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A Prospective Observational Cohort Study of Sleep in People with Acute Congestive Heart Failure in Mozambique
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A3964 - A Prospective Observational Cohort Study of Sleep in People with Acute Congestive Heart Failure in Mozambique
Author Block: P. N. DeYoung1, I. M. Mbanze2, J. E. Orr3, R. U. Banze2, G. A. Muchanga2, V. Govo4, E. A. Nunes5, A. Malhotra6, A. A. Damasceno7; 1Pulmonary and Sleep Medicine, UCSD, La Jolla, CA, United States, 2Medicine, Maputo Central hospital, MAPUTO, Mozambique, 3Pulmonary and Critical Care Medicine, UCSD, La Jolla, CA, United States, 4Cardiology, Maputo Central hospital, Maputo, Mozambique, 5Medicine, Central Hospital Maputo, Maputo, Mozambique, 6Dept of Medicine, Univ of California at San Diego, La Jolla, CA, United States, 7Dept of Medicine, Eduardo Mondlane Univ Faculty of Medicine, Maputo, Mozambique.
ATS 2017 Abstract
Title:
Authors:
Rationale
Previously, we have presented data about sleep disordered breathing (SDB) in developing countries, finding a high prevalence of obstructive and central apnea in acute congestive heart failure. Given the uncertainty in the causal relationships, we sought to assess changes SDB over time following medical therapy.
Methods
Subjects were consented and enrolled in the acute care cardiology unit in Maputo, Mozambique. We used portable sleep testing (ApneaLink, Resmed) and performed echocardiography and biomarkers at both baseline and 6 month follow up. Follow up evaluation was performed after heart failure treatment according to local practice. Sleep studies were scored by a RPSGT using a modified Chicago criteria (3% desaturation).
Results
To date, 168 patients (61% female) have been assessed at baseline and at follow-up. Of these 115 (68%) completed the study, 46 (27%) have died prior to 6mos follow-up and 7(4%) were lost to follow-up. Among the participants, 34% had idiopathic dilated cardiomyopathy, 14% had peripartum cardiomyopathy, 34% had rheumatic heart disease, 9% had hypertensive heart disease, and 7% had endomyocardial fibrosis. The mean BMI was 21 kg/m2. Based on analyses thus far using an AHI cutoff of ≥5/h, 84% of subjects had SDB. Median AHI was 22/h, with median central apnea index of 5/h, obstructive apnea index 0.7/h, and hypopnea index 10/h. 50% of subjects had periods of Cheyne-Stokes respirations at baseline.
Conclusion
A number of conclusions seem evident. First, sleep disordered breathing is highly prevalence in acute congestive heart failure in Africa, even in patients with low BMI. Second, Cheyne Stokes breathing is common in Africa even in demographic groups (younger, female) who are not traditionally thought to have high risk of this condition Third, mortality among patients with sleep disordered breathing and acute heart failure is substantial in Mozambique. Fourth, medical therapy is effective in improving sleep disordered breathing, at least among those who survive. Fifth, ongoing efforts will be required to optimize care of these patients globally.
Author Block: P. N. DeYoung1, I. M. Mbanze2, J. E. Orr3, R. U. Banze2, G. A. Muchanga2, V. Govo4, E. A. Nunes5, A. Malhotra6, A. A. Damasceno7; 1Pulmonary and Sleep Medicine, UCSD, La Jolla, CA, United States, 2Medicine, Maputo Central hospital, MAPUTO, Mozambique, 3Pulmonary and Critical Care Medicine, UCSD, La Jolla, CA, United States, 4Cardiology, Maputo Central hospital, Maputo, Mozambique, 5Medicine, Central Hospital Maputo, Maputo, Mozambique, 6Dept of Medicine, Univ of California at San Diego, La Jolla, CA, United States, 7Dept of Medicine, Eduardo Mondlane Univ Faculty of Medicine, Maputo, Mozambique.
ATS 2017 Abstract
Title:
Authors:
Rationale
Previously, we have presented data about sleep disordered breathing (SDB) in developing countries, finding a high prevalence of obstructive and central apnea in acute congestive heart failure. Given the uncertainty in the causal relationships, we sought to assess changes SDB over time following medical therapy.
Methods
Subjects were consented and enrolled in the acute care cardiology unit in Maputo, Mozambique. We used portable sleep testing (ApneaLink, Resmed) and performed echocardiography and biomarkers at both baseline and 6 month follow up. Follow up evaluation was performed after heart failure treatment according to local practice. Sleep studies were scored by a RPSGT using a modified Chicago criteria (3% desaturation).
Results
To date, 168 patients (61% female) have been assessed at baseline and at follow-up. Of these 115 (68%) completed the study, 46 (27%) have died prior to 6mos follow-up and 7(4%) were lost to follow-up. Among the participants, 34% had idiopathic dilated cardiomyopathy, 14% had peripartum cardiomyopathy, 34% had rheumatic heart disease, 9% had hypertensive heart disease, and 7% had endomyocardial fibrosis. The mean BMI was 21 kg/m2. Based on analyses thus far using an AHI cutoff of ≥5/h, 84% of subjects had SDB. Median AHI was 22/h, with median central apnea index of 5/h, obstructive apnea index 0.7/h, and hypopnea index 10/h. 50% of subjects had periods of Cheyne-Stokes respirations at baseline.
Conclusion
A number of conclusions seem evident. First, sleep disordered breathing is highly prevalence in acute congestive heart failure in Africa, even in patients with low BMI. Second, Cheyne Stokes breathing is common in Africa even in demographic groups (younger, female) who are not traditionally thought to have high risk of this condition Third, mortality among patients with sleep disordered breathing and acute heart failure is substantial in Mozambique. Fourth, medical therapy is effective in improving sleep disordered breathing, at least among those who survive. Fifth, ongoing efforts will be required to optimize care of these patients globally.
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