Abstract 4358405: Risk for Central Sleep Apnea Remains High After Contemporary Heart Failure Guideline-Directed Medical Therapy

Introduction: Sleep disordered breathing (SDB) has been reported as a common comorbidity in heart failure (HF). Historic cohorts did not include patients using SGLT-2 inhibitors or neprilysin inhibitors, which may have an impact on the prevalence of sleep apnea due to improved cardiac function, decreased sympathetic drive, attenuated inflammation or weight loss. Research Question: Assess the prevalence of SDB including central sleep apnea (CSA) in a contemporary stable population of patients diagnosed HFrEF or HFmrEF at a single cardiovascular center in Poland. Methods: Patients ≥50 years old with stable HF, LVEF<50%, NYHA class ≥II, on optimized GDMT HF treatment, and no prior SDB diagnosis prospectively underwent a WatchPAT® home sleep apnea test to screen for SDB. Subjects were classified as not having SDB if the apnea hypopnea index (AHI) using a 4% desaturation rule was <5 events/hour of sleep, mild SDB if 5≤AHI<15, and moderate-to-severe SDB if AHI≥15. Subjects with AHI≥15 were further classified based on the percentage of AHI that was central. Results: The 200 participants had a median [Q1, Q3] age of 68 [61, 75] years, body mass index 28.1 [25.0, 31.4] kg/m 2 , and LVEF 35% [29, 42]. They were primarily male (84%), NYHA class II (97%; 3% class III) and well-treated on GDMT including 97% using 3 or 4 of the recommended drugs. Of the 200 participants, 71.5% (143) had SDB. Further, 39.0% (78) had moderate-to-severe SDB (Figure 1); obstructive sleep apnea (OSA) was the most common type, but about half of the predominantly OSA participants also experienced a meaningful burden of central events. Predominant moderate-to-severe CSA (central AHI≥50% of AHI) was identified in 9.5% (19) of all participants, while another 15.0% (30) had 10-<50% of events being central and 14.5% (29) had mostly obstructive events (<10% central). Examination of only central events revealed 19.5% (39) of participants had central AHI≥5 and 9.0% (18) had central AHI≥15. Conclusions: There is a significant prevalence of SDB, including CSA, in well-managed patients with HFrEF/HFmrEF despite advances in HF treatments that improve autonomic balance and promote weight loss. Treatment of SDB has demonstrated significant improvements in quality of life in patients with either OSA or CSA but continues to be underdiagnosed and undertreated. Therefore, all patients with HF should be questioned for signs and symptoms of SDB followed by appropriate testing and treatment. Registration: NCT06313840