title: Sleep disordered breathing and post-discharge mortality in patients with acute heart failure.
abstract: BACKGROUND
  Hospitalizations for heart failure are associated with a high post-discharge risk for mortality. Identification of modifiable predictors of post-discharge mortality during hospitalization may improve outcome. Sleep disordered breathing (SDB) is the most common co-morbidity in heart failure patients.
  
  
  METHODS
  Prospective cohort study of patients hospitalized with acute heart failure (AHF) in a single academic heart hospital. Between January 2007 and December 2010, all patients hospitalized with AHF who have left ventricular ejection fraction (LVEF) ≤ 45% and were not already diagnosed with SDB were the target population.
  
  
  METHODS
  Patients underwent in-hospital attended polygraphy testing for SDB and were followed for a median of 3 years post-discharge. Mortality was recorded using national and state vital statistics databases.
  
  
  RESULTS
  During the study period, 1117 hospitalized AHF patients underwent successful sleep testing. Three hundred and forty-four patients (31%) had central sleep apnoea (CSA), 525(47%) patients had obstructive sleep apnoea (OSA), and 248 had no or minimal SDB (nmSDB). Of those, 1096 patients survived to discharge and were included in the mortality analysis. Central sleep apnoea was independently associated with mortality. The multivariable hazard ratio (HR) for time to death for CSA vs. nmSDB was 1.61 (95% CI: 1.1, 2.4, P = 0.02). Obstructive sleep apnoea was also independently associated with mortality with a multivariable HR vs. nmSDB of 1.53 (CI: 1.1, 2.2, P = 0.02). The Cox proportional hazards model adjusted for the following covariates: LVEF, age, BMI, sex, race, creatinine, diabetes, type of cardiomyopathy, coronary artery disease, chronic kidney disease, discharge systolic blood pressure <110, hypertension, discharge medications, initial length of stay, admission sodium, haemoglobin, and BUN.
  
  
  CONCLUSIONS
  This is the largest study to date to evaluate the effect of SDB on post-discharge mortality in patients with AHF. Newly diagnosed CSA and OSA during AHF hospitalization are independently associated with post-discharge mortality.
authors: Sleep Heart Program, The Ohio State University, Columbus, OH, USA rami.khayat@osumc.edu.
authors: Rami
authors: R
authors: Khayat
authors: Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
authors: David
authors: D
authors: Jarjoura
authors: Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
authors: Kyle
authors: K
authors: Porter
authors: Sleep Heart Program, The Ohio State University, Columbus, OH, USA.
authors: Angela
authors: A
authors: Sow
authors: Sleep Heart Program, The Ohio State University, Columbus, OH, USA.
authors: Jacob
authors: J
authors: Wannemacher
authors: Sleep Heart Program, The Ohio State University, Columbus, OH, USA.
authors: Robert
authors: R
authors: Dohar
authors: Sleep Heart Program, The Ohio State University, Columbus, OH, USA Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
authors: Adam
authors: A
authors: Pleister
authors: Sleep Heart Program, The Ohio State University, Columbus, OH, USA Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
authors: William T
authors: WT
authors: Abraham
mesh_terms: D000208:Acute Disease; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality* / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000401:mortality* / Q000628:therapy; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
keywords: Heart failure; Post-discharge mortality; Sleep apnoea; Sleep disordered breathing
references: Am J Respir Crit Care Med. 2011 Feb 15;183(4):539-46
references: 20656940
references: J Card Fail. 2012 Jul;18(7):534-40
references: 22748486
references: Eur J Heart Fail. 2012 Sep;14(9):1009-19
references: 22730336
references: Sleep Med. 2013 May;14(5):422-7
references: 23453905
references: Eur J Heart Fail. 2013 Aug;15(8):937-43
references: 23535165
references: Eur Respir J. 2004 Sep;24(3):443-8
references: 15358704
references: Am J Respir Crit Care Med. 1995 Aug;152(2):473-9
references: 7633695
references: Circulation. 1999 Mar 30;99(12):1574-9
references: 10096933
references: Circulation. 2006 Feb 14;113(6):799-805
references: 16461823
references: Am J Med. 2006 Jul;119(7):591-9
references: 16828631
references: JAMA. 2007 Jan 3;297(1):61-70
references: 17200476
references: Eur J Heart Fail. 2007 Mar;9(3):251-7
references: 17027333
references: J Am Coll Cardiol. 2007 May 22;49(20):2028-34
references: 17512359
references: Arch Intern Med. 2007 Jul 23;167(14):1493-502
references: 17646603
references: Am Heart J. 2007 Nov;154(5):e21
references: 17967569
references: Arch Intern Med. 2008 Apr 28;168(8):847-54
references: 18443260
references: J Am Coll Cardiol. 2008 Jul 29;52(5):347-56
references: 18652942
references: Am Heart J. 2008 Oct;156(4):662-73
references: 18926148
references: Arch Cardiovasc Dis. 2009 Mar;102(3):169-75
references: 19375670
references: J Card Fail. 2009 Nov;15(9):739-46
references: 19879459
references: Circulation. 2010 Feb 23;121(7):e46-e215
references: 20019324
references: JAMA. 2010 May 5;303(17):1716-22
references: 20442387
references: JAMA. 2010 Jun 2;303(21):2141-7
references: 20516414
references: Am Heart J. 2010 Aug;160(2):308-14
references: 20691837
references: Eur J Heart Fail. 2011 Jan;13(1):68-75
references: 20961913
references: Eur Heart J. 2011 Jan;32(1):61-74
references: 20846992