In-Hospital Treatment of Obstructive Sleep Apnea During Decompensation of Heart Failure.

Chest. 2009 Jun 30; Khayat RN, Abraham WT, Patt B, Pu M, Jarjoura DBackground Treatment of obstructive sleep apnea (OSA) in outpatients with systolic heart failure improves cardiac function. We evaluated the impact of immediate inpatient diagnosis and treatment of OSA in hospitalized patients with acutely decompensated heart failure (ADHF) on in-hospital cardiac outcomes. Methods A pilot randomized controlled trial conducted in an academic heart hospital. Patients with ADHF underwent an attended in-hospital sleep study within two days of admission to establish the diagnosis of Sleep Disordered Breathing. Participants were 46 consecutive ADHF patients who had OSA (apnea-hypopnea index >/=15 events/h). Participants were randomized to either intervention arm (n = 23) with in-hospital treatment of OSA using auto-adjusting positive airway pressure along with standard treatment of ADHF, or to a control arm (n = 23) which received only standard treatment for ADHF. The primary outcome was the change in left ventricular ejection fraction (LVEF) three nights post randomization. Results The change in LVEF from baseline to three days post randomization in the intervention arm was significantly superior to the control group. The difference in LVEF improvement was 4.6% (p = 0.03). LVEF increased in the intervention group by 4.5% (se = 1.7). LVEF change in the control arm was -0.3% (se = 1.5). The difference in LVEF improvement between the two groups persisted after adjustment for baseline LVEF, type of cardiomyopathy, body mass index, AHI, and sex. Conclusions An approach of early identification and in-hospital treatment of OSA in patients with ADHF is feasible and resulted in improvement in systolic function. The impact of this approach on out of hospital outcomes requires further investigation.