Obstructive Sleep Apnea in Continuous Flow LVAD Supported Patients: Incidence and therapeutic implications

Background: Obstructive Sleep apneas (OSA) and hypopneas result from complete or partial collapse of a narrowed pharynx.

The reported prevalence of OSA in the healthy population is approximately 4% in women and 9% in men.

In the heart failure (HF) populations, prevalence of OSA varies between 37% up to 54%.

However, only a minority of the HF patients complain of excessive daytime sleepiness, suggesting that many patients with HF have relatively asymptomatic OSA.

The incidence of sleep apnea in HF patients supported with continuous flow LVAD is unknown.

The aim of this study was to assess the incidence and therapeutic implications of sleep apnea in LVAD supported patients.

Methods: Sleep study was performed in 12 continuous flow LVAD supported patients.

The participating patients were 6 months post operation, stable with no changes planned in their medical management and had no OSA related symptoms

Results: OSA was present in 11 patients (91%). According to the apnea-hypopnea index, OSA was mild (5 to 15) in 4, moderate (15 to 30) in 6 and severe (more than 30) in 1 patients.

CPAP treatment was offered to the entire group with OSA but was tolerated in only 8 patients who used it for more than 3 months.

After 3 months of CPAP therapy a mild improvement in kidney function (decrease in mean creatinine from 1.30 to 1.18 mmol/l), mean pulmonary pressures (from 22.75 to 18.5 mmHg) and mean cardiac index (from 2.05 to 2.70 l/min/m²) was observed.

Conclusion: OSA is very frequent in continuous flow LVAD supported patients.

The use of CPAP in LVAD supported patients has a significant hemodynamic effect. Due to the low symptomatology of OSA in the LVAD supported patients and the benefits of CPAP therapy; we propose to perform sleep study in all LVAD patients.