Sleep medicine and cardiology scientists at The Ohio State University Medical Center are believed to be the foremost ones to assess the impact of a common sleep disorder on patients admitted to the hospital with heart failure. Heart failure is known to be one of the most common causes of death in Americans.
OSA is known to be a disorder in which breathing is interrupted for short periods during sleep. These cyclic disruptions of breathing could possibly lead to drops in oxygen levels, known as intermittent hypoxia. Apparently, OSA also makes it difficult for patients with cardiovascular diseases including coronary disease, arrhythmia and hypertension, all of which are causes of ADHF. Moreover, it was estimated that it affects around 12 million Americans every year.
This pilot trial appears to be built upon a previous study published by experts at Ohio State showing an association between obstructive sleep apnea (OSA) and poor results in patients with heart failure, in addition to benefits to treating OSA with positive airway pressure (PAP). Supposedly, PAP prevents obstruction of the airway and reverses the negative consequences of sleep apnea on the heart.
“Our goal is to improve cardiac function prior to discharge, so we used an expedited approach to in-hospital diagnosis and treatment. Internal results indicate positive outcomes for patients suffering from heart failure,” says lead author of the study, Dr. Rami Khayat, a sleep medicine expert in the division of pulmonary, allergy, critical care and sleep medicine at Ohio State’s Medical Center.
The existing standard approach for treatment of OSA in patients with heart failure is known to include an outpatient sleep study with treatment usually beginning several weeks after discharge. In the latest study, Ohio State scientists were noted to have evaluated a novel approach for its safety and effectiveness of immediate diagnosis and treatment in this same patient population as inpatients.
During the study, the authors randomly categorized the patients with ADHF into two groups within two days of admission. The first group appears to have received treatment for OSA via auto-adjusted positive airway pressure (APAP) along with standard treatment of ADHF whereas; the other half was given standard treatment for ADHF. The sleep study was believed to have measured nasal flow, respiratory effort, oxygen saturation and body position.
The authors found that of the 46 participants, the difference in left ventricular ejection fraction (LVEF), or how well the heart is squeezing, between the two groups seems to have been 4.6 percent better in the APAP group. Furthermore, LVEF appears to have been 30.4 percent in the group receiving treatment for OSA and ADHF in contrast to 25.8 percent in the group only receiving ADHF treatment.
“The results make apparent the consistency in improvement for patients who received the PAP and ADHF treatment,” explains Khayat.
After three nights of treatment, LVEF seems to have increased by 4.5 percent in the group receiving both OSA and the standard treatment for ADHF. While the change in LVEF in the group only receiving treatment for ADHF was observed to be a decline of 0.3 percent.
The findings of the study revealed that early detection and treatment of obstructive sleep apnea in hospitalized patients with acutely decompensated heart failure (ADHF) seems to improve heart function.
Khayat claimed that they are encouraged by the findings of this study and the effect it will have on the management of heart failure in their patients. However, additional investigation appears to be required in order to test the impact of this approach on out-of-hospital outcomes.
The findings of the study have been published in the journal, Chest.