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.
A single site randomized controlled trial in hospitalized patients with decompensated HF (n=150) who were diagnosed with OSA during the hospitalization. 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).
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 to control (p = 0.84) in the intention to treat analysis. On treatment analysis in the intervention arm showed a significant increase in LVEF in participants who used PAP ≥ 3 hours per night (n=36, 48%) compared to those who used it less (p=0.01). There was a dose effect with higher hours of usage associated with more improvement in LVEF. Follow-up of readmissions after 6-months post discharge revealed a >60% decrease in readmissions for patients who used PAP ≥3 hours/night compared to those who used it less than 3 hours/night (p<0.02) and compared to controls (p<0.04).
In-hospital treatment with PAP was safe but did not significantly improve discharge LVEF in patients with decompensated HF and newly diagnosed OSA. Exploratory analysis showed that adequate use of PAP was associated with higher discharge LVEF and decreased 6 months readmissions.

Copyright © 2020. Published by Elsevier Inc.

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