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

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• 作者：Barnabas Gellen^a ; ^b ; ^h ; ^{barnabas.gellen@hmn.aphp.fr" class="auth_mail" title="E-mail the corresponding author} ; Florence Canouï ; -Poitrine^c ; ^d ; ¹ ; Laurent Boyer^b ; ^e ; Xavier Drouot^e ; ^f ; Auré ; lie Le Thuaut^c ; ^d ; Diane Bodez^a ; Ala Covali-Noroc^e ; Marie Pia D'ortho^g ; Soulef Guendouz^a ; Sté ; phane Rappeneau^a ; Mounira Kharoubi^a ; Jean-Luc Dubois-Rande^a ; ^b ; ^d ; Luc Hittinger^a ; ^b ; ^d ; Serge Adnot^b ; ^e ; Sylvie Bastuji-Garin^c ; ^d ; Thibaud Damy^a ; ^b
• 关键词：Heart failure ; Sleep disordered breathing ; Apnea&ndash ; hypopnea index ; Desaturation ; Prognosis
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：15 January 2016
• 年：2016
• 卷：203
• 期：Complete
• 页码：1022-1028
• 全文大小：598 K

文摘

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.