Obstructive Sleep Apnea in Obese Hospitalized Patients: A Single Center Experience

Sharma, Sunil; Mather, Paul; Efird, Jimmy T.; Kahn, Daron; Shiue, Kristin Y.; Cheema, Mohammed; Malloy, Raymond; Quan, Stuart F.

doi:10.5664/jcsm.4842

Cited by 36 publications

(23 citation statements)

References 24 publications

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“…Based on long-term follow-up, this study showed an improved survival among patients who were adherent with CPAP therapy after discharge. 9,10 In this posthoc analysis of the HoSMed database, we explore the characteristics, associations and mortality related to SDB in AA in comparison to their Caucasian counterparts. We hypothesize that these factors will be different for AA.…”

Section: Introductionmentioning

confidence: 99%

Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

Quintos

Naranjo

Kelly

et al. 2019

Journal of the National Medical Association

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word count : 264 Manuscript word count : 2528 ABSTRACT PURPOSE:The HoSMed Database recently demonstrated a high prevalence of obstructive sleep apnea (OSA) in hospitalized obese patients. Based on a long-term follow-up, this study showed an improved survival among patients who were adherent with the therapy. In this post-hoc analysis we explore the characteristics, associations, and mortality outcome of OSA in the African American (AA) population. METHODS:These subset analyses included obese AA patients screened in the hospital as high-risk for OSA.Stepwise logistic regression analysis was used to identify predictors of OSA. Patients who had polysomnography (PSG) and were initiated on positive airway pressure (PAP) therapy were followed and dichotomized to adherent versus non-adherent groups based on compliance data.Mortality rates in both groups were compared. RESULTS:Of the total of 2022 AA patients screened, 1370 (60.7% females) were identified as high risk for OSA. Of these, 279 had PSG diagnosed OSA (mean AHI = 36 /hour) and were initiated on PAP therapy. Adherence in AAs was significantly lower than for Caucasians (21% versus 45%, Chisquare p<0.0001). The following statistically significant predictors of OSA were found: heart failure, chronic kidney disease, hypertension and asthma/COPD, BMI and age. A Log-rank Recognition and Treatment of Sleep Disordered Breathing in African Americans 3 survival analysis of AAs on CPAP showed non-significant benefit of adherence (HR: 0.22; 95% CI 0.03 -1.7, p=0.11); a propensity analysis of AAs and Caucasians that adjusted for race and potential confounding variables found a statistically significant benefit of adherence (HR: 0.29; 0.13-0.64; p=0.002). CONCLUSION:This large database of hospitalized patients confirms a high prevalence and lower adherence to PAP therapy in African Americans. Adherent patients, however, showed mortality benefit similar to Caucasians.

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Section: Introductionmentioning

confidence: 99%

Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

Quintos

Naranjo

Kelly

et al. 2019

Journal of the National Medical Association

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“…[15][16][17] To reduce the future risk for previously unidentified SDB patients hospitalized with CHF, screening and diagnosis should ideally occur while the patient is admitted to the hospital. This approach ensures that patients can be adequately screened while they are a "captive audience," 14,18 and that they can also be provided education and implementation of therapy (eg, a trial of positive airway pressure therapy). A previous study has noted the value of PM in hospitalized patients.…”

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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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“…Our recent data on obese hospitalized patients showed a high prevalence of undetected SDB in patients hospitalized on the medical service. 7 Furthermore, a low-cost screening protocol was effectively able to detect underlying SDB. 8 We showed that the oxygen desaturation index (ODI) as determined by high-resolution photoplethysmography can reliably detect SDB; there was a high concordance with the outpatient apnea-hypopnea index (AHI) as determined by polysomnography.…”

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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Obstructive Sleep Apnea in Obese Hospitalized Patients: A Single Center Experience

Cited by 36 publications

References 24 publications

Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

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

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