0977 Impact of Guideline-Directed Therapy on the Prevalence and Outcomes of Sleep-Disordered Breathing in Acute HFrEF in Rural Appalachia

Abstract Introduction Prior studies report a high prevalence (67–75%) of sleep-disordered breathing (SDB) among patients hospitalized with acute decompensated heart failure with reduced ejection fraction (HFrEF), with obstructive sleep apnea (OSA) comprising 57% and central sleep apnea (CSA) 18%. SDB has also been linked to increased 90-day readmission and mortality. However, with the widespread adoption of guideline-directed medical therapy (GDMT) over the past decade, the prevalence and clinical impact of SDB in this population may have shifted. This study evaluated the contemporary prevalence of SDB and its association with short-term outcomes in patients hospitalized with acute HFrEF. Methods Sixty-seven consecutive patients admitted with acute decompensated HFrEF underwent home sleep apnea testing (HSAT) as part of a clinical program. Patients were followed for 90 days to assess readmission and mortality. Demographics, comorbidities, and admission medications were recorded, including GDMT use. Fisher’s exact test and logistic regression model were used to assess readmission and mortality in the statistical analysis. Results Among the 67 participants, 34 (51%) had SDB, with CSA present in 25 (37.3%) and OSA in 9 (13.4%). The cohort was predominantly male (68.7%), with a mean age of 63 years and mean BMI of 35 kg/m². Baseline characteristics did not differ significantly between the SDB and non-SDB groups. A total of 26 patients (38.8%) were receiving GDMT. There was no significant difference in 90-day cumulative readmission or mortality between patients with versus without SDB (32.4% vs. 67.6%; p=0.218). In logistic regression analysis, age >65 years and GDMT use were associated with higher 90-day readmission and mortality (OR 3.6 and 4.9, respectively), whereas OSA and CSA were not. Conclusion In the modern GDMT era, the prevalence of SDB among patients hospitalized with acute HFrEF appears lower than historically reported. Contrary to earlier studies, SDB was not associated with increased 90-day readmission or mortality. The higher event rates observed in patients on GDMT may reflect treatment allocation to a sicker subset rather than a causal relationship. Support (if any)