Impact of sleep-disordered breathing and efficacy of positive airway pressure on mortality in patients with chronic heart failure and sleep-disordered breathing: a meta-analysis

Backgrounds To conduct a meta-analysis to investigate whether sleep-disordered breathing (SDB) is an independent risk factor for mortality and whether positive airway pressure (PAP) decreases mortality in patients with chronic heart failure (HF). The impact of SDB and the effects of PAP on mortality in patients with chronic HF remain unclear. Methods We searched the MEDLINE, EMBASE, and Cochrane databases. Clinical trials that addressed mortality and the effect of PAP on mortality in chronic HF patients with SDB were included in this meta-analysis. Results Eleven studies (1,944 participants in total) that addressed mortality in chronic HF patients with SDB were included in this study. Patients with SDB showed a significantly increased mortality risk compared to those without SDB [risk ratio (RR) 1.66 (1.19–2.31)]. In sub-analyses, a significant increase in risk of mortality was observed for central sleep apnea versus no-SDB [RR 1.48 (1.15–1.91)], whereas no significant increase in risk was observed for obstructive sleep apnea versus no-SDB. Five randomized controlled studies (395 participants) that assessed the effect of PAP in chronic HF patients with SDB were analyzed. Adaptive servo-ventilation (ASV) significantly reduced all-cause mortality in chronic HF patients with SDB [RR 0.13 (0.02–0.95)], whereas continuous PAP did not significantly reduce all-cause mortality [RR 0.71 (0.32–1.57)]. Conclusions The prevalence of SDB in patients with chronic HF is associated with worse survival, and ASV reduces all-cause mortality in patients with chronic HF concomitant with SDB.