0519 Positive Airway Pressure Therapy in Patient Admitted for Acute Heart Failure with Pulmonary Hypertension and Obstructive Sleep Apnea Significantly Reduces Pulmonary Pressures. (27th April 2018) - Sharma, S
Abstract: Introduction: Pulmonary hypertension is common in congestive heart failure (CHF) patients and predicts higher mortality. Obstructive sleep apnea is also highly common in CHF patients and may contribute to the elevated pulmonary pressures with additional negative impact on morbidity and mortality. This study evaluates the impact of positive airway pressure (PAP) therapy on patients admitted for acute CHF with pulmonary hypertension and obstructive sleep apnea. Methods: A two center randomized control trial comparing optimal standard of care therapy for acute CHF versus addition of positive airway pressure therapy in patients with concomitant obstructive sleep apnea. Results: Twenty consecutive patients were enrolled with 1:1 randomization to standard of care versus standard of care plus PAP therapy. PAP therapy was instituted for 48 hours, as tolerated. The baseline characteristics of the intervention arm versus the standard of care arm were; Age (70.6 vs 65, BMI of 28.8 vs 31.6 and the mean apnea hypopnea index (AHI) was 29.8 ± 10.7 vs 34.7 ± 9.7. Compared to the patients with acute CHF with pulmonary hypertension treated as standard of care, patient randomized to PAP therapy showed significant reduction in pulmonary artery systolic pressure (PASP: 59 ± 3 to 43 ± 3 vs 62 ± 4 to 56 ± 4 (p-0.014) after 48 hours of therapy. Improvement in ejection fraction in the intervention arm was noted (3.4 ± 1.5) versus (-0.6 ± 0.5) (p-0.03). No significant differences were noted in six-minute walk test or pro-BNP between the groups. Conclusion: Compared with the standard of care arm, randomization to the addition of positive airway pressure therapy significantly reduced PASP in 48 hours in patients admitted with acute CHF with concomitant obstructive sleep apnea. Support (If Any): The trail (ASAP-HF) was supported by an Investigator initiated grant by ResMed Inc.