Introduction
Methods
Study design and study population
Collected data
Initial polygraphy (PG) or polysomnography (PSG) diagnosis and definition of SDB groups
Echocardiography
Statistical analyses
Results
N | Whole group, n = 177 | CSA group, n = 105 (59.3%) | OSA group, n = 36 (20.3%) | TECSA group n = 36 (20.3%) |
P
| |
---|---|---|---|---|---|---|
Anthropometric data | ||||||
Age (years) | 177 | 71 [65–77] | 71.00 [65.00–76.00] | 69.50 [65.00–77.00] | 74.50 [64.00–83.50] | 0.447 |
Gender, n (%) | 177 | 0.378 | ||||
Male | 155 (87.57%) | 93 (88.57%) | 33 (91.67%) | 29 (80.56%) | ||
Female | 22 (12.43%) | 12 (11.43%) | 3 (8.33%) | 7 (19.44%) | ||
BMI (kg/m2) | 175 | 29.90 [26.60–34.00] | 29.80 [26.55–33.60] | 29.10 [26.70–35.00] | 31.55 [26.70–36.05] | 0.530 |
Initial sleep data | ||||||
Initial exam | ||||||
PG | 101 (57.06%) | 55 (52.38%) | 22 (61.11%) | 24 (66.67%) | 0.281 | |
PSG | 76 (42.92%) | 50 (47.62%) | 14 (38.89%) | 12 (33.33%) | ||
Initial AHI (n/h) | 177 | 50.00 [38.30–62.30] | 50.00 [39.00–67.00] | 46.80 [34.75–58.50] | 47.05 [39.00–65.15] | 0.671 |
Initial OAI (n/h) | 154 | 7.70 [2.00–18.30] | 4.00ab [0.90–8.70] | 16.45b [9.80–21.80] | 18.45a [7.15–28.15] | <.001 |
Initial CAI (n/h) | 154 | 10.75 [3.60–23.60] | 17.00ab [9.00–33.80] | 7.50bc [2.50–9.80] | 3.50ac[0.65–7.70] | <.001 |
Initial MAI (n/h) | 153 | 1.70[0.00–5.00] | 1.50 [0.00–4.65] | 4.00 [0.00–9.70] | 0.75 [0.00–7.00] | 0.279 |
Initial HI (n/h) | 161 | 16.00 [8.70–24.90] | 16.75 [8.70–24.30] | 12.00 [8.35–23.50] | 17.00 [11.00–27.00] | 0.641 |
Initial ESS score | 136 | 10.00 [6.00–13.50] | 10.00 [6.00–13.00] | 9.00 [4.00–14.00] | 12.00 [6.50–13.50] | 0.598 |
CPAP trial before ASV initiation, n (%) | 166 | 91 (54.82%) | 36ab (37.11%) | 19bc (57.58%) | 36ac (100%) | < 0.001 |
Final sleep data | ||||||
Final AHIflow | 177 | 1.90 [0.70–3.80] | 1.80 [0.70–3.30] | 1.95 [0.85–5.35] | 2.25 [0.50–4.80] | 0.448 |
Final ESS score | 174 | 6.00 [3.0–9.0] | 5.00 [3.0–9.0] | 5.00 [2.0–10.0] | 6.00 [3.0–10.0] | 0.731 |
ASV-adherence | ||||||
Mean adherence > 4 h/day, n (%) | 177 | 154 (87.01%) | 99 (94.29%)a | 30 (83.33%) | 25 (69.44%)a | < 0.001 |
ASV
N | ≤4 h N = 23 | > 4 h N = 154 |
P
| |
---|---|---|---|---|
Age (years) | 177 | 74.00 [60.00;82.00] | 71.00 [65.00;77.00] | 0.964 |
Gender, n (%) | 177 | 0.316 | ||
Female | 22 | 1 (4.35%) | 21 (13.64%) | |
Male | 155 | 22 (95.65%) | 133 (86.36%) | |
BMI (kg/m2) | 175 | 29.40 [26.30;32.30) | 30.10 [26.95;34.40] | 0.379 |
SA sub-groups, n (%) | 177 | < 0.001 | ||
CSA | 105 | 6 (26.09%) | 99 (64.29%) | |
OSA | 36 | 6 (26.09%) | 30 (19.48%) | |
TESA | 36 | 11 (47.83%) | 25 (16.23%) | |
Initial exam, n (%) | 177 | 0.692 | ||
PG | 101 | 14 (60.87%) | 87 (56.49%) | |
PSG | 76 | 9 (39.13%) | 67 (43.51%) | |
Initial AHI (n/h) | 177 | 50.00 [40.00;67.20] | 50.00 [38.00;60.30] | 0.636 |
