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.