{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T08:42:39Z","timestamp":1780735359955,"version":"3.54.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T00:00:00Z","timestamp":1686873600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"Introduction<\/jats:title>Heart failure (HF) is an advanced stage of cardiac disease and is associated with a high rate of mortality. Previous studies have shown that sleep apnea (SA) is associated with a poor prognosis in HF patients. Beneficial effects of PAP therapy that is effective on reducing SA on cardiovascular events, were not yet established. However, a large-scale clinical trial reported that patients with central SA (CSA) which was not effectively suppressed by continuous positive airway pressure (CPAP) revealed poor prognosis. We hypothesize that unsuppressed SA by CPAP is associated with negative consequences in patients with HF and SA, including either obstructive SA (OSA) or CSA.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was a retrospective observational study. Patients with stable HF, defined as left ventricular ejection fraction of \u226450%; New York Heart Association class\u2009\u2265\u2009II; and SA [apnea\u2013hypopnea index (AHI) of \u226515\/h on overnight polysomnography], treated with CPAP therapy for 1 month and performed sleep study with CPAP were enrolled. The patients were classified into two groups according to AHI on CPAP (suppressed group: residual AHI\u2009\u2265\u200915\/h; and unsuppressed group: residual AHI\u2009&lt;\u200915\/h). The primary endpoint was a composite of all-cause death and hospitalization for HF.<\/jats:p><\/jats:sec>Results<\/jats:title>Overall, data of 111 patients including 27 patients with unsuppressed SA, were analyzed. The cumulative event-free survival rates were lower in the unsuppressed group during a period of 36.6 months. A multivariate Cox proportional hazard model showed that the unsuppressed group was associated with an increased risk for clinical outcomes (hazard ratio 2.30, 95% confidence interval 1.21\u20134.38, p<\/jats:italic>\u2009=\u20090.011).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Our study suggested that in patients with HF and SA including either OSA or CSA, presence of unsuppressed SA even on CPAP was associated with worse prognosis as compared to those with suppressed SA by CPAP.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1156353","type":"journal-article","created":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T06:10:00Z","timestamp":1686895800000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical outcomes of chronic heart failure patients with unsuppressed sleep apnea by positive airway pressure therapy"],"prefix":"10.3389","volume":"10","author":[{"given":"Ryo","family":"Naito","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takatoshi","family":"Kasai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasuhiro","family":"Tomita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Kasagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Narui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin-Ichi","family":"Momomura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,6,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"7","DOI":"10.15420\/cfr.2016:25:2","article-title":"Global public health burden of heart failure","volume":"3","author":"Savarese","year":"2017","journal-title":"Card Fail Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"e67","DOI":"10.1161\/CIR.0000000000000558","article-title":"Heart disease and stroke statistics-2018 update: a report from the American heart association","volume":"137","author":"Benjamin","year":"2018","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2403","DOI":"10.3390\/jcm11092403","article-title":"Association between frequency of central respiratory events and clinical outcomes in heart failure patients with sleep apnea","volume":"11","author":"Naito","year":"2022","journal-title":"J Clin Med"},{"key":"B4","doi-asserted-by":"publisher","first-page":"781054","DOI":"10.3389\/fneur.2022.781054","article-title":"Factors associated with the improvement of left ventricular systolic function by continuous positive airway pressure therapy in patients with heart failure with reduced ejection fraction and obstructive sleep apnea","volume":"13","author":"Naito","year":"2022","journal-title":"Front Neurol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1378\/chest.07-1901","article-title":"Prognosis of patients with heart failure and obstructive sleep apnea treated with continuous positive airway pressure","volume":"133","author":"Kasai","year":"2008","journal-title":"Chest"},{"key":"B6","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.jjcc.2012.05.013","article-title":"Sleep apnea and heart failure","volume":"60","author":"Kasai","year":"2012","journal-title":"J Cardiol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.jacc.2010.08.627","article-title":"Obstructive sleep apnea and heart failure","volume":"57","author":"Kasai","year":"2011","journal-title":"J Am Coll Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1056\/NEJMoa051001","article-title":"Continuous positive airway pressure for central sleep apnea and heart failure","volume":"353","author":"Bradley","year":"2005","journal-title":"N Engl J Med"},{"key":"B9","volume-title":"Sleep technicians and technologists","year":"2020"},{"key":"B10","volume-title":"The AASM manual for the scoring of sleep and associated events: