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Obstructive Sleep Apnea and Heart Failure

Mortality rates were twice as high among heart failure patients with untreated OSA as among those with mild or no OSA.

Obstructive sleep apnea (OSA), a common but underrecognized disorder in heart failure patients, is associated with adverse hemodynamic effects. To determine whether it is also associated with higher mortality rates, Canadian researchers performed polysomnography in 164 chronic heart failure patients with no history of sleep apnea; follow-up averaged 2.9 years.

Most patients (113) had mild or no sleep apnea. Of the 51 patients with moderate-to-severe OSA (apnea-hypopnea index, 15/hr of sleep), 14 were treated with continuous positive airway pressure (CPAP) and 37 were not treated. In an analysis controlled for age, New York Heart Association functional class, and left ventricular ejection fraction, the death rate was significantly higher in untreated OSA patients than in those with mild or no sleep apnea (hazard ratio, 2.81). No patients in the treated OSA group died, leading to a nonsignificant trend for reduced mortality in the treated-OSA group compared with the untreated-OSA group.

Comment: OSA was common in this cohort of heart failure patients and was associated with increased mortality when left untreated. Although CPAP treatment was associated only with a nonsignificant trend for reduced mortality, there were probably too few patients to demonstrate a significant reduction. In addition, treated patients had the highest average apnea-hypopnea indexes, suggesting that treatment actually might have been beneficial. Editorialists urge vigilance in diagnosing and treating OSA in our heart failure patients.

— Kirsten E. Fleischmann, MD, MPH

Published in Journal Watch General Medicine May 8, 2007

Citation(s):

Wang H et al. Influence of obstructive sleep apnea on mortality in patients with heart failure. J Am Coll Cardiol 2007 Apr 17; 49:1625-31.

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• Medline abstract (Free)

Le Jemtel TH and Jelic S. Seek and treat obstructive sleep apnea in heart failure. J Am Coll Cardiol 2007 Apr 17; 49:1632-3.

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• Medline abstract (Free)