Portable Sleep Monitoring for Diagnosing Sleep Apnea in Hospitalized Patients With Heart Failure

BACKGROUND: Sleep apnea is an underdiagnosed condition in patients with heart failure. Efficient identification of sleep apnea is needed, as treatment may improve heart failure–related outcomes. Currently, use of portable sleep monitoring in hospitalized patients and those at risk for central sleep apnea is discouraged. This study examined whether portable sleep monitoring with respiratory polygraphy can accurately diagnose sleep apnea in patients hospitalized with decompensated heart failure. METHODS: Hospitalized patients with decompensated heart failure underwent concurrent respiratory polygraphy and polysomnography. Both recordings were scored for obstructive and central disordered breathing events in a blinded fashion, using standard criteria, and the apnea‐hypopnea index (AHI) was determined. Pearson’s correlation coefficients and Bland‐Altman plots were used to examine the concordance among the overall, obstructive, and central AHI values derived by respiratory polygraphy and polysomnography. RESULTS: The sample consisted of 53 patients (47% women) with a mean age of 59.0 years. The correlation coefficient for the overall AHI from the two diagnostic methods was 0.94 (95% CI, 0.89–0.96). The average difference in AHI between the two methods was 3.6 events/h. Analyses of the central and obstructive AHI values showed strong concordance between the two methods, with correlation coefficients of 0.98 (95% CI, 0.96–0.99) and 0.91 (95% CI, 0.84–0.95), respectively. Complete agreement in the classification of sleep apnea severity between the two methods was seen in 89% of the sample. CONCLUSIONS: Portable sleep monitoring can accurately diagnose sleep apnea in hospitalized patients with heart failure and may promote early initiation of treatment.

[1]  J. Pankow,et al.  Obstructive sleep apnea and incident type 2 diabetes. , 2016, Sleep medicine.

[2]  W. Abraham,et al.  In-hospital testing for sleep-disordered breathing in hospitalized patients with decompensated heart failure: report of prevalence and patient characteristics. , 2009, Journal of cardiac failure.

[3]  Bonnie K. Lind,et al.  Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study , 2000 .

[4]  G. Pillar,et al.  The Effect of the Transition to Home Monitoring for the Diagnosis of OSAS on Test Availability, Waiting Time, Patients' Satisfaction, and Outcome in a Large Health Provider System , 2014, Sleep disorders.

[5]  T. Young,et al.  Prospective study of the association between sleep-disordered breathing and hypertension. , 2000, The New England journal of medicine.

[6]  G. Tomlinson,et al.  Influence of obstructive sleep apnea on mortality in patients with heart failure. , 2007, Journal of the American College of Cardiology.

[7]  S. Quan,et al.  Recognition and Treatment of Sleep-Disordered Breathing in Obese Hospitalized Patients May Improve Survival. The HoSMed Database. , 2017, The American journal of medicine.

[8]  Naresh M Punjabi,et al.  Sleep-disordered breathing and type 2 diabetes: a report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. , 2008, Diabetes research and clinical practice.

[9]  Brian Caffo,et al.  Prospective Study of Sleep-disordered Breathing and Hypertension the Sleep Heart Health Study at a Glance Commentary , 2022 .

[10]  R. Mehta,et al.  The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients , 2016, PloS one.

[11]  Dieter Horstkotte,et al.  Sleep‐disordered breathing in patients with symptomatic heart failure A contemporary study of prevalence in and characteristics of 700 patients , 2007, European journal of heart failure.

[12]  W. Abraham,et al.  Central sleep apnea is a predictor of cardiac readmission in hospitalized patients with systolic heart failure. , 2012, Journal of cardiac failure.

[13]  S. Quan,et al.  Sleep Overnight Monitoring for Apnea in Patients Hospitalized with Heart Failure (SOMA-HF Study). , 2017, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[14]  D. Altman,et al.  STATISTICAL METHODS FOR ASSESSING AGREEMENT BETWEEN TWO METHODS OF CLINICAL MEASUREMENT , 1986, The Lancet.

