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Targeted screening identifies sleep-disordered breathing in patients with HF
A screening process using plethysmographic signal-derived oxygen desaturation index led to early detection of sleep disorders in hospitalized patients with acute decompensated HF, researchers reported in the Journal of the American College of Cardiology: Heart Failure.
Researchers conducted a study to test the feasibility of using plethysmographic signal-derived oxygen desaturation index with a simple questionnaire, demographic data and arterial blood gas to detect sleep-disordered breathing in hospitalized patients with HF.
Using the STOP-BANG Questionnaire, the researchers identified and examined 246 patients (mean age, 63 years; 56% men; BMI > 35 kg/m2) with HF and high clinical suspicion of sleep-disordered breathing who were hospitalized from April 2013 to March 2014. Patients who tested positive for sleep-disordered breathing (n = 105) received a formal sleep consult and were monitored for their oxygen saturation. Those with high oxygen levels were recommended to participate in a postdischarge confirmatory study that was conducted within 4 weeks of discharge.
Sunil Sharma
“Our study, by showing a close association with a plethysmographic signal-derived apnea hypopnea index, opens up a possible cost-effective strategy for early detection of sleep-disordered breathing in acute decompensated HF,” Sunil Sharma, MD, FAASM, associate professor of pulmonary medicine, Sidney Kimmel Medical College, Thomas Jefferson University, said in a press release.
Results showed that 94% (n = 64) tested positive for sleep-disordered breathing (apnea hypoxia index ≥ 5): 39% had severe sleep-disordered breathing (apnea hypoxia index ≥ 30), 25% had moderate sleep-disordered breathing (apnea hypoxia index 16-29) and 36% had mild sleep-disordered breathing (apnea hypoxia index < 16).
Plethysmographic signal-derived oxygen desaturation index also correlated well with outpatient polysomnography-derived apnea hypoxia index, according to the results.
The researchers said sleep-disordered breathing is common and often underdiagnosed in patients with HF.
Although previous studies have shown a correlation between sleep disorders and increased risk for HF, the researchers noted that only 2% of patients with HF in this study were ever tested or treated for sleep-disordered breathing.
Paul J. Mather
“If we don’t treat the heart while somebody is asleep, we are missing out on 6 to 8 hours of therapy. [This can] greatly affect both the patient’s quality and quantity of life,” Paul J. Mather, MD, FACC, FACP, the Lubert Family Professor of Cardiology and director of the Advanced Heart Failure and Cardiac Transplant Center, Jefferson Heart Institute, told Cardiology Today.
The researchers noted several limitations of the study regarding the types of sleep apnea diagnosed and how accurately the device monitored the sleep cycle. Additionally, they suggested further analysis should include a larger constituency group, more diverse patient settings and follow-up outpatient monitoring. – by Trish Shea, MA
Disclosure: The researchers report no relevant financial disclosures.