Additional benefits ofSGLT2i therapy in patients with acute decompensated heart failure and central sleep apnea.

Abstract

Background
Acute decompensated heart failure (ADHF) is often linked to central sleep apnea (CSA), a condition that exacerbates cardiovascular strain and reduces quality of life. In ADHF patients, CSA leads to recurrent nocturnal oxygen desaturation, increased apnea-hypopnea index (AHI), and Cheyne-Stokes respiration episodes, all of which elevate health risks. Originally designed for diabetes management, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown benefits for renal function, sleep apnea symptoms, and heart failure outcomes, offering a promising multifaceted treatment approach.

Purpose
To investigate the effects of SGLT2i therapy in patients with central sleep apnea and acute decompensated heart failure with reduced systolic function (HFrEF).

Methods
We conducted a prospective open-label real-life cohort study involving 162 consecutive patients who met inclusion criteria: an ejection fraction (EF) < 40%, NT-proBNP > 900 pg/ml, a central apnea-hypopnea index (AHIcentral) > 5, and an obstructive apnea-hypopnea index (AHIobstructive) < 15. All participants were naive to SGLT2i therapy. We excluded patients with end-stage renal disease, NYHA class IV heart failure, COPD, or severe respiratory failure. Sleep apnea was assessed using the ApneaLink™ system, and echocardiograms were performed for evaluation. After starting SGLT2i treatment, we followed the patients for 3 months.

Results
After screening, 52 patients were found eligible for the study. However, 2 patients declined follow-up, and 2 patients passed away, resulting in a final analysis of 48 patients. At baseline, the mean AHI was 21.35 ± 4.91, which significantly decreased to 18.33 ± 4.75 after 3 months of SGLT2i therapy (p = 0.015). The AHIcentral improved from 13.16 ± 3.70 to 10.04 ± 3.57 (p < 0.001), indicating a substantial reduction in central apneas, while the AHIobstructive showed no significant change, remaining at 5.52 ± 2.36 and 5.63 ± 2.32 (p = 0.404). Cheyne-Stokes respiration frequency decreased from 33.70 ± 11.20 to 26.58 ± 9.95 (p < 0.001), reflecting an improvement in breathing patterns. The oxygen desaturation index (ODI) also showed a significant reduction from 24.29 ± 7.01 to 17.91 ± 5.90 (p < 0.001), indicating fewer episodes of desaturation. Average SpO2 improved from 89.56 ± 2.82% to 91.54 ± 2.04% (p < 0.001), and the lowest desaturation increased from 80.72 ± 5.64% to 82.02 ± 5.20% (p = 0.023). NT-proBNP levels, a marker of heart failure severity, decreased significantly from 1574.89 ± 652.80 pg/ml to 1250.35 ± 484.26 pg/ml (p < 0.001), indicating improved cardiac function. The EF also improved slightly from 35.60 ± 3.81% to 35.93 ± 3.86% (p = 0.034).

Conclusion
SGLT2i therapy showed promising benefits for patients with ADHF and CSA over three months. These findings support the potential of SGLT2i as an effective treatment option, warranting further investigation into its long-term effects on patient outcomes.