Rules, terminology and technical specifications","year":"2020"},{"key":"B11","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.cardfail.2008.11.015","article-title":"Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction","volume":"15","author":"Yumino","year":"2009","journal-title":"J Card Fail"},{"key":"B12","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s11897-018-0387-7","article-title":"Management of sleep disordered breathing in patients with heart failure","volume":"15","author":"Oates","year":"2018","journal-title":"Curr Heart Fail Rep"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1840","DOI":"10.1161\/CIRCULATIONAHA.117.029400","article-title":"INCOSACT Initiative (international collaboration of sleep apnea cardiovascular trialists). Sleep apnea and cardiovascular disease: lessons from recent trials and need for team science","volume":"136","author":"Drager","year":"2017","journal-title":"Circulation"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3173","DOI":"10.1161\/CIRCULATIONAHA.106.683482","article-title":"Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian continuous positive airway pressure for patients with central sleep apnea and heart failure trial (CANPAP)","volume":"115","author":"Arzt","year":"2007","journal-title":"Circulation"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1016\/j.jacc.2017.07.740","article-title":"Prognostic significance of central apneas throughout a 24-hour period in patients with heart failure","volume":"70","author":"Emdin","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"125","DOI":"10.3389\/fcvm.2019.00125","article-title":"Central and obstructive apneas in heart failure with reduced, mid-range and preserved ejection fraction","volume":"6","author":"Borrelli","year":"2019","journal-title":"Front Cardiovasc Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1161\/01.CIR.99.12.1574","article-title":"Influence of pulmonary capillary wedge pressure on central apnea in heart failure","volume":"99","author":"Solin","year":"1999","journal-title":"Circulation"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1093\/eurheartj\/ehv624","article-title":"Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients","volume":"37","author":"Oldenburg","year":"2016","journal-title":"Eur Heart J"},{"key":"B19","first-page":"146","article-title":"Evaluation of the apnea-hypopnea index determined by the S8 auto-CPAP, a continuous positive airway pressure device, in patients with obstructive sleep apnea-hypopnea syndrome","volume":"6","author":"Ueno","year":"2010","journal-title":"J Clin Sleep Med JCSM Off Publ Am Acad Sleep Med"},{"key":"B20","doi-asserted-by":"publisher","first-page":"2877","DOI":"10.2169\/internalmedicine.51.8249","article-title":"Comparison between the apnea-hypopnea indices determined by the REMstar auto M series and those determined by standard in-laboratory polysomnography in patients with obstructive sleep apnea","volume":"51","author":"Ikeda","year":"2012","journal-title":"Intern Med Tokyo Jpn"},{"key":"B21","doi-asserted-by":"publisher","first-page":"680053","DOI":"10.3389\/fcvm.2021.680053","article-title":"Evaluation of the apnea-hypopnea Index determined by adaptive servo-ventilation devices in patients with heart failure and sleep-disordered breathing","volume":"8","author":"Imanari","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1253\/circj.72.1100","article-title":"Bi-Level positive airway pressure ventilation for treating heart failure with central sleep apnea that is unresponsive to continuous positive airway pressure","volume":"72","author":"Dohi","year":"2008","journal-title":"Circ J"},{"key":"B23","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.jchf.2012.11.002","article-title":"Adaptive servo-ventilation in cardiac function and neurohormonal Status in patients with heart failure and central sleep apnea nonresponsive to continuous positive airway pressure","volume":"1","author":"Kasai","year":"2013","journal-title":"JACC Heart Fail"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1056\/NEJMoa1506459","article-title":"Adaptive servo-ventilation for central sleep apnea in systolic heart failure","volume":"373","author":"Cowie","year":"2015","journal-title":"N Engl J Med"},{"key":"B25","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1002\/ejhf.790","article-title":"Design of the effect of adaptive servo-ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT-HF trial","volume":"19","author":"Lyons","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"B26","article-title":"The ADVENT-HF trial","author":"Bradley","year":"2022","journal-title":"Eur Soc Cardiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"S0012369223000405","DOI":"10.1016\/j.chest.2022.12.048","article-title":"Factors associated with residual apnea-hypopnea index variability during continuous positive airway pressure treatment","volume":"163","author":"Rossetto","year":"2023","journal-title":"Chest"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1156353\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,6,16]],"date-time":"2023-06-16T06:10:04Z","timestamp":1686895804000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1156353\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,16]]},"references-count":27,"alternative-id":["10.3389\/fcvm.2023.1156353"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1156353","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,16]]},"article-number":"1156353"}}