Heart failure with preserved ejection fraction risk is associated with prevalence and severity of obstructive sleep apnea

While heart failure with preserved ejection fraction (HFpEF) is associated with the presence of obstructive sleep apnea (OSA), few studies have examined the association between scoring systems used to predict HFpEF risk, such as the H₂FPEF and HFA-PEFF scores, and OSA prevalence and severity.

We performed chart review on all patients who underwent both an echocardiogram and sleep study at the University of Pennsylvania between July 1, 2020, and June 30, 2022. There were 277 patients in the final cohort after excluding patients with relevant comorbidities. Associations between echocardiographic parameters and OSA severity, as well as between H₂FPEF score and OSA severity, were examined using linear tests of trend. The association between H₂FPEF score and prevalent OSA was examined with logistic regression.

OSA severity was associated with echocardiographic markers, including left atrial volume index (P = .03) and left ventricular relative thickness (P = .008). Patients with high H₂FPEF risk scores had over 17-fold higher odds of prevalent OSA compared with those with low-risk scores (17.7; 95% CI 4.3, 120.7; P < .001). Higher H₂FPEF scores were strongly correlated with OSA severity (P < .001). After controlling for body mass index, H₂FPEF scores were not associated with prevalence or severity of OSA.

In an ambulatory population referred for sleep study and echocardiogram, markers of diastolic dysfunction were associated with OSA severity. OSA prevalence and severity were associated with increased H₂FPEF scores, although these associations were largely explained by obesity. Clinicians should have low thresholds for referring patients with OSA for cardiac workup and patients with HFpEF for sleep study.