ResMed has announced results from a major analysis of the German Statutory Health Insurance database presented at a Rapid Fire session at the ESC Congress 2014 in Barcelona, Spain. Results showed that the three-year mortality of people with sleep apnoea – a prevalent co-morbidity in coronary heart disease and heart failure – was significantly lower in patients who were treated with positive airway pressure devices compared to a comparable cohort that received no positive airway pressure treatment. Mortality was reduced by 37.9% in patients with coronary heart disease (p=0.0002) and by 31.6% in patients with heart failure (p<0.0001).
“Sleep apnoea is a highly prevalent co-morbidity in both coronary heart disease and heart failure, yet it remains frequently undiagnosed and thus undertreated,” says Michael Böhm, professor of Cardiology, University of the Saarland, Homburg, Germany and co-author of the analysis. “The results from this analysis highlight just how important it can be to identify and appropriately treat this condition, not only to improve quality of life, but also patient survival. It is vital that, as a community, cardiologists do more to recognise this and explore how we can ensure patients receive respiratory device therapy when needed.”
The analysis assessed outcomes for a total of over four million individuals covered by the Statutory Health Insurance database (approximately 5% of the German Statutory Health Insurance population). A group of patients with sleep apnoea being treated with positive airway pressure therapy was chosen (4,068 patients). Propensity score was used to define a control group of an equal number of patients with sleep apnoea who received no positive airway pressure treatment. Patients were followed over three years after initiation of their positive airway pressure therapy with results showing that the three-year mortality rate was significantly lower in patients treated with positive airway pressure compared with the no positive airway pressure group (4.5% vs 7.2%, 37.5% reduction; p<0.0001). Three-year rates for coronary heart disease mortality (4.5% vs 7.2%, 37.9% reduction; p=0.0002) and heart failure mortality (14.7% vs 21.4%, 31.6% reduction; p<0.0001) were also significantly lower in the positive airway pressure vs. no positive airway pressure group.
In the spotlight at the ESC Congress 2014: A route to simpler, more accurate diagnosis of sleep apnoea
An additional study presented at the ESC Congress 2014, has highlighted that heart failure patients with sleep-disordered breathing (SDB, also referred to as sleep apnoea) could be more accurately diagnosed through longer-term use of the at-home, contactless SleepMinder device than through a single hospital-based polysomnography (PSG) assessment, which is currently the gold-standard of care. This study also noted potential for misdiagnosis from overnight assessments compared to just two weeks of home-based analysis with SleepMinder.
Heart failure affects around 15 million people in Europe and it is thought that between 50-75% of these patients will have some form of sleep apnoea. It is the most common heart failure co-morbidity, yet is also one of the least recognised by cardiologists, despite being linked to poorer outcomes including mortality, hospitalisations and quality of life.
The investigating team reported that, after just two weeks assessment with SleepMinder, 57% of patients were consistently above a threshold that would require treatment for their sleep-disordered breathing (AHI≥15). This rose to 74% in patients who were followed up for 12 months. The study also noted that sleep-disordered breathing diagnosis via a single night of inpatient PSG frequently lead to an underestimation of a patient’s sleep-disordered breathing severity when compared to a two week assessment with SleepMinder.
ResMed in cardiology: SERVE-HF, the largest randomised trial of sleep-disordered breathing in heart failure
A common type of sleep-disordered breathing, central sleep apnoea with Cheyne-Stokes respiration (CSA-CSR), can be successfully treated with PaceWave Adaptive Servo-Ventilation (ASV) therapy. In 2013 ResMed completed enrolment of the 1,325th patient in SERVE-HF, the world’s largest randomised study investigating by what degree the treatment of central sleep-disordered breathing (CSA-CSR) with PaceWave ASV may improve survival and outcomes of patients with stable heart failure. Results are expected to report in 2015 and could lead to significant changes in cardiology clinical practice.