[15]  V. Kapur,et al.  Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline. , 2017, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[16]  W. Abraham,et al.  Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. , 2015, European heart journal.

[17]  M. Povitz,et al.  Use of a level 3 portable monitor for the diagnosis and management of sleep disordered breathing in an inpatient tertiary care setting. , 2014, Canadian respiratory journal.

[18]  T. Young,et al.  Sleep apnea and cardiovascular disease: an American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Coun , 2008, Journal of the American College of Cardiology.

[19]  G. Tomlinson,et al.  Suppression of Central Sleep Apnea by Continuous Positive Airway Pressure and Transplant-Free Survival in Heart Failure: A Post Hoc Analysis of the Canadian Continuous Positive Airway Pressure for Patients With Central Sleep Apnea and Heart Failure Trial (CANPAP) , 2007, Circulation.

[20]  Sabin R. Bista,et al.  The Treatment of Central Sleep Apnea Syndromes in Adults : Practice Parameters with an Evidence-Based Literature Review and Meta-Analyses , 2011 .

[21]  J. Concato,et al.  Obstructive sleep apnea as a risk factor for stroke and death. , 2005, The New England journal of medicine.

[22]  B. Keenan,et al.  Diagnosis and treatment of sleep disordered breathing in hospitalized cardiac patients: a reduction in 30-day hospital readmission rates. , 2014, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[23]  Susan Redline,et al.  Underdiagnosis of Sleep Apnea Syndrome in U.S. Communities , 2002, Sleep and Breathing.

[24]  T. Young,et al.  Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. , 1997, Sleep.

[25]  Marie Diener-West,et al.  Obstructive sleep apnea-hypopnea and incident stroke: the sleep heart health study. , 2010, American journal of respiratory and critical care medicine.

[26]  Patrick Levy,et al.  Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure. , 2015, The New England journal of medicine.

[27]  S. Javaheri,et al.  Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure. , 2011, American journal of respiratory and critical care medicine.

[28]  Adelaide M. Arruda-Olson,et al.  Sleep Apnea and Cardiovascular Disease , 2003, Herz.

[29]  H. Teschler,et al.  Validation of ApneaLink as screening device for Cheyne-Stokes respiration. , 2009, Sleep.

[30]  W. M. Anderson,et al.  Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. , 2007, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[31]  J. Fleiss,et al.  Intraclass correlations: uses in assessing rater reliability. , 1979, Psychological bulletin.

[32]  D. Whellan,et al.  Photoplethysmographic Signal to Screen Sleep-Disordered Breathing in Hospitalized Heart Failure Patients: Feasibility of a Prospective Clinical Pathway. , 2015, JACC. Heart failure.

[33]  Scott D Ramsey,et al.  An Economic Evaluation of Home Versus Laboratory-Based Diagnosis of Obstructive Sleep Apnea. , 2015, Sleep.

[34]  Whitney Chiao,et al.  Trends in sleep studies performed for Medicare beneficiaries , 2017, The Laryngoscope.

[35]  T. Kasai,et al.  Prognosis of patients with heart failure and obstructive sleep apnea treated with continuous positive airway pressure. , 2008, Chest.

[36]  A. Newman,et al.  Prospective Study of Obstructive Sleep Apnea and Incident Coronary Heart Disease and Heart Failure: The Sleep Heart Health Study , 2010, Circulation.

[37]  H. Akre,et al.  High prevalence of sleep apnea in heart failure outpatients: even in patients with preserved systolic function. , 2011, Journal of cardiac failure.

[38]  S. Quan,et al.  Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. , 2012, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[39]  D. Horstkotte,et al.  Sleep‐disordered breathing in heart failure with normal left ventricular ejection fraction , 2009, European journal of heart failure.

[40]  Terry Young,et al.  Association of sleep-disordered breathing and the occurrence of stroke. , 2005, American journal of respiratory and critical care medicine.