Diagnosis and Treatment of Sleep Apnea in the Acute Exacerbation of Heart Failure
Condition: Sleep Apnea; Heart Failure
MeSH terms: Apnea; Sleep Apnea Syndromes; Heart Failure
Study type: Interventional

Summary: 
      Congestive heart failure affects 2.3 percent of the population (approximately 4,900,000) with
      an incidence of 10 per 1,000 of the population after the age of 65 (1). The admission rate
      for patients with heart failure is on the rise, so is the mortality associated with it and
      its national annual bill, now exceeding $21 billion (1). Obstructive Sleep Apnea (OSA) is
      present in 11-37 percent of patients with heart failure (2,3), and tends to increase in
      severity when the heart failure is less controlled (4, 5). Therefore, the actual prevalence
      of OSA in patients hospitalized with acute heart failure is likely higher. There is now
      evidence that treatment of OSA with nasal Continuous Positive Pressure (nCPAP) in outpatients
      with stable heart failure improves left ventricular ejection fraction, and quality of life
      (6), and confers a reduction in fatal and non-fatal cardiovascular events (7). However, there
      has not been any evaluation of the role of diagnosis and treatment of OSA in patients
      hospitalized with acute heart failure. This uncertainty about the true prevalence and role of
      OSA in exacerbations of heart failure, and the role of its treatment in the acute setting may
      explain why aggressive diagnostic and therapeutic strategy for OSA in patients admitted to
      the hospital with acute heart failure is not part of the standard clinical practice in acute
      care centers. Given the rising admission rate, and mortality associated with heart failure,
      an evaluation of the role of OSA and its treatment in this patient population is highly
      significant.
    

Detailed description: 
      OSA is associated with large negative swings in the intrathoracic pressure, significant
      increase in the sympathetic nerve activity and repetitive surges in blood pressure, along
      with episodic hypoxia and hypercapnea (8, 9). These autonomic and respiratory changes may
      increase the cardiac muscle workload, cardiac dysrrhythmia, and exacerbate ischemia
      (10,11,12). Treatment with continuous positive airway pressure (CPAP) is the most successful
      therapeutic modality available for obstructive sleep apnea. It is still not clear whether
      establishing the diagnosis of OSA and initiating treatment with CPAP while still in the
      hospital carries any benefit in the management of patients with acute heart failure. This
      study will evaluate the effect of work up and treatment of OSA on the outcome of patients
      hospitalized with acute congestive heart failure (CHF).
    

Intervention name(s): auto adjusting bi-level positive airway pressure device
Intervention type(s): Device
Intervention description(s): auto adjusting bi-level positive airway pressure device is provided for treatment of obstructive sleep apnea.
Other intervention name(s): APAP; CPAP
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Sleep apnea,; obstructive sleep apnea,; heart failure,; CHF