Effect of Early Intervention With Positive Airway Pressure Therapy for Sleep Disordered Breathing on Six-Month Readmission Rates in Hospitalized Patients With Heart Failure

Sharma, Sunil; Mather, Paul; Gupta, Ankit; Reeves, Gordon R.; Rubin, Sharon; Bonita, Raphael; Chowdhury, Anindita; Malloy, Raymond; Willes, Leslee; Whellan, David J.

doi:10.1016/j.amjcard.2015.12.032

Cited by 37 publications

(27 citation statements)

References 21 publications

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“…12 Now our new findings show that HRPO provides an effective low-cost tool to screen CHF patients, potentially leading to successful treatment. The results add considerably to the existing literature because they provide a substrate for the implementation of large-scale 2 .…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Recent data suggest that early recognition of SDB in CHF patients and subsequent intervention can reduce hospital readmissions. 8,9 Although hospitalized patients with CHF present a unique opportunity for screening and diagnosing SDB, they are rarely screened or evaluated. This is partly due to low awareness, lack of expertise for evaluation, and major costs associated with performing traditional polysomnography (PSG) in hospitalized settings.…”

Section: Introductionmentioning

confidence: 99%

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Sleep Overnight Monitoring for Apnea in Patients Hospitalized with Heart Failure (SOMA-HF Study)

Sharma

Mather

Chowdhury

et al. 2017

Journal of Clinical Sleep Medicine

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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...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sleep Overnight Monitoring for Apnea in Patients Hospitalized with Heart Failure (SOMA-HF Study)

Sharma

Mather

Chowdhury

et al. 2017

Journal of Clinical Sleep Medicine

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“…26 Last, recent data from our group show that early diagnosis and intervention in hospitalized SDB patients is associated with reduced 6-month hospital readmissions. 27 With the Patient Protection Affordable Care Act of 2010 now mandating a penalty for readmissions, 28 early treatment of SDB in patients with CHF may be an important factor in maintaining fiscal stability for hospitals. There are some limitations of our study.…”

Section: Discussionmentioning

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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Section: Heart Failurementioning

confidence: 99%

“…Seventy patients with acute HF diagnosed with sleep apnea by overnight polysomnography within 4 weeks of discharge were treated with continuous positive airway pressure (CPAP) treatment [24]. Of these, 37 (53%) met the definition of good compliance with the CPAP device [24]. Patients with good CPAP compliance showed a significant decrease in 6-month readmission rates after therapy compared with the 6-month readmission rates pre-therapy (mean ± SE: −1.5 ± 0.2 events; p < 0.0001) [24].…”

Section: Heart Failurementioning

confidence: 99%

A Review of the Key Clinical Trials of 2015: Results and Implications

2016

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IntroductionMultiple significant, potentially practice changing clinical trials in cardiology have been conducted and subsequently presented throughout the past year.MethodsIn this paper, the authors have reviewed and contextualized significant cardiovascular clinical trials presented at major international conferences of 2015 including American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, American Diabetes Association, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics, Heart Rhythm Congress, and the American Heart Association Scientific Sessions.ResultsThe authors describe new trial data for heart failure (including eplerenone, finerenone, patiromer, sacubitril/valsartan, the beta 3 agonist mirabegron, sitagliptin, empagliflozin, alginate-hydrogel LV epicardial implant), anticoagulation (idarucizumab and andexanet alfa reversal agents, adherence programmes, practice in ablation), transcatheter aortic valve replacement (long-term data, valve-in-valve use, the TriGuard embolic deflecting device), patent foramen ovale closure, cardiovascular prevention (PCSK9 inhibitors, hypertension treatment) and antiplatelets strategies (extended duration therapy with clopidogrel or ticagrelor). Trial data are also described for contemporary technologies including the Biofreedom polymer-free drug coated stent, bioabsorbable stents, PCI strategies, left main treatment, atrial fibrillation ablation techniques, leadless pacemakers and the role of coronary computed tomographic angiography.ConclusionsThis paper summarizes and contextualizes multiple pertinent 2015 clinical trials and will be of interest to both clinicians and cardiology researchers.

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Effect of Early Intervention With Positive Airway Pressure Therapy for Sleep Disordered Breathing on Six-Month Readmission Rates in Hospitalized Patients With Heart Failure

Cited by 37 publications

References 21 publications

Sleep Overnight Monitoring for Apnea in Patients Hospitalized with Heart Failure (SOMA-HF Study)

Sleep Overnight Monitoring for Apnea in Patients Hospitalized with Heart Failure (SOMA-HF Study)

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

A Review of the Key Clinical Trials of 2015: Results and Implications

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