Sacubitril-valsartan initiation in CHF may significantly decrease sleep apnea severity

ENTRESTO-SAS trial is a six-centre, prospective, open-label real-life cohort study. The researchers included 118 HFrEF patients who remain symptomatic despite optimal treatment and evaluated them before and after 3 months of SV (including nocturnal ventilatory polygraphy). They were divided into three groups according to initial central/obstructive apnoea–hypopnoea indices (AHIs):

Group 1: AHIcentral ≥ 5/h and AHIobstructive < 15/h; n=49,

Group 2: AHIobstructive ≥ 15/h; n=27,

Goup 3: AHIcentral < 5/h and AHIobstructive < 15/h;n = 42..

The major outcome assessed was changes in the apnoea–hypopnoea indices (AHI).

Key findings of the study were:

• By 3 months, the researchers noted that the AHI decreased significantly by −7.10/h in G1 + G2 without positive airway pressure treatment (45 patients, median initial AHI of 24.20).
• Among them, the researchers found that 24.4% presented an AHI decreased ≥50% and 37.78% had a final AHI < 15/h (the tendency for improvement from an initial value of 20%: P = 0.0574).
• In group 1, the researchers found that AHI significantly decreased in 37 patients from a median of 22.90/h to 19.20/h.
• For group 2 patients, they found AHI decreased in 8 patients from a median of 30.10/h to 22.75 /h. However, they noted that the findings were not significant.

The authors concluded, "In this real-life population, SV treatment for 3 months in SA patients is associated with a significant decrease in AHI. These results support the current guidelines that recommend first an optimization of the HFrEF treatment in patients with HFrEF and central SA. A potential positive airway pressure sparing effect merits further investigation."

For further information:

https://onlinelibrary.wiley.com/doi/10.1002/ehf2.13455?af=R