Universität zu Köln

Khayat, Rami N., Javaheri, Shahrokh, Porter, Kyle, Sow, Angela, Holt, Roger, Randerath, Winfried, Abraham, William T. and Jarjoura, David (2020). In-Hospital Management of Sleep Apnea During Heart Failure Hospitalization: A Randomized Controlled Trial. J. Card. Fail., 26 (8). S. 705 - 713. PHILADELPHIA: CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS. ISSN 1532-8414

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Abstract

Background: Obstructive sleep apnea (OSA) is associated with increased mortality and readmissions in patients with heart failure (HF). The effect of in-hospital diagnosis and treatment of OSA during decompensated HF episodes remains unknown. Methods and Results: A single-site, randomized, controlled trial of hospitalized patients with decompensated HF (n = 150) who were diagnosed with OSA during the hospitalization was undertaken. All participants received guideline-directed therapy for HF decompensation. Participants were randomized to an intervention arm which received positive airway pressure (PAP) therapy during the hospitalization (n = 75) and a control arm (n = 75). The primary outcome was discharge left ventricular ejection fraction (LVEF). The LVEF changed in the PAP arm from 25.5 +/- 10.4 at baseline to 27.3 +/- 11.9 at discharge. In the control group, LVEF was 27.3 +/- 11.7 at baseline and 28.8 +/- 10.5 at conclusion. There was no significant effect on LVEF of in-hospital PAP compared with controls (P = .84) in the intention-to-treat analysis. The on-treatment analysis in the intervention arm showed a significant increase in LVEF in participants who used PAP for 3 hours per night (n = 36, 48%) compared with those who used it less (P = .01). There was a dose effect with higher hours of use associated with more improvement in LVEF. Follow-up of readmissions at 6 months after discharge revealed a >60% decrease in readmissions for patients who used PAP >3 h/night compared with those who used it <3 h/night (P < .02) and compared with controls (P < .04). Conclusions: In-hospital treatment with PAP was safe but did not significantly improve discharge LVEF in patients with decompensated HF and newly diagnosed OSA. An exploratory analysis showed that adequate use of PAP was associated with higher discharge LVEF and decreased 6 months readmissions. (J Cardiac Fail 2020;26:705-712)

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Khayat, Rami N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Javaheri, Shahrokh UNSPECIFIED UNSPECIFIED UNSPECIFIED Porter, Kyle UNSPECIFIED UNSPECIFIED UNSPECIFIED Sow, Angela UNSPECIFIED UNSPECIFIED UNSPECIFIED Holt, Roger UNSPECIFIED UNSPECIFIED UNSPECIFIED Randerath, Winfried UNSPECIFIED UNSPECIFIED UNSPECIFIED Abraham, William T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Jarjoura, David UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-324462
DOI:	10.1016/j.cardfail.2020.06.007
Journal or Publication Title:	J. Card. Fail.
Volume:	26
Number:	8
Page Range:	S. 705 - 713
Date:	2020
Publisher:	CHURCHILL LIVINGSTONE INC MEDICAL PUBLISHERS
Place of Publication:	PHILADELPHIA
ISSN:	1532-8414
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language POSITIVE AIRWAY PRESSURE; PREVALENCE; MORTALITY; CPAP Multiple languages Cardiac & Cardiovascular Systems Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/32446