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Opiates linked to escalation of care in patients with heart failure at high risk for sleep-disordered breathing

Sunil Sharma

In-hospital opiate use is associated with an increased likelihood of escalation of care in adults with acute heart failure who are at high-risk for sleep-disordered breathing, a recent study suggests.

“In patients acutely admitted to the hospital, the combination of sleep apnea and opioids in heart failure patients can be very detrimental and may lead to worsening of respiratory failure requiring ICU-level care,” Sunil Sharma, MD, N. Leroy Lapp Professor and chief of the section of pulmonary, critical care and sleep medicine at West Virginia University, wrote in an email to Healio Pulmonology. “Clinicians need to be cognizant of the high prevalence of undiagnosed sleep apnea in hospitalized patients.”

Researchers examined a preliminary group of 1,511 adult patients admitted to Albert Einstein Medical Center in Philadelphia for acute heart failure. The STOP-BANG questionnaire was administered between November 2016 and October 2017 to identify patients at risk for sleep-disordered breathing. From the preliminary group, 712 patients showed high risk for sleep-disordered breathing and 301 were evaluated via portable sleep study or high resolution pulse-oximetry and were considered to have sleep-disordered breathing if oxygen desaturation index/ apopnea-hypopnea index (AHI) > 10.

A retrospective chart review was used to determine opiate use, 30-day readmission, length of stay and need for escalation of care, which was defined as a transfer to the ICU. Patients were then subdivided into groups based on AHI severity — severe (AHI 30 events per hour), moderate (AHI 15 to 30 events per hour), mild (AHI 10 to 15 events per hour) and no sleep-disordered breathing (AHI < 10 events per hour).

Of the 301 participants, 49.5% were found to have sleep-disordered breathing and 41.5% received opiates while in the hospital. Thirty-two percent of patients with sleep-disordered breathing received opiates. Escalation of care was more common among these patients than among those who did not receive opiates (26% vs. 4%; P < .001). There was also a trend toward increased hospital readmissions among those who received opiates (15% vs. 9%; P = .14). Both groups had similar baseline characteristics, although patients who were not administered opiates tended to be older. Average length of stay did not vary between the two groups.

“Our clinical experience and prior data made us suspect that opioids and narcotics may not be safe in hospitalized patients with underlying heart failure, but the extent of escalation of care (ICU transfers) did surprise us,” Sharma said. “We recommend these findings should be replicated in other patient cohorts, preferably in a randomized, controlled fashion.” – by Eamon Dreisbach

Disclosures: Niroula reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.