Peak Oxygen Consumption and Survival after Heart Transplant is Similar in Patients with and without Comorbid Obstructive Sleep Apnea

Purpose Obstructive sleep apnea (OSA) is associated with increased all-cause and cardiovascular mortality in the general population and may be associated with decreased exercise capacity on cardiopulmonary exercise testing (CPET). While comorbid OSA is often considered when evaluating patients for heart transplantation, post-transplant outcomes are poorly studied. Methods We conducted a retrospective analysis of 307 heart transplant recipients at a large academic institution with CPET ≤2 years after transplant. Patients with and without comorbid OSA were compared with respect to baseline characteristics and post-transplant exercise performance. Survival was compared with Cox proportional hazards modeling with time-varying exposure to account for patients who developed OSA during follow-up. Analyses were repeated after restricting the case definition to only ≥moderate OSA (apnea hypopnea index ≥15 or physician's qualitative report of sleep study result). Results Of 307 heart transplant recipients, 32 had OSA at baseline with 23 cases ≥moderate. Patients with OSA had higher body mass index (30.5 vs 27.0 kg/m2, p Conclusion Heart transplant recipients with and without OSA have similar peak VO2 and post-transplant survival. Exercise time may be shorter in patients with ≥moderate OSA compared to patients with no or only mild disease. Whether compliance with nocturnal positive airway pressure mitigates these comparable outcomes remains to be explored.