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

作者：Gellen Barnabas^*; Canoui Poitrine Florence; Boyer Laurent; Drouot Xavier; Le Thuaut Aurelie; Bodez Diane; Covali Noroc Ala; D'ortho Marie Pia; Guendouz Soulef; Rappeneau Stephane; Kharoubi Mounira; Dubois Rande Jean Luc; Hittinger Luc; Adnot Serge; Bastuji Garin Sylvie; Damy Thibaud

来源：International Journal of Cardiology, 2016, 203: 1022-1028.

DOI：10.1016/j.ijcard.2015.11.108

• Heart failure
• Sleep disordered breathing
• Apnea-hypopnea index
• Desaturation
• Prognosis

Background: 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.

• 出版日期2016-1-15