Sacubitril-valsartan reduced apnea-hypopnea index by 5.35 events/h and improved LVEF by 4.43% in heart failure patients with sleep apnea after 3-6 months.
Does sacubitril-valsartan improve sleep apnea indices and echocardiographic parameters in patients with HFrEF and sleep apnea?
Sacubitril-valsartan therapy for 3-6 months significantly improves sleep apnea severity and echocardiographic parameters in patients with HFrEF and comorbid sleep apnea.
Abstract Background Sleep apnea (SA) is identified among the most common comorbidities in heart failure patients with reduced ejection fraction (HFrEF) and potentially impacts prognosis of heart failure. Sacubitril-valsartan (SV) can attenuate SA development via several pathophysiologic mechanisms. Purpose To evaluate the effects of initiating SV therapy on cardiorespiratory parameters in patients with HFrEF and SA. Methods A systematic review was conducted according to Cochrane Handbook and the PRISMA statement. A comprehensive systematic literature search was performed using EMBASE and MEDLINE, and Cochrane Library. RStudio software was used to pool baseline characteristics and calculate pooled mean difference (MD) with 95% confidence intervals (CI). Random-effects model was used to allow a more conservative assessment of the pooled effect size. Results Six studies enrolling 409 patients were included. The pooled mean age was 65.18 (95% CI: 63.46; 66.90) years. Males accounted for 80.0% (95% CI: 75.0; 84.0) and smokers for 22.0% (95% CI: 17.0; 28.0) of patients. Most patients were taking beta-blockers (93.0%, 95% CI: 79.0; 98.0), and loop diuretics (81.0%, 95% CI: 52.0; 94.0). Up to half of the patients have implantable cardiac devices (Table 1). After 3 – 6 months of SV administration, there was significant improvement in natriuretic peptide levels (-784.62 pg/mL, 95% CI: -969.91; -599.32, P 0.0001) and echocardiographic parameters such as LVEF (4.43%, 95% CI: 1.17; 7.69, P=0.0077), LVEDD (-3.39 mm, 95% CI: -4.4969; -2.2784, P0.0001), TAPSE (1.18 mm, 95% CI: 0.49; 1.87, P=0.0008), LAVI (-6.03 mL/m2, 95% CI: -12.31; -0.76, p=0.0266), and sPAP (-3.73 mmHg, 95% CI: -5.84; -1.62, p=0.0005) compared to baseline values. Moreover, SV caused significant reduction in AHI (-5.35 events/h, 95% CI: -6.60; -4.10, p0.0001) and TC90% (-6.53%, 95% CI: -8.44; -4.63, p0.0001) values, as well as significant increase in oxygen saturation (0.58%, 95% CI: 0.28; 0.88, p=0.0002) (Table 2). Conclusion Sacubitril-valsartan significantly improved the cardiorespiratory parameters in patients with HFrEF and SA.
Kaddoura et al. (2025) studied this question. Sacubitril-valsartan reduced apnea-hypopnea index by 5.35 events/h and improved LVEF by 4.43% in heart failure patients with sleep apnea after 3-6 months.
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