In HIV, Sleep Apnea Raises Risk of HF Hospitalization

Among individuals with heart failure (HF), people living with HIV (PLHIV) are more likely to have obstructive sleep apnea (OSA) than central sleep apnea and are more likely to use CPAP for long durations than those uninfected with the virus, according to a recent study.

While SA and HF have been reported among PLHIV, there is currently no data characterizing the presence, association, and prognostic significance of SA among PLHIV with HF.
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The researchers conducted a study of 1124 PLHIV with HF with reduced ejection fraction, analyzing the effects of SA on 30-day HF hospital readmission rate and cardiovascular-related and all-cause mortality.

Overall, 15% of the 1124 participants were PLHIV, of whom 92% were on antiretroviral therapy. SA was present in 28% of PLHIV and 26% of controls. Compared with uninfected controls with HF and SA, PLHIV with HF and SA had lower BMI, higher pulmonary artery systolic pressure, and were more likely to have obstructive rather than central sleep apnea. They also had higher rates of CPAP use. Low CD4 count, high viral load, and SA parameters were predictors of 30-day HF readmission rate, and each 1 hour increase in CPAP use was associated with a 14% reduction in risk of 30-day HF readmission.

“As compared to uninfected controls with HFrEF and SA, PLHIV were more likely to have obstructive SA rather than central SA, and were more likely to use CPAP and for a longer duration. Apnea severity, low CD4 count, high VL and cocaine use were positively associated with 30-day HF hospital readmission rate whereas CPAP use and increased duration of CPAP use conferred protection,” the researchers concluded.

—Michael Potts

Reference:

Alvi RM, Tariq N, Malhotra A, et al. Sleep apnea and heart failure with a reduced ejection fraction among persons living with HIV [published online March 9, 2018]. Clin Infect Dis. doi:10.1093/cid/ciy216.