More than half of hospitalized patients with heart failure have sleep apnea
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More than half of hospitalized adults with HF have obstructive sleep apnea or central sleep apnea, with male sex, higher BMI, higher heart rate and more comorbidities predicting sleep-disordered breathing, researchers reported.
“Considering the frequent co‐occurrence of sleep-disordered breathing in HF and its adverse prognosis, early diagnosis and treatment of sleep-disordered breathing may be beneficial,” Jian Zhang, MD, PhD, FACC, FESC, director of the Heart Failure Center at Fuwai Hospital in Beijing, and colleagues wrote in Clinical Cardiology. “Subjective daytime sleepiness symptoms are often absent in HF patients with sleep-disordered breathing and are therefore often missed. Thus, use of the clinical characteristics of patients with HF can provide clues for the diagnosis of sleep-disordered breathing, potentially increasing the detection rate of sleep-disordered breathing.”
Zhang and colleagues analyzed data from sleep studies that included 1,069 adults hospitalized for HF from January 2015 to February 2019. The mean age of patients was 56 years; mean BMI was 24.9 kg/m2. Sleep-disordered breathing was categorized as no/mild sleep-disordered breathing, obstructive sleep apnea (OSA) and central sleep apnea (CSA).
Within the cohort, the prevalence of OSA and CSA was 16.6% and 36.9%, respectively. Patients with OSA or CSA were more likely to be men, to have a higher BMI and to have more comorbidities.
In logistic regression analysis, researchers found that male sex (OR = 1.803; 95% CI, 1.099-2.958), BMI per 5 kg/m2 increase (OR = 2.27; 95% CI, 1.852-2.783), hypertension (OR = 2.719; 95% CI, 1.817-4.07), diabetes (OR = 1.477; 95% CI, 1.02-2.139), and each 5% increase in left ventricular ejection fraction (OR = 1.126; 95% CI, 1.053-1.204) were independent predictors of OSA.
Independent predictors of CSA included male sex (OR = 1.699; 95% CI, 1.085-1.271), age per 10 years (OR = 1.235; 95% CI, 1.118‐1.363), heart rate per 10 bpm (OR = 1.174; 95% CI, 1.099-2.958), N-terminal pro-B-type natriuretic peptide levels (OR = 1.234; 95% CI, 1.089-1.398) and hypocapnia (OR = 1.455; 95% CI, 1.105-1.915). Higher LVEF was protective against CSA, with an OR of 0.882 per 5% increase (95% CI, 0.835-0.932).
The areas under the receiver operating characteristic curves were 0.794 and 0.673 for OSA and CSA, respectively.
“Our study ... found that male sex, BMI, hypertension, diabetes and LVEF were independent correlated factors of OSA, indicating a close link between OSA and metabolic syndrome,” the researchers wrote. “Age, male sex, heart rate, LVEF, NT‐proBNP levels and hypocapnia are independent correlated factors of CSA in hospitalized patients with HF, suggesting that CSA is more likely to be the indicator and result of the severity of HF.”
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