus reduced function
Session:
Posters 4 - Écran 10 - Insuficiência Cardíaca
Speaker:
Bruno M. Rocha
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.1 Chronic Heart Failure – Pathophysiology and Mechanisms
Session Type:
Posters
FP Number:
---
Authors:
Bruno M. Rocha; Gonçalo Lopes Da Cunha; Joana A. Duarte; Rita Ventura Gomes; Rui Morais; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background: </strong>Sleep Apnea (SA) is scarcely investigated in Heart Failure (HF) with preserved ejection fraction (HFpEF) compared to HF with reduced ejection fraction (HFrEF). The main goals of this study were to determine the features of patients with HFrEF vs HFpEF and SA [defined by apnea-hypopnea index (AHI) >15/h] or a desaturation time with SpO<sub>2</sub> <90% (T90) ≥22 minutes.</p> <p><strong>Methods: </strong>Our work is based on a single-center retrospective cohort of patients hospitalized for decompensated HF during 2013-2018. All patients were screened for SA with ApneaLink<sup>TM </sup>the day preceding discharge, a thoroughly validated screening tool in this population. HF was defined as recommended by the European Society of Cardiology guidelines. A left ventricular ejection fraction (LVEF) ≤45% and >45% was used to define HFrEF and HFpEF, respectively, as per SERVE-HF trial.</p> <p><strong>Results: </strong>A total of 228 patients were included in the analysis. Mean age of the overall cohort was 75,3 ± 10,5 years and 41,2% had HFrEF. Compared HFpEF, those with HFrEF were more often male with ischemic HF (p<0,001), had more often AHI>15/h (73,4% vs 48,5%, p<0,001), and were significantly more likely to have 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). T90 ≥22 minutes was highly prevalent and no different between groups (78,7% vs 71,6%, p=0,227). In multivariate models, oxygen desaturation index (ODI) was the only predictor of AHI >15/h in both HFrEF [area under the curve (AUC) 0,942, p<0,001) and HFpEF (AUC 0,935, p<0,001), with the best cutoff of ≥11,50/h (sensitivity 91,9%; specificity 86,2%) and ≥14,50/h (sensitivity 90,4%; specificity 84,9%), respectively. Similarly, mean SpO<sub>2</sub> was the only predictor of T90 ≥22 minutes in both HFrEF (AUC 0,910, p<0,001) and HFpEF (AUC 0,959, p<0,001), with the best cutoff of ≤92,5% (sensitivity 92,3%; specificity 77,5%) and ≤92,5% (sensitivity 96,0%; specificity 89,0%), respectively.</p> <p><strong>Conclusions: </strong>In a cohort of patients with recently compensated HF, SA was more prevalent in HFrEF compared to HFpEF. Even so, almost half of those with HFpEF had SA. Interestingly, the multivariate models were highly predictive of AHI >15/h and T90 ≥22minutes, both prognostic markers validated in a population with HFrEF, and equally so in HFrEF and HFpEF. Thus, one may argue that these findings hypothesize a similar pathophysiology of SA in HF, regardless of LVEF.</p>
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