Final AHIflow | 177 | 2.00 [0.80;5.20] | 1.85 [0.70;3.60] | 0.362 |
Initial ESS score | 136 | 12.50 [9.00;16.00] | 9.00 [5.00;13.00] | 0.012 |
Final ESS score | 174 | 8.50 [4.00;12.00] | 5.00 [3.00;9.00] | 0.034 |
Initial ESS-final ESS score | 136 | 2 (0.00–6.00) | 2.50 (0.00–7.00) | 0.775 |
ASV initiation during continuous hospitalization, n (%) | 173 | 13 (61.90%) | 65 (42.76%) | 0.098 |
CPAP trial before ASV initiation, n (%) | 166 | 16 (69.57%) | 75 (52.45%) | 0.126 |
Interface Type, n (%) | 175 | |||
Facial | 87 | 12 (52.17%) | 75 (49.34%) | 0.800 |
Nasal/Nasal Pillows | 88 | 11 (47.83%) | 77 (50.66%) | |
Cardiological comorbidity/etiology, n (%) | 177 | 18 (78.26%) | 116 (75.32%) | 0.759 |
Neurological comorbidity/etiology, n (%) | 177 | 0 (0.00%) | 22 (14.29%) | 0.053 |
Renal comorbidity/etiology, n (%) | 177 | 2 (8.70%) | 6 (3.90%) | 0.278 |
Opiod comorbidity/etiology, n (%) | 177 | 0 (0.00%) | 6 (3.90) | 0.336 |
Idiopathic CSA, n (%) | 177 | 2 (8.70%) | 15 (9.74%) | 1.000 |
No comorbidity/etiology, n (%) | 177 | 5 (21.74%) | 28 (18.18%) | 0.774 |
Patients with at least one hospitalization for cardiologic cause, n (%) | 177 | 3 (13.04%) | 8 (5.19%) | 0.157 |
Number of cardiological medications | 169 | 3.00 [1.00;4.00] | 2.00 [1.00;3.00] | 0.535 |
Knowledge of the medical treatment by the patient, n (%) | 162 | 8 (40.00%) | 83 (58.45%) | 0.119 |
Echocardiography or cardiological consultation in the last 6 months, n (%) | 144 | 11 (64.71%) | 65 (51.18%) | 0.294 |
Oxymetry or Polygraphy ASV control in the last 6 months | 157 | 2 (10.00%) | 52 (37.96%) | 0.014 |
Modification of ASV settings as a consequence of Polygraphy or oximetry, n (%) | 54 | 0 (0%) | 14 (26.92%) | 1.000 |
Odds ratio [95% CI] | P-value | |
---|---|---|
SA groups | P = 0.034 | |
TECSA group versus CSA group | 7.57 [1.063–35.21] | p = 0.010 |
OSA group versus CSA group | 2.73 [0.49–15.27] | p = 0.252 |
Absence of night monitoringa in the last 6 months | 5.91 [1.003–34.82] | p = 0.0496 |
Initial EES score | 1.18 [1.03–1.35] | p = 0.019 |
Comorbidities/etiologies reported for ASV-treated patients
Cardiological characteristic
N | Whole group, N = 177 | CSA group, N = 105 | OSA group, N = 36 | TECSA group, N = 36 |
P
| |
---|---|---|---|---|---|---|
Existence of cardiac disease, n (%)
| 177 | 134 (75.71) | 81 (77.14) | 26 (72.22) | 27 (75.00) | 0.833 |
Ischaemic HF | 175 | 61 (34.86%) | 37 (35.58%) | 11 (31.43%) | 13 (36.11%) | 0.891 |
Non Ischaemic HF | 175 | 43 (24.57%) | 26 (25.00%) | 9 (25.71%) | 8 (22.22%) | 0.931 |
Valvulopathy | 175 | 13 (7.43%) | 4 (3.85%)c | 6 (17.14%)c | 3 (8.33%) | 0.025 |
History of AF | 174 | 53 (30.46%) | 32 (31.07%) | 11 (31.43%) | 10 (27.78%) | 0.925 |
Other cardiac disease | 175 | 33 (18.86%) | 18 (17.31%) | 4 (11.43%) | 11 (30.56%) | 0.098 |
Cardiological monitoring
| ||||||
