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Apnea-hypopnea and desaturations in heart failure with reduced ejection fraction: Are we aiming at the right target?

Abstract：

BACKGROUND:Sleep disordered breathing (SDB) is common in patients with heart failure with reduced ejection fraction (HFrEF). An increased apnea-hypopnea index (AHI) is associated with poor outcomes. We examined whether an analysis of nocturnal desaturations (NDs) can improve the risk stratification. METHODS:Three-hundred seventy-six consecutive patients with stable chronic HFrEF and LVEF ≤ 45% were prospectively screened using polygraphy. Sleep apnea (SA) was defined as an AHI ≥ 15. The mean age was 59 ± 13 years, the mean LVEF was 30 ± 6%, and the median AHI was 18 [IQR: 9.33). The composite end-point of death, heart transplantation or LV assistance occurred in 98 patients (26%) within 3 years. Minimal oxygen saturation (MOS) during sleep, the number of desaturations <90%/h and the time spent with oxygen saturation <90% were significantly associated with adverse events (adjusted HR 1.25 [1.03-1.52], 1.25 [1.03-1.53], and 1.28 [1.04-1.59]), whereas the AHI was not (1.10 [0.86-1.39]). The best MOS cut-off value for poor outcomes was ≤ 88%. The patients with an MOS ≤ 88% had a significantly higher event rate (31.9%) than those with an MOS >88% (15.6%; p<0.01). The risk assessment using an MOS of ≤ 88% in addition to established prognostic markers yielded a net reclassification index (NRI) of nearly 6% and was particularly useful in the subgroup of patients with events (NRI: 8.4%). CONCLUSIONS:In HFrEF patients, ND ≤ 88% appears to be predictive of adverse events, independent of the presence of SA. This suggests that the risk assessment in HFrEF should also include ND in top of AHI.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Gellen B,Canouï-Poitrine F,Boyer L,Drouot X,Le Thuaut A,Bodez D,Covali-Noroc A,D'ortho MP,Guendouz S,Rappeneau S,Kharoubi M,Dubois-Rande JL,Hittinger L,Adnot S,Bastuji-Garin S,Damy T

doi

10.1016/j.ijcard.2015.11.108

subject

Has Abstract

pub_date

2016-01-15 00:00:00

pages

1022-8

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(15)30913-X

journal_volume

203

pub_type

杂志文章

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