Analysis of echocardiographic changes in patients whit central sleep apnea treated with GLT2i
Authors: Kalaydzhiev P. , Ilieva R. , Georgieva N. , Yakov S. , Somleva D. , Voynova G. , Spasova N. , Kinova E. , Goudev A. 
Published: February 2025

Background: Acute decompensated heart failure (ADHF) is often associated with central sleep apnea (CSA), which exacerbates cardiovascular strain and impacts quality of life. In ADHF patients, CSA contributes to recurrent nocturnal oxygen desaturation, elevated apnea-hypopnea index (AHI), and frequent Cheyne-Stokes respiration episodes, increasing health risks. Echocardiographic monitoring is essential in these patients, providing reliable assessment of heart function over time. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed for diabetes management, have shown bene&#64257; ts for renal function, sleep apnea symptoms, and heart failure outcomes, suggesting potential for multifaceted treatment. Purpose: To evaluate the effects of SGLT2i therapy on echocardiographic parameters and sleep apnea severity in patients with CSA and ADHF with reduced systolic function (HFrEF). Material and methods: We conducted a prospective cohort study with 162 patients, including those with an ejection fraction < 40%, NT-proBNP > 900 pg/ml, and AHIcentral > 5. Exclusions were patients with end-stage renal disease, NYHA class IV heart failure, COPD, or severe respiratory failure. ApneaLink&trade; and echocardiograms were used for assessments, and patients were followed for three months post-initiation of SGLT2i. Results: Among the 52 eligible patients, 48 completed the study. Echocardiographic improvements were signi&#64257; cant, particularly in diastolic function with a reduction in the E/e&rsquo; ratio (from 14.74 &plusmn; 2.57 to 13.64 &plusmn; 2.18, p = 0.002) and right heart function, as shown by decreases in RVOT (from 39.25 &plusmn; 4.01 to 38.32 &plusmn; 3.59, p = 0.004) and s-PAP (from 41.26 &plusmn; 5.74 to 40.07 &plusmn; 5.20, p = 0.001). TAPSE also improved (from 18.37 &plusmn; 2.17 mm to 18.87 &plusmn; 1.96 mm, p < 0.001), and the s-PAP/TAPSE ratio re&#64258; ected better right heart ef&#64257; ciency (from 0.46 &plusmn; 0.11 to 0.48 &plusmn; 0.10, p < 0.001). Sleep apnea metrics also showed improvement, with reductions in AHI (from 21.35 &plusmn; 4.91 to 18.33 &plusmn; 4.75, p = 0.015), central AHI (from 13.16 &plusmn; 3.70 to 10.04 &plusmn; 3.57, p < 0.001), and Cheyne-Stokes respiration episodes (from 33.70 &plusmn; 11.20 to 26.58 &plusmn; 9.95, p < 0.001). Oxygen desaturation index (ODI) decreased (from 24.29 &plusmn; 7.01 to 17.91 &plusmn; 5.90, p < 0.001), and NT-proBNP levels, indicating heart failure severity, were reduced (from 1574.89 &plusmn; 652.80 pg/ml to 1250.35 &plusmn; 484.26 pg/ml, p < 0.001). Conclusion: SGLT2i therapy led to substantial improvements in echocardiographic measures of diastolic and right heart function, along with signi&#64257; cant reductions in CSA severity and oxygen desaturation in ADHF patients. These &#64257; ndings support the potential of SGLT2i as an effective treatment option, meriting further study for long-term bene&#64257; ts on cardiac and respiratory health.