Cardiological consultation, n (%) | 151 | 147 (97.35%) | 89 (95.70%) | 26 (100.00%) | 32 (100.00%) | 0.467 |
Delay since the last consultation (days)a | 147 | 183 [70–365] | 188.0 [80.0–365] | 117.5 [24–262] | 214.5 [125–470] | 0.070 |
Cardiological echocardiography, n (%) | 148 | 145 (97.97%) | 89 (97.80%) | 25 (100.00%) | 31 (96.88%) | 1.000 |
Delay since the last echocardiography (days)a | 145 | 263 [116–529] | 266c [113–541] | 175d [28–356] | 315cd [172–665] | 0.015 |
Hemodynamic parameters
a
| ||||||
Systolic BP (mmHg) | 149 | 130 [118–140] | 130.0 [119.0–140.0] | 130.0 [111.0–40.00] | 131.0 [114.0–147.0] | 0.740 |
Diastolic BP (mmHg) | 149 | 75 [70–82] | 75.00 [70.00–80.00] | 78.50 [66.00–85.00] | 74.00 [70.00–85.00] | 0.937 |
Heart Rhythm (bpm) | 155 | 70 [62–77] | 70.00 [62.00–76.00] | 68.00 [60.00–78.00] | 70.00 [63.00–77.00] | 0.876 |
LVEF, n (%) | 177 | < 0.001 | ||||
Reduced (LVEF ≤45%) | 13 (7.34%) | 0 (0.00%)bc | 8 (22.22%)c | 5 (13.89%)b | ||
Normal | 164 (92.6%) | 105 (100.00%) | 28 (77.78%) | 31 (86.11%) | ||
Treatment, n (%)
| ||||||
Diuretic | 168 | 73 (43.45%) | 39 (37.14%) | 18 (56.25%) | 16 (51.61%) | 0.097 |
Spironolactone | 166 | 19 (11.45%) | 12 (11.65%) | 4 (12.50%) | 3 (9.68%) | 1.000 |
ACE inhibitor | 168 | 61 (36.31%) | 36 (34.29%) | 13 (40.63%) | 12 (38.71%) | 0.771 |
β-receptor blocker | 168 | 64 (38.10%) | 38 (36.19%) | 12 (37.50%) | 14 (45.16%) | 0.663 |
ARB | 165 | 35 (21.21%) | 24 (23.53%) | 7 (21.88%) | 4 (12.90%) | 0.446 |
Calcium blocker | 169 | 38 (22.49%) | 23 (21.90%) | 11 (33.33%) | 4 (12.90%) | 0.144 |
Cardiac glycoside | 168 | 2 (1.19%) | 2 (1.90%) | 0 (0.00%) | 0 (0.00%) | 1.000 |
Antiarrhythmic drug | 168 | 24 (14.29%) | 12 (11.43%) | 6 (18.75%) | 6 (19.35%) | 0.326 |
Antiagregants | 168 | 45 (26.79%) | 25 (23.81%) | 8 (25.00%) | 12 (38.71%) | 0.250 |
Anticoagulant | 168 | 37 (22.02%) | 22 (20.95%) | 8 (25.00%) | 7 (22.58%) | 0.887 |
Pacemaker | 175 | 22 (12.57%) | 12 (11.54%) | 4 (11.43%) | 6 (16.67%) | 0.664 |
ICD | 175 | 7 (4.00%) | 0 (0%)bc | 3 (8.57%)c | 4 (11.11%)b | 0.002 |
Hospitalization during the preceding year
| ||||||
Patients with at least one hospitalization for any cause, n (%) | 177 | 37 (20.90%) | 19 (18.10%) | 7 (19.44%) | 11 (30.56%) | 0.276 |
Patients with at least one hospitalization for a cardiologic cause, n (%) | 177 | 11 (6.21%) | 5 (4.76%) | 3 (8.33%) | 3 (8.33%) | 0.509 |
Polygraphy and oximetry-based ASV monitoring data
N | Whole group N = 177 | CSA group N = 105 | OSA group N = 36 | TECSA group N = 36 |
P
| |
---|---|---|---|---|---|---|
Polygraphy, n (%) | 173 | 31 (17.9%) | 18 (17.5%) | 7 (20.6%) | 6 (16.7%) | 0.897 |
Apnea Hypopnea Index, (n/h) | 31 | 1.90 [0.4;4.2] | 1.50 [0.4;2.4] | 3.5 [0.4;21.9] | 1.55 [0.2;4.2] | 0.578 |
Apnea Index, (n/h) | 31 | 0.0 [0.0;0.2] | 0.0 [0.0;0.2] | 0.10 [0.00;2.70] | 0.0 [0.0;0.2] | 0.369 |
