The Effect of Obstructive Sleep Apnea on 3-Year Outcomes in Patients Who Underwent Orthotopic Heart Transplantation

The Utility of Home Sleep Apnea Testing in the Advanced Heart Failure Populations

Untreated sleep disorders form a risk of coronary artery disease, hypertension, obesity, and diabetes mellitus. Access to polysomnography is limited, especially during the COVID-19 pandemic, with home sleep apnea testing (HSAT) being a potentially viable alternative. We describe an HSAT protocol in patients with advanced heart failure (HF). In a single-center, observational analysis between 2019 and 2021 in patients with advanced HF and heart transplant (HT), 135 screened positive on the STOP-Bang sleep survey and underwent a validated HSAT (WatchPAT, ZOLL-Itamar). HSAT was successful in 123 patients (97.6%), of whom 112 (91.1%; 84 HF and 28 HT) tested positive for sleep apnea. A total of 91% of sleep apnea cases were obstructive, and 63% were moderate to severe. Multivariable linear regression showed that the apnea hypopnea index was 34% lower in the HT group than in the HF group (p = 0.046) after adjusting for gender, and that this effect persisted in White patients but not among African-Americans. Patient characteristics were similar between groups, with coronary artery disease, diabetes mellitus, and hypertension as the most prevalent co-morbidities. In conclusion, sleep apnea remains prevalent in patients with HF with a high co-morbidity burden. HSAT is a feasible and effective tool for screening and diagnosis in this population.

Sleep-disordered breathing in pediatric heart transplant recipients

BACKGROUND

Sleep-disordered breathing is commonly found in adults with heart failure both before and after HTx. Untreated sleep-disordered breathing post-transplant has been linked to late graft dysfunction, reduced quality of life, and increased morbidity. Sleep-disordered breathing has not been investigated in pediatric HTx recipients.

METHODS

We conducted retrospective review of patients <21yo who underwent primary HTx at our center from 2009 to 2019 to describe clinical characteristics, cardiac history, and PSG results.

RESULTS

One hundred and fifty patients were included; 60% had congenital heart disease, and 40% had cardiomyopathy. Fifty patients had PSG performed at median age of 6.1 years. Forty-one were referred for symptoms of sleep-disordered breathing. Obstructive sleep apnea was diagnosed in 45 patients and central sleep apnea in 3 patients. Of those with first PSG post-transplant (n = 36), median AHI was 9.1/h, and 19 (53%) were diagnosed with moderate or severe sleep apnea. Patients diagnosed with obstructive sleep apnea on PSG had more post-transplant ventilator days (median 3 vs 2 days, P < .05) and longer post-transplant lengths of stay (median 28 vs 22 days, P < .05).

CONCLUSIONS

In this single-center cohort of pediatric HTx recipients, sleep-disordered breathing was common and associated with longer peri-transplant respiratory support and length of stay. Given the high incidence of moderate and severe OSA detected in this population, clinicians should regularly screen for SDB and consider PSG testing more frequently in children who have undergone HTx. Further study into the long-term impact of sleep-disordered breathing in pediatric HTx recipients is needed.

[Sleep disordered breathing in patients with chronic heart failure: prognosis and management]

Sleep disordered breathing is a frequent comorbidity (50-75%) in patients with chronic heart failure, but it is usually underestimated. This review analyzes sleep disordered breathing in patients with chronic heart failure, demonstrates pathogenetic relationships and the prognostic role of sleep apnea. The authors present modern treatment options for sleep apnea in this cohort (from non-invasive ventilation to implantable devices), highlight the role of drug therapy and outline perspectives of different treatment approaches. This clinical problem is designated as multidisciplinary, which requires a dialogue between researchers and doctors of various specialties to organize comprehensive effective care for this cohort of patients.