Prognosis of patients with heart failure and obstructive sleep apnea treated with continuous positive airway pressure.
BACKGROUND
Therapy with continuous positive airway pressure (CPAP) provides several benefits for patients with heart failure (HF) complicated by obstructive sleep apnea (OSA). However, the effect on the prognosis of such patients remains unknown.


OBJECTIVE
To determine whether CPAP therapy and compliance affects the prognosis of HF patients with OSA.


METHODS
We classified 88 patients with HF and moderate-to-severe OSA into a CPAP-treated group (n = 65) and an untreated group (n = 23), and then those treated with CPAP were further subclassified according to CPAP therapy compliance. The frequency of death and hospitalization was analyzed using multivariate analysis.


RESULTS
During a mean (+/- SD) period of 25.3 +/- 15.3 months, 44.3% of the patients died or were hospitalized. Multivariate analysis showed that the risk for death and hospitalization was increased in the untreated group (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.07 to 3.68; p = 0.030) and in less compliant CPAP-treated patients (HR, 4.02; 95% CI, 1.33 to 12.2; p = 0.014).


CONCLUSIONS
Therapy with CPAP significantly reduced the risk of death and hospitalization among patients with HF and OSA. However, reduced compliance with CPAP therapy was significantly associated with an increased risk of death and hospitalization.
Kasai
Takatoshi
T
Sleep Center, Toranomon Hospital., 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan. kasai-t@mx6.nisiq.net
Narui
Koji
K
Dohi
Tomotaka
T
Yanagisawa
Naotake
N
Ishiwata
Sugao
S
Ohno
Minoru
M
Yamaguchi
Tetsu
T
Momomura
Shin-Ichi
S
D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017286:Polysomnography; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors