Does positive airway pressure improve heart failure mortality?

Takeaway

• Positive airway pressure (PAP) therapy for central sleep apnoea with heart failure (HF) is not tied to reduced cardiac mortality or rehospitalisation and has unclear benefit for all-cause mortality.
• This Cochrane review found hints of benefit for QoL.

Why this matters

• Some studies have found a benefit of PAP in this population, whereas others have found increased mortality risk.

Key results

• PAP therapy duration, 1-31 months.
• All but 1 trial included only patients with HF with reduced ejection fraction.
• Risk ratios (95% CIs) suggested little benefit of PAP for:
  • All-cause mortality: 0.81 (0.54-1.21; 6 studies, 1804 patients; I², 47%; evidence, very low quality).
  • Cardiac-related mortality: 0.97 (0.77-1.24; 5 studies, 1775 patients; I², 11%; moderate-quality evidence).
  • All-cause rehospitalisation: 0.95 (0.70-1.30; 5 studies, 1533 patients; I², 40%; low-quality evidence).
  • Cardiac rehospitalisation: 0.97 (0.70-1.35; 5 studies, 1533 patients; I², 40%; low-quality evidence).
• However, QoL scores were better with PAP (low-quality evidence).

Study design

• Included 16 randomised controlled trials (n=2125).
• PAP compared with usual care.
• Funding: National Institute for Health Research, UK; Clinical Research Program for Child Health and Development, Japan; others.

Limitations

• High heterogeneity among studies, which mostly had low-quality or very low-quality evidence, wide confidence intervals, and poor descriptions of design.