Estimating the Burden of Undiagnosed Heart Failure With Preserved Ejection Fraction and Sleep Abnormalities in the Community.

OBJECTIVE

To determine the co-prevalence of heart failure with preserved ejection fraction (HFpEF) and sleep abnormalities in the community.

PATIENTS AND

METHODS

We performed a cross-sectional symptom survey of Sleep Number Company smart bed users with continuous physiological monitoring in the United States. We computed HFpEF probability using the validated HFpEF-ABA (Age, Body Mass Index, and History of Atrial Fibrillation) algorithm, collected symptoms surveys, and measured 5 weeks of sleep data to estimate the prevalence of undiagnosed HFpEF and association with sleep abnormalities between April 1 to May 9, 2023.

RESULTS

Six thousand sixty-four, individuals completed the symptom survey (median age, 53 years [Q1-Q3: 43-63 years], median body mass index 29.3 kg/m2 [Q1-Q3: 25.6-34.2 kg/m2], 53.3% female, and 2.9% atrial fibrillation). The prevalence of chronic exertional dyspnea was 17.7%, and individuals with dyspnea had higher HFpEF probability compared with nondyspneic individuals (56.3%; Q1-Q3: 31.4% to 74.9% vs 39.1%; Q1-Q3: 21.5% to 59.2%; P<.001). Based on median HFpEF-ABA probabilities in the dyspneic participants, the prevalence of potentially undiagnosed HFpEF was 10.0%. Women were more likely to have dyspnea (19.4% vs 15.7%; P<.001), but estimated prevalence of HFpEF was comparable in men (9.8%) and women (10.2%), due to lower average HFpEF probabilities in women (52.5%; Q1-Q3: 28.8% to 72.3% vs 62.5%; Q1-Q3: 38.3% to 78.7%; P<.001). Higher HFpEF probability was associated with greater prevalence/severity of dyspnea and edema along with shorter sleep duration, more frequent naps, restless sleep, greater nocturia, maximal motion, respiratory rate and heart rate variability during sleep (P<.001 for all).

CONCLUSION

Nearly 1 in 10 smart bed users across the United States have dyspnea and HFpEF-ABA probability scores suggesting potentially undiagnosed HFpEF with multiple sleep abnormalities. The role of ABA-based community screening for HFpEF and sleep abnormalities requires further study.