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Introduction: Sleep-disordered breathing (SDB) is highly prevalent in hospitalized patients with congestive heart failure (CHF) and the condition is diagnosed and treated in only a minority of these patients. Portable monitoring (PM) is a screening option, but due to costs and the expertise required, many hospitals may find it impractical to implement. We sought to test the utility of an alternative approach for screening hospitalized CHF patients for SDB, high-resolution pulse oximetry (HRPO). Methods: We conducted a prospective controlled trial of 125 consecutive patients admitted to the hospital with CHF. Simultaneous PM and HRPO for a single night was performed. All but one patient were monitored on breathing room air. The HRPO-derived ODI (oxygen desaturation index) was compared with PM-derived respiratory event index (REI) using both receiver operator characteristic (ROC) curve analysis and a Bland-Altman plot. Results: Of 105 consecutive CHF patients with analyzable data, 61 (58%) were males with mean age of 64.9 ± 15.1 years and mean body mass index of 30.3 ± 8.3 kg/m 2 . Of the 105 patients, 10 (9.5%) had predominantly central sleep apnea (central events > 50% of the total events), although central events were noted in 42 (40%) of the patients. The ROC analysis showed an area under the curve of 0.89 for REI > 5 events/h. The Bland-Altman plot showed acceptable agreement with 95% limits of agreement between −28.5 to 33.7 events/h and little bias. Conclusions:We conclude that high-resolution pulse oximetry is a simple and cost-effective screening tool for SDB in CHF patients admitted to the hospital. Such screening approaches may be valuable for large-scale implementation and for the optimal design of interventional trials. Keywords: decompensated congestive heart failure, early diagnosis, high-resolution pulse oximetry, hospitalized patients, lung, portable monitoring, sleepdisordered breathing Citation: Sharma S, Mather PJ, Chowdhury A, Gupta S, Mukhtar U, Willes L, Whellan DJ, Malhotra A, Quan SF. Sleep overnight monitoring for apnea in patients hospitalized with heart failure (SOMA-HF Study). J Clin Sleep Med. 2017;13(10):1185-1190. I NTRO DUCTI O NCongestive heart failure (CHF) is the most common cause of hospital admissions and readmissions in the United States.1 Despite identifying and mitigating several risk factors for CHF decompensation, readmissions for decompensated heart failure remain unacceptably high.2 As a result, efforts are ongoing to find ways to reduce readmissions related to CHF.Studies have shown that patients with untreated sleep-disordered breathing (SDB) are at increased risk of heart failure, and untreated SDB in CHF is independently associated with higher mortality.3,4 The implications of these findings are considerable, because SDB is highly prevalent 5,6 and also highly underrecognized and under-treated in patients with CHF.6,7 Recent data suggest that early recognition of SDB in CHF patients and subsequent intervention can reduce hospital readmissions. 8,9Although hospitaliz...

BackgroundRapid response system (RRS) is a safety tool designed for early detection and intervention of a deteriorating patient on the general floor in the hospital. Obstructive sleep apnea (OSA) has been associated with significant cardiovascular complications. We hypothesized that patients with high-risk of OSA have higher rate of RRS events and intervention with positive airway pressure therapy in these patients can mitigate the RRS events.MethodsAs part of a clinical pathway, during a 15 month period, patients with BMI ≥ 30 kg/m2 in select medical services were screened with a validated sleep questionnaire. Patients were characterized as high or low risk based on the screening questionnaire. RRS rates were compared between the groups. Subsequently the impact of PAP therapy on RRS events was evaluated.ResultsOut of the 2,590 patients screened, 1,973 (76%) were identified as high-risk. RRS rates calculated per 1,000 admissions, were 43.60 in the High-Risk OSA group versus 25.91 in the Low-Risk OSA Group. The PAP therapy compliant group had significantly reduced RRS event rates compared to non-compliant group and group with no PAP therapy (16.99 vs. 53.40 vs. 56.21) (p < 0.01).ConclusionIn a large cohort of patients at a tertiary care hospital, we show an association of increased rate of RRS events in high-risk OSA patients and reduction of the risk with PAP intervention in the compliant group.

