Can sacubitril/valsartan enhance sleep quality and reduce daytime dysfunction in HFrEF patients?

Congestive heart failure (CHF) affects 65 million people worldwide, with significant prevalence among the elderly. Despite therapeutic advancements, CHF often coexists sleep disorder, impacting morbidity and mortality. Optimizing heart failure management is crucial, especially in light of recent debates on respiratory therapies for heart failure with reduced ejection fraction (HFrEF). Sacubitril/valsartan (SV) has shown promise in reducing cardiovascular mortality and hospital readmissions, though its impact on sleep is less explored.

This prospective, cohort, open-label study evaluated HFrEF patients with LVEF < 40%, NYHA class II-IV, and optimized medical management. Exclusions included sleep apnea, primary insomnia, or psychiatric conditions. Patients transitioned from ACE inhibitors or ARBs to SV, with dose adjustments and biweekly clinical assessments. Sleep quality and daytime alertness were measured using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) at baseline and after reaching the target dosage of SV. Functional capacity was assessed via the six-minute walk test (6-MWT).

Over a mean follow-up of 132 ± 31 days, adjusted analyses showed improvement in PSQI (β - 2.60, 95% CI - 3.20 to - 2.00; p < 0.001) and ESS (β - 3.10, - 3.80 to - 2.40; p < 0.001), with increases in LVEF (+ 6.8 pp, + 5.2 to + 8.3; p < 0.001) and 6-MWT (+ 96 m, + 35 to + 157; p = 0.002); odds of PSQI > 5 and ESS ≥ 11 at follow-up were lower (OR 0.30, 0.18-0.48; p < 0.001 and OR 0.25, 0.11-0.52; p = 0.001; Table 3, and 4).

SV improves sleep quality, reduces daytime dysfunction, and enhances exercise capacity in HFrEF patients, indicating potential dual therapeutic benefits. Further studies are needed to explore SV's full impact on sleep parameters and quality of life in this high-risk group.