Positive airway pressure benefits for HF mortality are not clear

  • Yamamoto S & al.
  • Cochrane Database Syst Rev
  • 04.12.2019

  • von Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Positive airway pressure (PAP) therapy for central sleep apnea with heart failure (HF) is not tied to reduced cardiac mortality or rehospitalization and has unclear benefit for all-cause mortality.
  • This Cochrane review found hints of benefit for QoL.

Why this matters

  • Some studies have found a benefit of PAP in this population, whereas others have found increased mortality risk.

Key results

  • PAP therapy duration, 1-31 months.
  • All but 1 trial included only patients with HF with reduced ejection fraction.
  • Risk ratios (95% CIs) suggested little benefit of PAP for:
    • All-cause mortality: 0.81 (0.54-1.21; 6 studies, 1804 patients; I2, 47%; evidence, very low quality).
    • Cardiac-related mortality: 0.97 (0.77-1.24; 5 studies, 1775 patients; I2, 11%; moderate-quality evidence).
    • All-cause rehospitalization: 0.95 (0.70-1.30; 5 studies, 1533 patients; I2, 40%; low-quality evidence).
    • Cardiac rehospitalization: 0.97 (0.70-1.35; 5 studies, 1533 patients; I2, 40%; low-quality evidence).
  • However, QoL scores were better with PAP (low-quality evidence).

Study design

  • Included 16 randomized controlled trials (n=2125).
  • PAP compared with usual care.
  • Funding: National Institute for Health Research, UK; Clinical Research Program for Child Health and Development, Japan; others.

Limitations

  • High heterogeneity among studies, which mostly had low-quality or very low-quality evidence, wide confidence intervals, and poor descriptions of design.