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Automatic positive airway pressure for obstructive sleep apnea in heart failure with reduced ejection fraction.

Authors :
Fox H
Bitter T
Sauzet O
Rudolph V
Oldenburg O
Source :
Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2021 Jul; Vol. 110 (7), pp. 983-992. Date of Electronic Publication: 2020 Jul 10.
Publication Year :
2021

Abstract

Background: Moderate-to-severe obstructive sleep apnea (OSA) is highly prevalent in heart failure patients with reduced left ventricular ejection fraction (HFrEF), and is associated with worsening cardiac function and increased mortality.<br />Objectives: The automatic positive airway pressure (APAP) trial tested the impact of APAP treatment on changes for the pre-specified endpoints: changes in peak oxygen uptake (peak VO <subscript>2</subscript> ), percent-predicted peak VO <subscript>2</subscript> and oxygen uptake at anaerobic threshold (VO <subscript>2</subscript> -AT).<br />Methods: This randomized, controlled pilot study included patients with chronic, stable HFrEF who had moderate-to-severe OSA. Patients were randomized 1:1 to either APAP (AutoSetâ„¢, ResMed) or nasal strips (control) for 6 months.<br />Results: 76 patients have been randomized and 58 had complete data for final analysis. There was a statistically significant change in the APAP intervention arm for the primary endpoint percent-predicted peak VO <subscript>2</subscript> in comparison to control (67 ± 17 to 73 ± 19%; p = 0.01). Additional primary endpoints peak VO <subscript>2</subscript> and VO <subscript>2</subscript> -AT showed a trend in increase in the APAP group. Moreover, there were significant improvements within the APAP group for hypoxemia, left ventricular function and quality of life from baseline to 6 months, but not within the control group (p = 0.001 and p = 0.037, respectively).<br />Conclusion: APAP intervention was shown to significantly improve outcome compared to control group, represented in percent-predicted peak VO <subscript>2</subscript> , an established surrogate marker for cardiovascular prognosis in HFrEF. APAP has additional beneficial effects on hypoxemia, cardiac function and quality of life.

Details

Language :
English
ISSN :
1861-0692
Volume :
110
Issue :
7
Database :
MEDLINE
Journal :
Clinical research in cardiology : official journal of the German Cardiac Society
Publication Type :
Academic Journal
Accession number :
32651657
Full Text :
https://doi.org/10.1007/s00392-020-01701-1