Heart failure, investigator-reported sleep apnea and dapagliflozin: A patient-level pooled meta-analysis of DAPA-HF and DELIVER (original) (raw)

Butt, J. H. et al. (2024) Heart failure, investigator-reported sleep apnea and dapagliflozin: A patient-level pooled meta-analysis of DAPA-HF and DELIVER.Journal of Cardiac Failure, 30(3), pp. 436-448. (doi: 10.1016/j.cardfail.2023.08.027) (PMID:38104937)

Abstract

Background: Sleep apnea is more common in patients with heart failure (HF) than in the general population, but little is known about its association with clinical outcomes in different HF phenotypes or how it might modify the effect of HF therapy. Objectives: To examine the prevalence of sleep apnea, its association with outcomes, and the effects of dapagliflozin in HF patients with and without sleep apnea in a pooled analysis of two trials comparing dapagliflozin to placebo in HFrEF (DAPA-HF) and HFmrEF/HFpEF (DELIVER). Methods: A history of sleep apnea was investigator-reported. The primary outcome was a composite of worsening HF or cardiovascular death. Results: The prevalence of sleep apnea was 5.7% and 7.8% in patients with HFrEF and HFmrEF/HFpEF, respectively. The primary outcome occurred at a rate of 16.0 in participants with sleep apnea compared to 10.6 per 100 person-years in those without (adjusted HR 1.29 [95%CI, 1.10-1.52]). Compared with placebo, dapagliflozin reduced the risk of the primary endpoint to the same extent in patients with (HR 0.78 [95% CI, 0.59-1.03]) and without sleep apnea (HR 0.79 [0.72-0.87]) [Pinteraction=0.93]. The beneficial effects of dapagliflozin on other clinical outcomes and symptom burden, physical function, and quality of life were consistent in participants with and without sleep apnea. Conclusions: In DAPA-HF and DELIVER, the true prevalence of sleep apnea was likely underestimated.An investigator-reported history of sleep apnea was associated with higher rates of worsening HF events. The benefits of dapagliflozin on clinical outcomes were consistent in patients with and without sleep apnea.

University Staff: Request a correction | Enlighten Editors: Update this record

Funder and Project Information

BHF Centre of Excellence

Colin Berry

RE/18/6/34217

SCMH - Cardiovascular & Metabolic Health

Deposit and Record Details