Sleep apnea and recurrent heart failure hospitalizations after coronary artery bypass grafting

Abstract

Study objectives: Sleep apnea is prevalent in patients undergoing coronary artery bypass grafting (CABG). We investigated the relationship between sleep apnea and recurrent heart failure hospitalizations in patients undergoing nonurgent CABG.

Methods: Between November 2013 and December 2018, 1,007 patients completed a sleep study prior to CABG and were followed up until April 2020. Recurrent heart failure hospitalizations were analyzed by Poisson, negative binomial, Andersen-Gill, and joint frailty models, with partial and full adjustment for covariates.

Results: At an average follow-up of 3.3 years, the number of patients with 0, 1, or ≥ 2 heart failure hospitalizations were 908 (90.2%), 62 (6.2%), and 37 (3.7%), respectively. The total number of heart failure hospitalizations was 179, comprising 62 (35%) first and 117 (65%) repeat events. The numbers of heart failure hospitalizations for the sleep apnea (n = 513, 50.9%) and nonsleep apnea groups were 127 and 52, respectively. Negative binomial regression demonstrated that sleep apnea was associated with recurrent heart failure hospitalizations (fully adjusted rate ratio, 1.71; 95% confidence interval [CI], 1.12-2.62; P = .013). Similar results were found in Poisson (1.63; 95% CI, 1.15-2.31; P = .006), Andersen-Gill (1.66; 95% CI, 1.01-2.75; P = .047), and joint frailty models (1.72; 95% CI, 1.00-3.01; P = .056).

Conclusions: In patients after CABG, repeat events accounted for two-thirds of heart failure hospitalizations. Sleep apnea was independently associated with recurrent heart failure hospitalizations.

Citation: Teo YH, Tam WT, Koo C-Y, et al. Sleep apnea and recurrent heart failure hospitalizations after coronary artery bypass grafting. J Clin Sleep Med. 2021;17(12):2399-2407.

Keywords: coronary artery bypass grafting; heart failure; sleep; statistics.