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

Sleep apnoea [SA, either predominantly obstructive SA (OSA) or predominantly central SA (CSA)] is considered as a potential therapeutic target in CHF as underlined by the 2017 European Respiratory Society Task Force. Optimizing medical cardiac treatment for sleep apnoea (SA) in patients with chronic heart failure and reduced ejection fraction (HFrEF) is an expert Grade C recommendation based on six studies encompassing a total of 67 patients only. Whether sacubitril–valsartan (SV), a cornerstone of HFrEF medical treatment, impacts SA is unknown and requires evaluation. Therefore, Dr François Roubille and his team conducted a study to assess whether SV initiation could improve SA outcomes in HFrEF patients treated under real-life conditions.

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