• Hanqiao Wang, John D Parker, Gary E Newton, John S Floras, Susanna Mak, Kuo-Liang Chiu, Pimon Ruttanaumpawan, George Tomlinson, and T Douglas Bradley.
• Sleep Research Laboratory of the Toronto Rehabilitation Institute, Toronto, Ontario, Canada.
• J. Am. Coll. Cardiol. 2007 Apr 17;49(15):1625-31.

ObjectivesThis 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).BackgroundObstructive 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.MethodsIn 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).ResultsDuring 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).ConclusionsIn patients with HF, untreated OSA is associated with an increased risk of death independently of confounding factors.

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