“Our goal is to improve cardiac function prior to discharge, so we used an expedited approach to in-hospital diagnosis and treatment,” says Dr. Rami Khayat, a sleep medicine expert in the division of pulmonary, allergy, critical care and sleep medicine at Ohio State’s Medical Center. “Internal results indicate positive outcomes for patients suffering from heart failure.”
The study results, which appeared in a recent issue of the journal Chest, showed that early identification and treatment of obstructive sleep apnea in hospitalized patients with acutely decompensated heart failure (ADHF) improves heart function.
The pilot trial builds upon previous research published by experts at Ohio State showing an association between obstructive sleep apnea (OSA) and poor outcomes in patients with heart failure, as well as benefits to treating OSA with positive airway pressure (PAP), which prevents obstruction of the airway and reverses the negative consequences of sleep apnea on the heart.
The current standard approach for treatment of OSA in patients with heart failure includes an outpatient sleep study with treatment typically commencing several weeks after discharge.
In the most recent study, Ohio State researchers evaluated a new approach for its safety and effectiveness of immediate diagnosis and treatment in this same patient population as inpatients.
Patients with ADHF were randomized, within two days of admission, and approximately half received treatment for OSA using auto-adjusted positive airway pressure (APAP) along with standard treatment of ADHF, with the other half receiving standard treatment for ADHF. The sleep study measured nasal flow, respiratory effort, oxygen saturation and body position.
Of the 46 participants, the difference in left ventricular ejection fraction (LVEF), or how well the heart is squeezing, between the two groups was 4.6 percent better in the APAP group. LVEF was 30.4 percent in the group receiving treatment for OSA and ADHF, compared to 25.8 percent in the group only receiving ADHF treatment.
After three nights of treatment, the group receiving both OSA and the standard treatment for ADHF, LVEF increased 4.5 percent, while the change in LVEF in the group only receiving treatment for ADHF was a decrease of -0.3 percent.
“The results make apparent the consistency in improvement for patients who received the PAP and ADHF treatment,” says Khayat, who is also lead author of the study.
OSA is a disorder, affecting approximately 12 million Americans, in which breathing is interrupted for brief periods during sleep. These repetitive disruptions of breathing lead to drops in oxygen levels, known as intermittent hypoxia. OSA also makes it difficult for patients with cardiovascular diseases including coronary disease, arrhythmia and hypertension, all of which are causes of ADHF.
“We are encouraged by the results of this study and the effect it will have on the management of heart failure in our patients. Further investigation is needed to test the impact of this approach on out-of-hospital outcomes,” adds Khayat.
Along with Khayat, other Ohio State researchers who participated in the study were William T. Abraham, Brian Patt, Min Pu and David Jarjoura.
Funding from the National Institutes of Health, along with a grant from Respironics, Inc supported this research. The researchers have no potential conflicts of interest.
Drs. Khayat and Abraham, a world-renowned heart failure specialist and head of Ohio State’s Sleep Heart Program, are currently conducting a study, in a much larger patient population, to provide access to expedited diagnosis and treatment of OSA for all heart failure patients. Ohio State’s Richard M. Ross Heart Hospital is the only institution in the nation where all patients hospitalized with heart failure receive a study for identification of OSA.