S. Yakov’s research while affiliated with University Hospital "Tsaritsa Yoanna – ISUL" and other places

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.

Background: Acute decompensated heart failure (ADHF) is often associated with central sleep apnea (CSA), which exacerbates cardiovascular strain and impacts quality of life. In ADHF patients, CSA contributes to recurrent nocturnal oxygen desaturation, elevated apnea-hypopnea index (AHI), and frequent Cheyne-Stokes respiration episodes, increasing health risks. Echocardiographic monitoring is essential in these patients, providing reliable assessment of heart function over time. Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed for diabetes management, have shown benefi ts for renal function, sleep apnea symptoms, and heart failure outcomes, suggesting potential for multifaceted treatment. Purpose: To evaluate the effects of SGLT2i therapy on echocardiographic parameters and sleep apnea severity in patients with CSA and ADHF with reduced systolic function (HFrEF). Material and methods: We conducted a prospective cohort study with 162 patients, including those with an ejection fraction < 40%, NT-proBNP > 900 pg/ml, and AHIcentral > 5. Exclusions were patients with end-stage renal disease, NYHA class IV heart failure, COPD, or severe respiratory failure. ApneaLink™ and echocardiograms were used for assessments, and patients were followed for three months post-initiation of SGLT2i. Results: Among the 52 eligible patients, 48 completed the study. Echocardiographic improvements were signifi cant, particularly in diastolic function with a reduction in the E/e' ratio (from 14.74 ± 2.57 to 13.64 ± 2.18, p = 0.002) and right heart function, as shown by decreases in RVOT (from 39.25 ± 4.01 to 38.32 ± 3.59, p = 0.004) and s-PAP (from 41.26 ± 5.74 to 40.07 ± 5.20, p = 0.001). TAPSE also improved (from 18.37 ± 2.17 mm to 18.87 ± 1.96 mm, p < 0.001), and the s-PAP/TAPSE ratio refl ected better right heart effi ciency (from 0.46 ± 0.11 to 0.48 ± 0.10, p < 0.001). Sleep apnea metrics also showed improvement, with reductions in AHI (from 21.35 ± 4.91 to 18.33 ± 4.75, p = 0.015), central AHI (from 13.16 ± 3.70 to 10.04 ± 3.57, p < 0.001), and Cheyne-Stokes respiration episodes (from 33.70 ± 11.20 to 26.58 ± 9.95, p < 0.001). Oxygen desaturation index (ODI) decreased (from 24.29 ± 7.01 to 17.91 ± 5.90, p < 0.001), and NT-proBNP levels, indicating heart failure severity, were reduced (from 1574.89 ± 652.80 pg/ml to 1250.35 ± 484.26 pg/ml, p < 0.001). Conclusion: SGLT2i therapy led to substantial improvements in echocardiographic measures of diastolic and right heart function, along with signifi cant reductions in CSA severity and oxygen desaturation in ADHF patients. These fi ndings support the potential of SGLT2i as an effective treatment option, meriting further study for long-term benefi ts on cardiac and respiratory health.

The individual approach in the treatment of heart failure (HF) and personalized medicine have been the main topic in recent years in all scientific forums. The combination of chronic obstructive pulmonary disease (COPD) and sleep apnea (SA) further complicates the clinical presentation in patients with HF. The overlap of all three diseases requires a team of specialists and additional therapeutic approach for better control and to improve the prognosis. A large number of the pathophysiological mechanisms of the three diseases also overlap. The novel therapies for HF have shown good results, both in COPD and CA subgroups. Noninvasive ventilation during hospitalization and at home is an established method in the individual groups. In a combination of the three diseases, definitive data from randomized trials are still lacking.

Background: Acute decompensated heart failure (ADHF) is a condition with a high frequency of hospitalizations and mortality, and obstructive sleep apnea (OSA) is a common comorbidity. Continuous positive airway pressure (CPAP) therapy at home can be a good adjunctive non-drug therapy for these patients. Methods: We conducted a single-center, prospective cohort study from 150 consecutive patients hospitalized for heart failure exacerbation in the cardiology department. Of these, 57 patients had obstructive sleep apnea. After discharge, CPAP therapy at home was offered. We divided them into two groups and followed them for 1 year. All patients received optimal medical treatment. At the end of the period, patients underwent a follow-up physical examination, a follow-up echocardiography, and a follow-up evaluation of the Epworth Sleepiness Scale (ESS). Results: From 81 patients with sleep apnea, 72.8% (n = 59) had obstructive sleep apnea (OSA) and 27.2% (n = 22) had central sleep apnea (CSA). There was a statistically significant difference in body mass index (BMI), ESS, systolic blood pressure (SBP), diastolic blood pressure (DBP), and left ventricular ejection fraction (LVEF%) in the group with CPAP therapy compared to the no-CPAP group. The CPAP group had a median survival of 11.7 months vs. 10.1 months in the no-CPAP group (log-rank (Mantel–Cox) p = 0.044). Conclusions: This study suggests that obstructive sleep apnea is a common comorbidity in patients with acute decompensated heart failure. The addition of CPAP therapy in these patients improves the symptoms and the prognosis.