Background: Sleep apnea is more common in patients with heart failure (HF) than in the general population, but little is known about its association with clinical outcomes in various HF phenotypes or how it might modify the effect of HF therapy.

Objectives: To examine the prevalence of sleep apnea, its association with outcomes and the effects of dapagliflozin in patients with HF with and without sleep apnea in a pooled analysis of 2 trials comparing dapagliflozin to placebo in HFrEF (DAPA-HF trial) and HFmrEF/HFpEF (DELIVER trial).

Methods: A history of sleep apnea was investigator-reported. The primary outcome was a composite of worsening HF or cardiovascular death.

Results: The prevalence of sleep apnea was 5.7% and 7.8% in patients with HFrEF and HFmrEF/HFpEF, respectively. The primary outcome occurred at a rate of 16.0 in participants with sleep apnea compared to 10.6 per 100 person-years in those without (adjusted HR 1.29 [95%CI, 1.10-1.52]). Compared with placebo, dapagliflozin reduced the risk of the primary endpoint to the same extent in patients with (HR 0.78 [95% CI, 0.59-1.03]) and without sleep apnea (HR 0.79 [0.72-0.87]) [P = 0.93]. The beneficial effects of dapagliflozin on other clinical outcomes and symptom burden, physical function, and quality of life were consistent in participants with and without sleep apnea.

Conclusions: In DAPA-HF and DELIVER, the true prevalence of sleep apnea was likely underestimated. An investigator-reported history of sleep apnea was associated with higher rates of worsening HF events. The benefits of dapagliflozin on clinical outcomes were consistent in patients with and without sleep apnea.

Clinical Trial Registration: Unique identifiers: NCT01920711 CONDENSED ABSTRACT: In a pooled analysis of the DAPA-HF and DELIVER trials of more than 11,000 patients with heart failure (HF) across the range of ejection fractions, an investigator-reported history of sleep apnea was associated with higher rates of worsening HF events but not mortality. The beneficial effects of dapagliflozin on clinical outcomes were consistent in patients with and without sleep apnea. These findings provide further evidence for dapagliflozin as a new treatment option for patients with heart failure across the range of ejection fractions.

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.cardfail.2023.08.027DOI Listing

Publication Analysis

Top Keywords

sleep apnea
48
heart failure
16
clinical outcomes
16
sleep
14
apnea
12
dapa-hf deliver
12
patients heart
12
prevalence sleep
12
effects dapagliflozin
12
patients sleep
12

Similar Publications

Background: Pregnancy-related anatomic, physiologic, and hormonal factors can occur at different stages of pregnancy and affect sleep disturbances. The relationship between sleep problems during pregnancy and postpartum depressive symptoms as well as neonatal condition at delivery have not been well described. This study hypothesized that sleep problems are associated with postpartum depressive symptoms and adverse neonatal outcomes at delivery.

View Article and Find Full Text PDF

Obstructive sleep apnea and structural and functional brain alterations: a brain-wide investigation from clinical association to genetic causality.

BMC Med

January 2025

Sleep Medicine Center, State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, NO.28 Qiaozhong Mid Road, Guangzhou, Guangdong, 510160, China.

Background: Obstructive sleep apnea (OSA) is linked to brain alterations, but the specific regions affected and the causal associations between these changes remain unclear.

Methods: We studied 20 pairs of age-, sex-, BMI-, and education- matched OSA patients and healthy controls using multimodal magnetic resonance imaging (MRI) from August 2019 to February 2020. Additionally, large-scale Mendelian randomization analyses were performed using genome-wide association study (GWAS) data on OSA and 3935 brain imaging-derived phenotypes (IDPs), assessed in up to 33,224 individuals between December 2023 and March 2024, to explore potential genetic causality between OSA and alterations in whole brain structure and function.

View Article and Find Full Text PDF

Shift work sleep disorder.

Handb Clin Neurol

January 2025

Department of Health and Society, School of Public Health, University of São Paulo, São Paulo, Brazil. Electronic address:

Shift work sleep disorder (SWSD) is a circadian rhythm sleep-wake disorders affecting individuals who work in nonstandard hours, particularly night shifts. It manifests as difficulty sleeping during the day and staying awake during work hours, leading to health issues. SWSD is not universally experienced by all shift workers, with about 30% affected.

View Article and Find Full Text PDF

Advanced sleep phase syndrome: Role of genetics and aging.

Handb Clin Neurol

January 2025

Sleep Medicine Center, Department of Neurology, Villa Serena Hospital, Città S. Angelo, Pescara, Italy; Villaserena Research Foundation, Città S. Angelo, Pescara, Italy.

Advanced sleep phase (ASP) is seldom brought to medical attention because many individuals easily adapt to their early chronotype, especially if it emerges before the age of 30 and is present in a first-degree relative. In this case, the disorder is considered familial (FASP) and is mostly discovered coincidentally in the presence of other sleep disorders, mainly obstructive sleep apnea syndrome (OSAS). The prevalence of FASP is currently estimated to be between 0.

View Article and Find Full Text PDF

Obstructive sleep apnea syndrome, orexin, and sleep-wake cycle: The link with the neurodegeneration.

Handb Clin Neurol

January 2025

Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; Sleep Medicine Centre, Neurology Unit, University Hospital of Rome Tor Vergata, Rome, Italy.

Obstructive sleep apnea syndrome (OSAS) significantly affects the sleep-wake circadian rhythm through intermittent hypoxia and chronic sleep fragmentation. OSAS patients often experience excessive daytime sleepiness, frequent awakenings, and sleep fragmentation, leading to a disrupted circadian rhythm and altered sleep-wake cycle. These disruptions may exacerbate OSAS symptoms and contribute to neurodegenerative processes, particularly through the modulation of clock gene expression such as CLOCK, BMAL1, and PER.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!