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First published online on January 15, 2008
Chest, doi:10.1378/chest.07-1901
doi:10.1378/chest.07-1901
(Chest. 2008; 133:690-696)
© 2008 American College of Chest Physicians
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Prognosis of Patients With Heart Failure and Obstructive Sleep Apnea Treated With Continuous Positive Airway Pressure*

Takatoshi Kasai, MD, PhD; Koji Narui, MD; Tomotaka Dohi, MD; Naotake Yanagisawa, MS; Sugao Ishiwata, MD; Minoru Ohno, MD; Tetsu Yamaguchi, MD and Shin-ichi Momomura, MD

* From the Sleep Center (Drs. Kasai and Narui) and the Cardiovascular Center (Drs. Dohi, Ishiwata, Ohno, and Yamaguchi), Toranomon Hospital, Tokyo, Japan; the Department of Cardiology (Dr. Yanagisawa), School of Medicine, Juntendo University, Tokyo, Japan; and the Cardiovascular Division (Dr. Momomura), Saitama Medical Center, Jichi Medical University, Saitama, Japan.

Correspondence to: Takatoshi Kasai, MD, PhD, Sleep Center, Toranomon Hospital., 2-2-2 Toranomon, Minato-ku, Tokyo 105-8470, Japan; e-mail: kasai-t{at}mx6.nisiq.net

Abstract

Background: Therapy with continuous positive airway pressure (CPAP) provides several benefits for patients with heart failure (HF) complicated by obstructive sleep apnea (OSA). However, the effect on the prognosis of such patients remains unknown.

Aims: To determine whether CPAP therapy and compliance affects the prognosis of HF patients with OSA.

Methods: We classified 88 patients with HF and moderate-to-severe OSA into a CPAP-treated group (n = 65) and an untreated group (n = 23), and then those treated with CPAP were further subclassified according to CPAP therapy compliance. The frequency of death and hospitalization was analyzed using multivariate analysis.

Results: During a mean (± SD) period of 25.3 ± 15.3 months, 44.3% of the patients died or were hospitalized. Multivariate analysis showed that the risk for death and hospitalization was increased in the untreated group (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.07 to 3.68; p = 0.030) and in less compliant CPAP-treated patients (HR, 4.02; 95% CI, 1.33 to 12.2; p = 0.014).

Conclusion: Therapy with CPAP significantly reduced the risk of death and hospitalization among patients with HF and OSA. However, reduced compliance with CPAP therapy was significantly associated with an increased risk of death and hospitalization.

Key Words: compliance • continuous positive airway pressure • heart failure • obstructive sleep apnea • prognosis






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