Central Sleep Apnea is a Predictor of Cardiac Readmission in Hospitalized Patients With Systolic Heart Failure

Khayat, Rami; Abraham, William T.; Patt, Brian; Brinkman, Vincent; Wannemacher, Jacob; Porter, Kyle; Jarjoura, David

doi:10.1016/j.cardfail.2012.05.003

Cited by 127 publications

(81 citation statements)

References 41 publications

(54 reference statements)

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“…These data support, that both central and obstructive SA diagnosed during hospital stay are independently related to postdischarge mortality (multivariable hazard ratio 1.61 and 1,53) and hospital readmissions (adjusted rate ratio 1,53 and 1,49) [14][15][16].…”

Section: Discussionsupporting

confidence: 78%

Research Article. Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

Kocsis

Fehérvári

Fogarasi³

et al. 2017

Acta Medica Marisiensis

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Objectives. Evaluation of the characteristics of sleep apnea (SA) in patients hospitalized with acute heart failure, considering that undiagnosed SA could contribute to early rehospitalization. Methods. 56 consecutive patients (13 women, 43 men, mean age 63.12 years) with acute heart failure, in stable condition, underwent nocturnal polygraphy before hospital discharge. The type and severity of SA was determined. Besides descriptive statistics, correlations between the severity of SA and clinical and paraclinical characteristics were also analyzed (t-test, chi-square test, significancy at alpha < 0.05). Results. 12 (21.4%) subjects were free of SA (AHI -apnea-hipopnea index <5/h), 15 (26.7%) had mild SA (AHI=5-14/h), 17 (30.3%) had moderate SA (AHI 15-30/h), and 12 (21.4 %) had severe SA (AHI>30/h). The apnea was predominantly obstructive (32 cases vs. 12 with central SA). Comparing the patients with mild or no SA with those with severe SA, we did not find statistically significant correlations (p>0.05) between the severity of SA and the majority of main clinical and paraclinical characteristicsage, sex, BMI, cardiac substrates of heart failure, comorbidities. Paradoxically, arterial hypertension (p=0.028) and atrial fibrillation (p=0.041) were significantly more prevalent in the group with mild or no SA. Conclusions. Before discharge, in the majority of patients hospitalized with acute heart failure moderate and severe SA is present, and is not related to the majority of patient related factors. Finding of significant SA in this setting is important, because its therapy could play an important role in preventing readmissions and improving prognosis. IntroductionThe relationship between sleep disordered breathing (SDB), represented by obstructive and central sleep apnea (SA), and cardiovascular diseases has been demonstrated in numerous studies. SDB confers an increased risk for cardiovascular complications and events, playing role in the pathophysiology of resistant hypertension, arrhythmias (from those benign to sudden cardiac death), myocardial ischemia, pulmonary hypertension and heart failure [1][2][3][4].The prevalence of symptomatic obstructive SA in the general population is about 4% in middle-aged men, and 2% in middle-aged women. SDB is common in heart failure (HF), being present in nearly one half of the patients, impairing both the quality of life and prognosis. The specific manifestation is central SA, which is directly related to the level of congestion and functional status [5][6][7].Acute HF is a common cause of hospitalizations in the course of HF, moreover, readmissions represent the most predictive factor for poor prognosis and increased mortality. Rehospitalizations within 30 days post-discharge are high, almost one third of patients being involved. The precipitating factors for these admissions are multiple, including cardiac and noncardiac conditions, like myocardial ischemia, arrhythmias, infections, treatment non-compliance, improper medications, etc., and, also, undiagnosed and/or untre...

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Section: Discussionsupporting

confidence: 78%

Research Article. Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

Kocsis

Fehérvári

Fogarasi³

et al. 2017

Acta Medica Marisiensis

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“…This variation in the rates may be due to a number of factors, including patients with cardiac disease and SDB being more likely to be readmitted to the hospital than cardiac patients without SDB. 31 Furthermore, in order to be comprehensive, our study included emergency department visits as well as admissions to other institutions.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Treatment of Sleep Disordered Breathing in Hospitalized Cardiac Patients: A Reduction in 30-Day Hospital Readmission Rates

Kauta

Keenan

Goldberg

et al. 2014

Journal of Clinical Sleep Medicine

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BRIEF SUMMARYCurrent Knowledge/Study Rationale: Sleep disordered breathing (SDB) is known to be common in patients with underlying cardiovascular disease. We hypothesized that diagnosing and initiating treatment for SDB in hospitalized cardiac patients would improve the overall management of their underlying cardiac condition. Study Impact: Our study identifi es a model of care that can increase the diagnosis and treatment of SDB in hospitalized cardiac patients. Finding a reduced 30-day cardiac readmission rate in CPAP adherent patients is important for both improving patient care and hospital fi nances.

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“…8 Recent data also suggest that early detection and initiation of therapy for SDB in hospitalized patients may reduce readmissions in patients with congestive heart failure (CHF). 9, 10 The nonadherence of…”

Section: Introductionmentioning

confidence: 99%

Adherence to Positive Airway Pressure Therapy in Hospitalized Patients with Decompensated Heart Failure and Sleep-Disordered Breathing

Sharma

Chakraborty

Chowdhury

et al. 2016

Journal of Clinical Sleep Medicine

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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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Central Sleep Apnea is a Predictor of Cardiac Readmission in Hospitalized Patients With Systolic Heart Failure

Cited by 127 publications

References 41 publications

Research Article. Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

Research Article. Characteristics of Sleep Apnea Assessed Before Discharge in Patients Hospitalized with Acute Heart Failure

Diagnosis and Treatment of Sleep Disordered Breathing in Hospitalized Cardiac Patients: A Reduction in 30-Day Hospital Readmission Rates

Adherence to Positive Airway Pressure Therapy in Hospitalized Patients with Decompensated Heart Failure and Sleep-Disordered Breathing

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