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Cited by 616Obstructive Sleep Apnea ResearchSleep and related disordersHeart Failure Treatment and Management

Influence of Obstructive Sleep Apnea on Mortality in Patients With Heart Failure

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Wang, Hanqiao, Parker, John D., Newton, Gary E., Floras, John S., Mak, Susanna, Chiu, Kuo-Liang, Ruttanaumpawan, Pimon, Tomlinson, George +1 more·2007·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2006.12.046
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Abstract

Objectives This study sought to determine, in patients with heart failure (HF), whether untreated moderate to severe obstructive sleep apnea (OSA) is associated with a higher mortality rate than in patients with mild to no sleep apnea (M-NSA).Background Obstructive sleep apnea is common in patients with HF and exposes the heart and circulation to adverse mechanical and autonomic effects. However, its effect on mortality rates of patients with HF has not been reported.Methods In a prospective study involving 164 HF patients with left ventricular ejection fractions (LVEFs) < or =45%, we performed polysomnography and compared death rates between those with M-NSA (apnea-hypopnea index [AHI] <15/h of sleep) and those with untreated OSA (AHI > or =15/h of sleep).Results During a mean (+/- SD) of 2.9 +/- 2.2 and a maximum of 7.3 years of follow-up, the death rate was significantly greater in the 37 untreated OSA patients than in the 113 M-NSA patients after controlling for confounding factors (8.7 vs. 4.2 deaths per 100 patient-years, p = 0.029). Although there were no deaths among the 14 patients whose OSA was treated by continuous positive airway pressure (CPAP), the mortality rate was not significantly different from the untreated OSA patients (p = 0.070).Conclusions In patients with HF, untreated OSA is associated with an increased risk of death independently of confounding factors.

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  • Subgroup meta-analyses demonstrated a clinically significant reduction in the risk ratio for mortality of 0.2 (95% CI 0.1 to 0.5) for heart failure participants.

    “meta-analyses demonstrated clinically significant reductions in the risk ratio for mortality of 0.2 (95% CI: 0.1 to 0.5) and 0.4 (95% CI: 0.2 to 0.7) for heart failure 142,146 and no heart failure participants, 137,139,143,144,147 respectively”

    From Treatment of Adult Obstructive Sleep Apnea With Positive Airway Pressure: An American Academy of Sleep Medicine Systematic Review, Meta-Analysis, and GRADE Assessment (2019) · cites this paper as [146]

    The Mortality section (p. 1629) reports fewer deaths among treated heart-failure patients with obstructive sleep apnea than among untreated patients, so this study supplies relevant mortality data. It is an observational study, not a subgroup meta-analysis, and it reports no risk ratio of 0.2 (95% CI 0.1–0.5); its treated-versus-untreated mortality difference was not statistically significant (p = 0.07). (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Identification of OSA may be especially important in heart failure with reduced ejection fraction, where it is an independent risk factor for mortality.

    “Identification of OSA may be especially important in the setting of hFrEF, where it is an independent risk factor for mortality.741,742”

    From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [742]

  • In patients with heart failure, mortality is significantly higher in the untreated moderate to severe OSA group compared to the mild to no OSA group.

    “found that the mortality was significantly higher in the untreated moderate to severe OSA group(99).”

    From Sleep: important considerations for the prevention of cardiovascular disease (2016) · cites this paper as [99]

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Research works printed but not linked: 1

  1. [32]32. Spaak J, Egri Z, Kubo T, et al. Increased daytime muscle sympathetic nerve activity in heart failure patients with sleep apnea. Hypertension 2005;46:1327-32.

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Authors
Wang, H., Parker, J. D., Newton, G. E., Floras, J. S., Mak, S., Chiu, K.-L., Ruttanaumpawan, P., Tomlinson, G., & Bradley, T. D.
Affiliations
  • Toronto Rehabilitation Institute (CA)
  • Mount Sinai Hospital (CA)
  • University Health Network (CA)
Corresponding author
Bradley, T. Douglas
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2007-04
Volume
49
Issue
15
Pages
1625-1631
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2006.12.046
OpenAlex
W2068328326
Semantic Scholar
0c30729e82cfd1e5a7f3e601d945289d1f698575
Cited by
616
References
42
Citations by year
2026: 9 · 2025: 10 · 2024: 19 · 2023: 25 · 2022: 27 · 2021: 29 · 2020: 25 · 2019: 21 · 2018: 23 · 2017: 37 · 2016: 36 · 2015: 39 · 2014: 46 · 2013: 49 · 2012: 40
FWCI
33.61
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
Keywords
obstructive sleep apnea, heart failure, mortality, untreated sleep apnea, apnea-hypopnea index, continuous positive airway pressure, left ventricular ejection fraction, polysomnography, comorbidities
MeSH terms
Adult, Analysis of Variance, Cause of Death, Female, Heart Failure, Humans, Male, Middle Aged, Prospective Studies, Reference Values, Severity of Illness Index, Comorbidity, Incidence, Proportional Hazards Models, Survival Analysis, Case-Control Studies, Polysomnography, Age Distribution, Sex Distribution, Risk Assessment, Statistics, Nonparametric, Sleep Apnea, Obstructive, Continuous Positive Airway Pressure

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