Prognostic value of sleep apnea and nocturnal hypoxemia in patients with decompensated heart failure

Abstract

Background: Nocturnal hypoxemia is an important factor underlying the impact of sleep apnea on heart failure. It remains unclear whether nocturnal hypoxemia has a greater prognostic value in acute decompensated heart failure (ADHF) compared with the frequency of sleep apnea. Hypothesis: Nocturnal hypoxemia might be better than the frequency of sleep apnea in predicting the outcomes in ADHF. Methods: Sleep studies were prospectively performed during an ADHF hospitalization from January 2015 to December 2017. Sleep apnea was defined as the apnea-hypopnea index (AHI) ≥15/h. The severity of nocturnal hypoxemia was determined by the percentage of time with saturation below 90% (T90%). The endpoint was the first event of all-cause death, heart transplantation, implantation of left ventricular assist device, unplanned hospitalization for worsening heart failure, acute coronary syndrome, significant arrhythmias, or stroke. Results: Of 382 patients, 189 (49.5%) had sleep apnea. The endpoint incidence did not differ between AHI categories (≥15/h vs <15/h: 52.4% vs 44.6%, log rank P =.353), but did between T90% categories (≥3.6% vs <3.6%: 54.5% vs 42.4%, log rank P =.023). Multivariate Cox regression analysis showed that T90% was independently associated with the endpoint (hazard ratio [HR] 1.008, 95% confidence interval [CI] 1.001-1.016, P =.033), whereas AHI was not; the risk of the endpoint increased by 40.8% in patients with T90% ≥3.6% (HR 1.408, 95%CI 1.030-1.925, P =.032). Conclusion: Nocturnal hypoxemia had a greater prognostic value in ADHF than the frequency of sleep apnea.