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

Abstract

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...

Oximetry use in obstructive sleep apnea

“…In recent years, a number of new pulse oximeters have been launched. These novel devices include improved features, such as high resolution and sample frequency, as well as an enhanced output in artifact and low perfusion conditions [49,82]. However, very few studies have been devoted to the comparison of the performance among these new devices [14,15,49,58].…”

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“…First, we used a portable SDB‐monitoring device, which may not fully detect sleep architecture. However, ApneaLink plus is a validated tool that has been efficiently utilized in generalized settings with low cost in HF and non‐HF samples (Collop et al., ; Sharma et al., ). In‐lab polysomnography could provide additional information on SDB.…”

“…To evaluate the AHI, we used an in‐home, multichannel portable sleep‐monitoring device called ApneaLink Plus (ResMed Corp, San Diego, CA, USA), which is a valid measure that has been used in HF samples (Hjelm et al., ; Sharma et al., ). The AHI is calculated and corresponds to the number of apneas and hypopneas in an hour.…”

The association of sleep-disordered breathing and white matter hyperintensities in heart failure patients

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“…32 Also, the device was used successfully in HF samples. 33,34 Consistent with previous research, we used an AHI cutoff of 10 to compare higher AHI and lower AHI groups for descriptive purposes and to calculate the effect size. 35 …”