The Role of Sleep Apnea in the Acute Exacerbation of Heart Failure
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Purpose
This study will evaluate whether treating sleep apnea while in the hospital would help heart failure, and assist recovery from the worsening of the heart function more than the current clinical standard of waiting for treatment until the subject have left the hospital.
Heart failure affects more than 2% of the US population and is the only cardiovascular disorder with rising incidence. The annual cost of CHF in 2005 was $ 27.9 billion, large percentage of which is the cost of hospitalizations for exacerbation of CHF. Half of patients with CHF have some form of sleep apnea, and most of them go undiagnosed. Patients with CHF and OSA benefit from treatment with CPAP as an outpatient. The society can benefit from developing recommendations for approaching sleep apnea in the hospitalized CHF patient, which may shorten length of stay, improve functional status of discharged patient, and reduce rehospitalizations.
| Condition | Intervention |
|---|---|
|
Heart Failure Obstructive Sleep Apnea Heart Failure, Congestive |
Device: CPAP Therapy |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Treatment |
| Official Title: | The Role of Sleep Apnea in the Acute Exacerbation of Heart Failure |
- EF Improvement [ Time Frame: 3 month ] [ Designated as safety issue: No ]
- Quality of life [ Time Frame: 6 months ] [ Designated as safety issue: No ]
- BNP, BUN, Creatine levels [ Time Frame: 3 month ] [ Designated as safety issue: No ]
| Estimated Enrollment: | 170 |
| Study Start Date: | March 2008 |
| Estimated Study Completion Date: | February 2013 |
| Estimated Primary Completion Date: | February 2013 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: DEVICE
Provided CPAP as an inpatient
|
Device: CPAP Therapy
CPAP therapy is provided as an inpatient.
Other Name: CPAP Device
|
|
No Intervention: Control
No device provided
|
Detailed Description:
Target population:
Patients admitted to the OSU Heart Hospital with ADHF routinely undergo a cardiorespiratory sleep study to identify OSA. Patients with ADHF who are newly diagnosed with OSA during the same hospital stay are eligible for this study.
Enrollment:
Given the presence of significant previously unrecognized OSA in 62% of patients hospitalized with ADHF, we expect to need to screen 270 patient volunteers to recruit 170 patients with OSA.
Eligibility for randomization: The criteria for ADHF is admission diagnosis of heart failure; a chief complaint of dyspnea; and ejection fraction of 45% or less. Additionally, elevated left ventricular pressure as indicated by at least one sign and one symptom of volume overload (pedal edema, crackles, consistent chest X-ray, increased left ventricular end-diastolic diameter, or elevated BNP level) is required [46].
Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- Previously unrecognized OSA with an Apnea Hypopnea Index (AHI) > 15 events per hour on the attended in-hospital sleep study. Patients with apnea index of less than 5 events / hour are excluded (see design consideration for rationale)
- Projected length of stay 3 days or more on the morning following the cardio-respiratory sleep study
- Ongoing or planned targeted treatment for heart failure including one of the following: IV diuretics, IV infusion of inotropes or vasodilators, or planned revascularization, or device therapy
Exclusion Criteria:
- Patients who are already diagnosed with OSA
- Patients with Central Sleep Apnea
- Patients with diastolic only heart failure
- Cardiogenic shock and hemodynamic instability with MAP less than 55 mmHg off vasopressors, or concurrently on vasopressor treatment, left ventricular assist devices, or intra-aortic Balloon Pump. Inotropic agents will not constitute an exclusion criterion. Patients will be eligible once off vasopressors.
- Acute respiratory failure or insufficiency defined by P/F (PaO2/FIO2) ratio less than 250, or FIO2 requirement more than 50%
- Overt neurological deficit
- Renal failure requiring renal replacement therapy; Patients will not be excluded if they were undergoing ultra-filtration for volume removal
- Patients scheduled for procedures that will interfere with post randomization measurement: This includes scheduled coronary bypass surgery, or expected left ventricular assist device placement.
- Patients who arrived from a long-term care facility or expected to be discharged to one; and patients who have very poor functional outcome precluding ability to use the CPAP device independently.
- Patients on long term or "bridging" inotropic infusion, or short life expectancy due to concomitant illness
Contacts and Locations More Information
No publications provided
| Responsible Party: | Rami Khayat, Associate Professor-Clinical, Ohio State University |
| ClinicalTrials.gov Identifier: | NCT00679549 History of Changes |
| Other Study ID Numbers: | 2008H0011 |
| Study First Received: | May 15, 2008 |
| Last Updated: | November 6, 2012 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by Ohio State University:
|
Heart Failure Obstructive Sleep Apnea OSA |
CHF Sleep apnea CHD |
Additional relevant MeSH terms:
|
Apnea Heart Failure Sleep Apnea Syndromes Sleep Apnea, Obstructive Respiration Disorders Respiratory Tract Diseases Signs and Symptoms, Respiratory |
Signs and Symptoms Heart Diseases Cardiovascular Diseases Sleep Disorders, Intrinsic Dyssomnias Sleep Disorders Nervous System Diseases |
ClinicalTrials.gov processed this record on May 16, 2013