Hypopnea Index, (n/h) | 31 | 1.9 [0.4;3.9] | 1.3 [0.4;2.4] | 3.5 [0.2;11.8] | 1.5 [0.9;3.9] | 0.659 |
ODI 3%, (n/h) | 30 | 6.9 [3.9;11.6] | 4.7 [2.4;7.2] | 9.1 [7.5;23.9] | 11.3 [4.5;19.9] | 0.056 |
Mean SpO2, (%) | 30 | 95.2 [94.0;96.0] | 95.5 [94.8;96.0] | 95.0 [93.0;95.9] | 94.0 [92.70;96.0] | 0.379 |
Modification of ASV settings as a consequence of polygraphy, n (%) | 31 | 7 (22.6%) | 2 (11.1%) | 3 (42.9%) | 2 (33.3%) | 0.138 |
Oximetry, n (%) | 160 | 24 (15.0%) | 17 (17.9%) | 4 (11.8%) | 3 (9.7%) | 0.531 |
ODI (n/h) | 24 | 3.2 [1.5;9.7] | 2.8 [1.9;10.9] | 3.5 [2.1;5.8] | 8.7 [1.1;10.7] | 0.908 |
Mean SpO2, (%) | 24 | 93.5 [92.0;94.0] | 93.1 [91.4;94.0] | 94.0 [93.0;96.0] | 93.6 [93.0;93.6] | 0.478 |
Modification of ASV settings as a consequence of oximetry, n (%) | 24 | 7 (29.2%) | 6 (35.3%) | 0 (0%) | 1 (33.33%) | 0.519 |
Discussion
Conditions associated with ASV
N / C | Main sub-groups analysis reported | Prevalence of related SA comorbidity/etiology | CPAP trial before ASV | Duration of ASV / ASV-adherence | Initial AHI/h / Final AHI/h or AHIflow/h | Initial Epworth / Final Epworth | |
---|---|---|---|---|---|---|---|
Carnevale et al., 2011 [10]. Retrospective | 74 / 2 | 55% non-CHF and 45% CHF | NA CHF with LVEF≤45% NA CHF with LVEF> 45% 17% N, NA R, NA O, 28% I | 15/74 patients Duration of the trial NA | 36 ± 18 months / 75.6% > 3 h/jour | 53.0 ± 23.8/h / 5.9 ± 8.0/h | 8.9 ± 5.3 / NA |
Momomura et al., 2015 [11]. Retrospective | 115 / 16 | 24% ASV-discontinued CHF and 76% ASV-continued CHF | NA CHF (LVEF≤45%) NA CHF (LVEF> 45%) NA N, NA R, NA O, NA I | No CPAP trial | NA / NA | 28.8 ± 19.2/h for ASV-discontinued CHF and 24 ± 21.3/h for ASV-continued CHF/NA | NA / NA |
Malfertheiner et al., 2017 [12]. Retrospective | 285 / 2 | 32% Cardiac center 68% Pulmonary center | 39% CHF with LVEF≤45% 40% CHF with LVEF> 45% 0% N, NA R, 0.4% O, 10% ICSA | 1 night for 86 CSA patients and median trial of 17 days for 178 OSA patients | NA / NA | NA / NA | 9 ± 4.5 / NA |
Randerath et al., 2017 [13]. Retrospective | 293 / 1 | 57% CSA, 36% OSA, and presence of risk criteria (LVEF ≤45% and CSA) | 16% CHF with LVEF≤45% 23% CHF with LVEF> 45% NA N, NA R, 8% O, NA I | NA | NA / NA | 46.4 ± 20.5/h / NA | 7.8 ± 4.5 / 5.4 ± 3.7 |
Oldenburg et al., 2019 [8]. Retrospective | 224 / 1 | 100% CHF and LVEF ≤45% and AHI ≥ 15/h with predominant central pattern | NA | No CPAP trial | 24 months 65.9% > 4 h/day at 24 months | 37.7 ± 13.4 / 2.8 ± 3.2/h at 24 months | NA / NA |
Jaffuel et al. Prospective | 177 / 5 | 59.3% CSA, 20.3% OSA, 20.3% TECSA (11 patients with LVEF≤45% and CSA were excluded) | 7.3% CHF with LVEF≤45% 51.4% CHF with LVEF> 45% 12.4% N, 4.5% R, 3.4% O, 9.6% I | 91/177 Duration of the trial NA | 34.5 (21.1–59.5) months / 87% > 4 h/day | 50/h (38–62) / 1.9/h (0.7–3.8) | 10 (6–13.5) / 6 (3–9) |