In-Hospital Treatment of Obstructive Sleep Apnea During Decompensation of Heart Failure

Khayat, Rami; Abraham, William T.; Patt, Brian; Pu, Min; Jarjoura, David

doi:10.1378/chest.09-0597

Cited by 57 publications

(35 citation statements)

References 39 publications

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“…Moreover, studies using auto-CPAP have shown that it improves left ventricular ejection fraction in patients with heart failure. 24 In addition, most of the subjects in this study had obstructive sleep apnea, and auto-CPAP is indicated in those patients.…”

Section: Discussionmentioning

confidence: 86%

“…22 Moreover in heart failure patients, treating SDB with CPAP increases left ventricular ejection fraction by 2% to 8%. [23][24][25] The 2013 report from the American College of Cardiac Foundation/American Heart Association Task Force on practice guidelines for the management of heart failure supports the use of PAP in patients with heart failure. 26 This report indicated that PAP has been shown to increase ejection fraction and improve functional status in patients with heart failure and sleep apnea.…”

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 86%

Section: S C I E N T I F I C I N V E S T I G a T I O N Smentioning

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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“…A previous study has noted the value of PM in hospitalized patients. 19 However, PM can be expensive due to logistic and technical support requirements. Many smaller facilities in the community may not have these resources.…”

Section: 14mentioning

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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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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“…In HF patients following recovery from acute decompensation, the presence or absence of SDB may play key roles in determining whether PAP therapy should be considered. Although most previous data regarding SDB in HF and its treatment with PAP mentioned earlier involve HF patients in the chronic phase, it was recently reported that hospitalized HF patients following ADHF frequently develop SDB and that the presence of SDB during hospitalization following ADHF is a predictor of readmission and mortality [116][117][118] . Thus, PAP therapy should be considered even for hospitalized HF patients, especially in the setting of symptomatic SDB.…”

Section: Hf Patients Following Acute Decompensationmentioning

confidence: 99%

“…Thus, PAP therapy should be considered even for hospitalized HF patients, especially in the setting of symptomatic SDB. One study suggests a beneficial effect of in-hospital bi-level PAP (with S-mode) therapy for OSA on improvement of cardiac function following ADHF [117] . An ongoing study may elucidate whether PAP therapy improve outcomes in these patients [119] .…”

Section: Hf Patients Following Acute Decompensationmentioning

confidence: 99%

Positive airway pressure therapy for heart failure

Kato

Suda

Kasai

2014

WJC

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In-Hospital Treatment of Obstructive Sleep Apnea During Decompensation of Heart Failure

Cited by 57 publications

References 39 publications

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

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

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

Positive airway pressure therapy for heart failure

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