Article: Role of obstructive sleep apnea on the response to cardiac resynchronization therapy and all-cause mortality
Authors: Ghanshyam Shantha MBBS, MPH, Amgad Mentias MD, Naga Venkata K. Pothineni MBBS, Prashant D. Bhave MD, FHRS, Tyler Rasmussen MD, PhD, Abhishek Deshmukh MBBS, FHRS, Frank Pelosi MD, FHRS and Michael Giudici MD, FHRS
Journal: Heart Rhythm. 2018 Sep;15(9):1283-1288
BACKGROUND: The role of obstructive sleep apnea (OSA) on the response to cardiac resynchronization therapy (CRT) and all-cause mortality in patients with advanced heart failure (HF) is unknown.
OBJECTIVE: We assessed the association between OSA, response to CRT, and all-cause mortality in patients with HF.
METHODS: We analyzed records of 548 consecutive patients (mean age 65 ± 13 years; 216 (39%) women; mean follow-up period 76 ± 17 months) who received a CRT-defibrillator device from January 15, 2007 to March 30, 2016 at our tertiary care referral center.
RESULTS: A total of 180 patients (33%) had OSA. Fewer patients in the OSA group (109 [61%]) had improvement in left ventricular ejection fraction (EF) than did those in the non-OSA group (253 [69%]) (P = .001). A total of 144 patients (27%) died by the end of follow-up (OSA group: 61 [33%]; non-OSA group 83 [23%]; P < .001). OSA diagnosis was associated with a lower chance of improvement in EF (hazard ratio 0.71; 95% confidence interval 0.60-0.89) and a higher risk of all-cause mortality (hazard ratio 3.7; 95% confidence interval 2.5-6.8). This was true in continuous positive airway pressure-compliant patients and in patients with nonischemic cardiomyopathy. However, among patients with ischemic cardiomyopathy, the chance of improvement in EF and all-cause mortality was similar in patients with OSA and those without OSA.
CONCLUSION: OSA is associated with a decreased response to CRT and an increase in all-cause mortality in patients with HF. The differential effect of OSA on CRT response in patients with ischemic cardiomyopathy and nonischemic cardiomyopathy needs further study.
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