Patients hospitalized with heart failure could benefit from inpatient screening for sleep apnea, a practice that is not routinely done, despite the link between apnea and worsened heart failure, according to a new study. The study, whose lead author is Sunil Sharma, MD, of Einstein Medical Center Philadelphia, found that patients diagnosed in the hospital were as likely to comply with apnea treatment, even though they were asymptomatic, as those who sought treatment for symptoms at outpatient sleep clinics. It also showed trends toward survival benefit in patients who were compliant with the PAP therapy. The study was be published in Thursday’s issue of the Journal of Clinical Sleep Medicine (JCSM) (Dec. 15).
Previous studies have shown that patients who receive treatment are less likely to be readmitted to the hospital for heart failure than patients who don’t.
“Heart failure is the most common cause of hospital admission, and sleep disordered breathing is a very prevalent co-morbid condition which can cause or worsen heart failure,” said Dr. Sharma, Division Chair and Program Director of Pulmonary and Critical Care Medicine at Einstein. “It’s underdiagnosed and underrecognized because most patients with heart failure don’t have symptoms of apnea.”
Sleep apnea is a condition in which people stop breathing repeatedly during their sleep, which may deprive the body and brain of enough oxygen. If untreated, sleep apnea can lead to stroke, high blood pressure, heart failure, irregular heartbeats and other health problems. The recommended treatment is the use of a CPAP machine—continuous positive airway pressure—which increases air pressure in the throat so the airway doesn’t close.
Dr. Sharma’s study explored early diagnosis by a novel protocol of screening in hospitalized patients with a low-cost technology—a pulse oximeter that determines the amount of oxygen in the blood. The diagnosis was confirmed 90 percent of the time when patients were subsequently evaluated at an outpatient sleep medicine clinic.
Patients who are hospitalized are a “captive audience” who can be screened, diagnosed, and educated about the link between apnea and heart failure. “This gives us more ammunition in our medical bag of tricks to be able to reduce hospital readmissions in a cohort of patients suffering from repeated admission,” Dr. Sharma said.
“Over 6 million people in US are diagnosed with heart failure today,” said Behman Bozorgnia, MD, Einstein’s director of Heart Failure Services. “It is a very common disease with high morbidity and mortality despite current advanced therapies. Any new research or development that can reduce the mortality while improving the quality of life of so many patients will be invaluable,” he said.
Vincent Figueredo, MD, Vice Chair of Cardiology, agreed that the research “adds to our understanding of the role of early detection of apneas in hospitalized heart failure patients"