Central sleep apnea treatment in patients with heart failure with reduced ejection fraction: a network meta-analysis

2021 ◽  
Author(s):  
Imran H. Iftikhar ◽  
Rami N. Khayat
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Central Sleep Apnea ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Sleep Apnea Treatment

scholarly journals Transvenous Phrenic Nerve Stimulation and Positive Airway Pressure devices for Central Sleep Apnea in Patients with Heart Failure with Reduced Ejection Fraction: A Network Meta-analysis

2021 ◽  
Author(s):  
IMRAN HASAN IFTIKHAR ◽  
Rami N Khayat
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Meta Analysis ◽  
Central Sleep Apnea ◽  
Phrenic Nerve Stimulation ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

Abstract Purpose: Adaptive servo-ventilation (ASV) is contraindicated for central sleep apnea (CSA) treatment in patients with heart failure with reduced ejection fraction (HFrEF) limiting treatment options. Though, continuous positive airway pressure (CPAP), bi-level PAP with back-up rate (BPAP-BUR) and transvenous phrenic nerve stimulation (TPNS) are alternatives, not much is known about their comparative efficacies, which formed the basis of this network meta-analysis, in which their effects on apnea hypopnea index (AHI) and subjective daytime sleepiness (based on Epworth sleepiness score (ESS)), were analyzed.Methods: PubMed was searched for potentially includable randomized controlled trials and network meta-analysis was conducted in R program using package netmeta.Results: Network meta-analysis showed no statistically significant differences between interventions in AHI reduction. In exploring heterogeneity, sensitivity analysis elicited statistically significant differences in AHI reduction between ASV and TPNS (-18.30 [-27.8; -8.79]), with BPAP-BUR (-21.90 [-30.79; -13.01]) and CPAP (-23.10 [-29.22; -16.98]), favoring ASV. Of all the interventions, only TPNS showed a statistically significant decrease in ESS (-3.70 (-5.58; -1.82)) when compared to guideline directed medical therapy (used as a common comparator across trials), while also showing significant differences when compared with ASV (-3.20 (-5.86; -0.54)), BPAP-BUR (-4.00 (-7.33; -0.68)), and CPAP (-4.45 (-7.75; -1.14)). Hasse diagram, accounting for both AHI and ESS as outcomes for relative hierarchy showed relative superiority of both ASV and TPNS over BPAP-BUR and CPAP.Conclusions: Results indicate relative superiority of TPNS and ASV to BPAP-BUR and CPAP in their effects on AHI and ESS reduction in patients with CSA and HFrEF.

SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials

The Lancet ◽  
2020 ◽  
Vol 396 (10254) ◽  
pp. 819-829 ◽  
Author(s):  
Faiez Zannad ◽  
João Pedro Ferreira ◽  
Stuart J Pocock ◽  
Stefan D Anker ◽  
Javed Butler ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Sglt2 Inhibitors ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure

scholarly journals 0602 Daytime Sleepiness in Heart Failure with Preserved Versus Reduced Ejection Fraction

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A230-A230
Author(s):  
S G Schütz ◽  
A Nguyen-Phan ◽  
M Konerman ◽  
S Hummel ◽  
R D Chervin
Keyword(s):  
Heart Failure ◽  
Sleep Apnea ◽  
Ejection Fraction ◽  
Daytime Sleepiness ◽  
Diastolic Heart Failure ◽  
Apnea Hypopnea Index ◽  
Central Apnea ◽  
Reduced Ejection Fraction ◽  
Significant Difference ◽  
Patients With Heart Failure

Abstract Introduction Sleep apnea is common in patients with heart failure, though often not associated with significant daytime sleepiness in heart failure with reduced ejection fraction (HFrEF). The clinical presentation of sleep apnea in patients who have heart failure with borderline or preserved ejections fraction (HFbEF and HFpEF, respectively) is not well characterized. Methods Eighty patients with heart failure were identified retrospectively in data from University of Michigan Sleep Disorders Laboratories. Heart failure was categorized as heart failure with reduced ejection fraction (HFrEF)/systolic heart failure, heart failure with borderline ejection fraction (HFbEF) or heart failure with preserved ejection fraction (HFpEF)/diastolic heart failure. Clinical information and Epworth Sleepiness Scale (ESS) scores were extracted from medical records. A subset of subjects underwent a diagnostic polysomnogram. ANOVA was used to compare clinical characteristics in subjects with different heart failure types. Results ESS scores trended higher in 49 subjects with HFpEF (ESS mean 10.9±4.7 [sd]) compared to 9 with HFbEF (ESS 8.0±3.4) and 22 with HFrEF (ESS 8.4±5.0) (p=0.058). Among the 40 subjects who underwent diagnostic polysomnography, no statistically significant difference emerged in apnea-hypopnea index between subjects with HFpEF, HFbEF, and HFrEF (p=0.43). No significant differences emerged for the central apnea index (p=0.16), despite magnitudes of discrepancy that suggested a larger sample size might show different results CAI in participants with HFrEF showed a mean of 9.0±14.6/h, compared to 0.1±0.1/h in HFbEF and 3.1±6.3/h in HFpEF. Conclusion Among these patients with HFpEF, HFbEF, and HFrEF, subjects with HFpEF showed a trend towards increased subjective daytime sleepiness, though overall apnea and central apnea severity did not differ between groups. Further examination of clinical phenotypes in larger cohorts may help guide care in heterogeneous heart failure populations. Support National Institutes of Health grant NS107158

scholarly journals Iron deficiency in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001012 ◽  
Author(s):  
Anna L Beale ◽  
Josephine Lillian Warren ◽  
Nia Roberts ◽  
Philippe Meyer ◽  
Nick P Townsend ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Conclusive Evidence ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Related Quality ◽  
Health Related

ObjectiveIron deficiency (ID) has an established impact on outcomes in patients with heart failure with reduced ejection fraction; however, there is a lack of conclusive evidence in patients with heart failure with preserved ejection fraction (HFpEF). We sought to clarify the prevalence and impact of ID in patients with HFpEF.MethodsA systematic search of Cohcrane, MEDLINE, EMBASE, Web of Science and CINAHL electronic databases was performed to identify relevant studies. Included studies defined HFpEF as heart failure with an ejection fraction ≥50%. We used a random-effects meta-analysis to determine the composite prevalence of ID in patients with HFpEF across the included studies. Other outcomes were assessed with qualitative analysis due to a paucity of studies with comparable outcome measures.ResultsThe prevalence of ID in the included studies was 59% (95% CI 52% to 65%). ID was associated with lower VO2 max in three of four studies reporting VO2 max as an outcome measure, lower functional status as determined by dyspnoea class or 6 min walk test in two of three studies, and worse health-related quality of life in both studies reporting on this outcome. Conversely, ID had no impact on death or hospitalisation in three of the four studies investigating this.ConclusionsID is highly prevalent in patients with HFpEF and is associated with worse exercise capacity and functional outcomes, but not hospitalisation or mortality. Our study establishes that ID may play an important a role in HFpEF.

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