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CLINICAL RESEARCH: HEART FAILURE

Influence of Obstructive Sleep Apnea on Mortality in Patients With Heart Failure

Hanqiao Wang, MD^_*, John D. Parker, MD, FACC^,, Gary E. Newton, MD, FACC, John S. Floras, MD, DPhil, FACC^,, Susanna Mak, MD, PhD, Kuo-Liang Chiu, MD, MSc^_*, Pimon Ruttanaumpawan, MD^_*, George Tomlinson, PhD and T. Douglas Bradley, MD^_*,,,_*

^_* Sleep Research Laboratory of the Toronto Rehabilitation Institute
Department of Medicine of the Mount Sinai Hospital
Department of Medicine of the Toronto General Hospital/University Health Network
Centre for Sleep Medicine and Circadian Biology, University of Toronto, Toronto, Ontario, Canada

Manuscript received April 24, 2006; revised manuscript received December 11, 2006, accepted December 19, 2006.

^_* Reprint requests and correspondence: Dr. T. Douglas Bradley, Toronto General Hospital/University Health Network, 9N-943, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada. (Email: douglas.bradley{at}utoronto.ca).

Objectives: This study sought to determine, in patients with heart failure (HF), whether untreated moderate to severe obstructive sleep apnea (OSA) is associated with a higher mortality rate than in patients with mild to no sleep apnea (M-NSA).

Background: Obstructive sleep apnea is common in patients with HF and exposes the heart and circulation to adverse mechanical and autonomic effects. However, its effect on mortality rates of patients with HF has not been reported.

Methods: In a prospective study involving 164 HF patients with left ventricular ejection fractions (LVEFs) 45%, we performed polysomnography and compared death rates between those with M-NSA (apnea-hypopnea index [AHI] <15/h of sleep) and those with untreated OSA (AHI 15/h of sleep).

Results: During a mean (± SD) of 2.9 ± 2.2 and a maximum of 7.3 years of follow-up, the death rate was significantly greater in the 37 untreated OSA patients than in the 113 M-NSA patients after controlling for confounding factors (8.7 vs. 4.2 deaths per 100 patient-years, p = 0.029). Although there were no deaths among the 14 patients whose OSA was treated by continuous positive airway pressure (CPAP), the mortality rate was not significantly different from the untreated OSA patients (p = 0.070).

Conclusions: In patients with HF, untreated OSA is associated with an increased risk of death independently of confounding factors.

Abbreviations and Acronyms   AHI = apnea-hypopnea index   BMI = body mass index   CPAP = continuous positive airway pressure   HF = heart failure   HR = hazard ratio   LVEF = left ventricular ejection fraction   M-NSA = mild to no sleep apnea   NYHA = New York Heart Association   OSA = obstructive sleep apnea   SaO 2 = arterial oxygen saturation   SNA = sympathetic nervous system activity

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