Study Objectives: Sleep-disordered breathing (SDB) has been implicated as a risk factor for the development of several adverse cardiovascular outcomes, but can be mitigated with positive airway pressure therapy (PAP). The nonadherence of patients with SDB on PAP in the outpatient setting ranges from 29% to 84%. However, adherence of PAP in patients with congestive heart failure (CHF) admitted for decompensated CHF and in whom SDB has been diagnosed in the hospital setting is not known. We hypothesized that despite a diagnosis in the hospital, the compliance of these patients with PAP therapy would not be different from the well-established adherence in patients with a diagnosis and treatment in the outpatient setting. Methods: The study was a retrospective analysis of patients admitted to an academic tertiary care hospital between March 2013 and February 2014. Patients presenting with decompensated CHF were screened and high-risk patients were started on PAP empirically and advised to undergo a postdischarge polysomnogram. Compliance of the patients with PAP was tracked for over 12 mo. Data from a similar outpatient group who underwent polysomnography during the study period were also reviewed. Results: Ninety-one patients underwent polysomnograhy postdischarge. Of the 91 patients, 81 patients agreed to PAP therapy. One patient was excluded as data were missing. The adherence at 3, 6, and 12 mo was 52%, 37%, and 27%, which was not significantly different than an outpatient control group. There was a trend for those with CHF plus SDB and compliant with PAP to have a higher probability of survival compared to those who were noncompliant (p = 0.07). Conclusions: Adherence of patients to PAP therapy in whom a SDB diagnosis is made during acute hospitalization for heart failure is comparable to patients in the ambulatory setting. Adherence in first 3 mo is a predictive marker for improved survival trend. Keywords: sleep-disordered breathing, congestive heart failure, hospitalized patients, adherence to therapy, outcome Citation: Sharma S, Chakraborty A, Chowdhury A, Mukhtar U, Willes L, Quan SF. Adherence to positive airway pressure therapy in hospitalized patients with decompensated heart failure and sleep-disordered breathing. J Clin Sleep Med 2016;12(12):1615-1621. I NTRO DUCTI O NSleep-disordered breathing (SDB) is a common condition with a prevalence reported to be as high as 24%.1 It has been implicated as a risk factor for the development of several adverse cardiovascular outcomes.2-5 Despite this association and recent data on sudden deaths, 6 the practice of sleep medicine remains largely confined to the outpatient setting. Patients admitted to the hospital are rarely screened for SDB despite significant co-morbid conditions. Our recent data on obese hospitalized patients showed a high prevalence of undetected SDB in patients hospitalized on the medical service. Furthermore, a low-cost screening protocol was effectively able to detect underlying SDB. 8 We showed that the oxygen desaturation index (ODI) as de...

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We retrospectively evaluated 99 intensive care unit patients with methicillin-resistant Staphylococcus aureus bacteremia to determine whether having a vancomycin minimum inhibitory concentration (MIC) of 2 mg/L affected mortality. This MIC was found in 5.1% of patients and was associated with the probability of death (adjusted odds ratio, 13.9 [95% confidence interval, 1.1-171.2]) independent of other factors.

type III home monitors are difficult for patients to set up and wearing the monitors is disruptive to patient's typical sleep pattern. The diagnostic value of an inexpensive easy-to-use light-weight flexible skin-adhesive patch (SomnaPatch) that minimally affects sleep was evaluated in this study. Methods: Simultaneous polysomnography (PSG) and the diagnostic patch recordings were made in 179 subjects (mean age 54.0 ± 13.6 y, 55% male) selected from the databases of patients previously tested with PSG to ensure even representation of the clinically important apnea-hypopnea index (AHI) ranges. The skin-adhesive diagnostic patch weighs less than one ounce and records nasal pressure, blood oxygen saturation, pulse rate, respiratory effort, sleep time and body position (S 3 C 4 O 2 P 2 E 3 R 2 category). To compare the apnea-hypopnea index of the diagnostic patch with polysomnography, all recordings were auto-scored with the Somnolyzer software (Respironics). BlandAltman analysis was performed. Sensitivity, specificity and accuracy were calculated and receiver operating characteristic (ROC) curves were constructed for six AHI thresholds (5, 10, 15, 20, 25 and 30 events per hour). The rate of clinical agreement and positive likelihood ratio were calculated. Results: Overnight recordings from 174 subjects were included in the final analysis. All six ROC curves had area under the curve of over 0.9. Sensitivity, specificity and accuracy for the optimal threshold of AHI≥15 were 0.86, 0.83 and 0.85 respectively. Positive likelihood ratio (LR+) was 7.4. Bland-Altman analysis showed that the bias was 0.9 events per hour and the limits of agreement were 18.1 and -16. Introduction: Hypermobility syndromes can be an important risk factor for Sleep Disordered Breathing (SDB). The risk factors for SDB, such as obesity, male gender, or post-menopausal status, are frequently absent in hypermobile populations, yet the impact of SDB on the quality of these patients' lives can be profound. Methods: Charts of 49 consecutive patients with a Beighton hypermobility score ≥5 from a Neurology Institute were retrospectively reviewed. All ± values reflect the standard error of the mean. Results: Eighty-four percent of these patients had sleep complaints. Thirty underwent Polysomnography (PSG), though PSG was requested for all. Five were denied by insurance, and 6 refused PSG. PSGs demonstrated SDB in 29 patients: 19 had Obstructive Sleep Apnea (G47.33) and 10 had Sleep Apnea -Unspecified (Upper Airway Resistance Syndrome) (G47.30). The average age was 33.4 ± 2.3 years, the average BMI was 26.9 ± 1.6, and the average Epworth Sleepiness Scale Score was 12.1 ± 0.98. Twenty-one of these 30 patients received an MRI of the cervical spine for symptoms and signs of cervical radiculopathy. On a T1-weighted, mid-sagittal section, the following measurements were made of the narrowest dimensions in centimeters: Retropalatal (0.47 ± 0.06), Retrolingual (0.86 ± 0.05), and Retroepiglottal (0.47 ± 0.04), and Epiglottal length (2.22 ± 0.06). These measureme...