Particularities of older patients with obstructive sleep apnea and heard failure with mid-range ejection fraction

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Objectives: To assess the particularities of patients with obstructive sleep apnea syndrome (OSAS) and heart failure (HF) focusing in the latest guideline recommendation of mid-range ejection fraction (HFmrEF) and comparing with reduced EF (HFrEF) and preserved EF (HFpEF). Methods: A number of 143 older patients with OSAS and HF were evaluated in 3 sleep labs of Victor Babes Hospital and Cardiovascular Institute, Timisoara, Western Romania. We collected general data, sleep questionnaires, anthropometric, comorbidities, lab test results and performed polysomnography and echocardiographic measurements. Results: Patients were divided in three groups depending of ejection fraction, with the following characteristics: HFrEF (17 patients, 13 male (88%), age 61 (56-69), apnea-hypopnea index (AHI) 42 (24-53)/h, HFmrEF (33 patients, 22 male (67%), age 64.5 (57.5-71), AHI 38(24-48.5)/h, HFpEF (93 patients, 62 male (67%), age 61(56-67), AHI 44 (26-62)/h. Patients with HFmrEF were older (p=0.035), with higher creatinine (p=0.0013), lower glomerular filtration rate (p< 0.001), higher glycemic levels( p=0.008), larger left atrial diameter(p< 0.001). For comorbidities, higher prevalence of diabetes mellitus (p= 0.006), chronic kidney disease (p<0.001), tricuspid insufficiency (p=0.018), aortic insufficiency (p=0.038), chronic obstructive pulmonary disease (COPD) (p=0.009), coronary artery disease (CAD) (p=0.026) and impaired parietal kinetics (p<0.001). Conclusion: Patients with OSAS and HF with mid-range EF are a new described group with increased risk of developing life-long chronic kidney disease, diabetes mellitus, tricuspid and aortic insufficiency and with more COPD and CAD.

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