Auto positive airway pressure therapy reduces pulmonary pressures in adults admitted for acute heart failure with pulmonary hypertension and obstructive sleep apnea. The ASAP-HF Pilot Trial.

Authors:
Sunil Sharma
Sunil Sharma
Huntsman Cancer Institute
India
Henrik Fox
Henrik Fox
Johann Wolfgang Goethe-University Frankfurt
Germany
Leslee Willes
Leslee Willes
Willes Consulting Group
Thomas Bitter
Thomas Bitter
Ruhr University Bochum
Germany
Olaf Oldenburg
Olaf Oldenburg
Ruhr University Bochum
Germany

Sleep 2019 Jul;42(7)

Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.

Objectives: Pulmonary hypertension (PH) is extremely common in acute decompensated heart failure (ADHF) patients and predicts increased mortality. Obstructive sleep apnea (OSA), highly prevalent in congestive heart failure patients, may contribute to further elevated pulmonary pressures. This study evaluates the impact of positive airway pressure (PAP) therapy on PH in patients admitted for ADHF with OSA.

Methods: A two-center randomized control trial comparing standard of care (SOC) therapy for ADHF versus addition of PAP therapy in patients with concomitant OSA.

Results: Twenty-one consecutive patients were enrolled with 1:1 randomization to SOC versus SOC plus 48-hour PAP therapy protocol. In the intervention arm, the mean pulmonary artery systolic pressure (PASP) difference before therapy and after 48 hours of PAP therapy was -15.8 ± 3.2 (58.6 ± 2.5 mm Hg to 42.8 ± 2.7) versus the SOC arm where the mean PASP difference was -5.2 ± 2.6 (62.7 ± 3.3 mm Hg reduced to 57.5 ± 3.9) (p = 0.025). In addition, ejection fraction in the intervention arm improved (3.4 ± 1.5% versus -0.5 ± 0.5 %) (p = 0.01). Significant improvement was also noted in tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic area in the intervention arm but not in NT-pro-BNP or 6-minute walk distance.

Conclusions: In patients with ADHF and OSA, addition of 48 hours of PAP therapy to SOC treatment significantly reduced PH. In addition, PAP therapy was able to improve right and left ventricular function. ClinicalTrials.gov identifier: NCT02963597.

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https://academic.oup.com/sleep/advance-article/doi/10.1093/s
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http://dx.doi.org/10.1093/sleep/zsz100DOI Listing

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July 2019
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(Supplied by CrossRef)
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Positive airway pressure therapy for sleep disordered breathing in congestive heart failure is associated with reduction in pulmonary artery systolic pressure
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J Sleep Disor: Treat Care 2016
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Circulation 2013
ATS statement: guidelines for the six-minute walk test
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories et al.
Am J Respir Crit Care Med 2002

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