1
|
Sharma S, Stansbury R, Adcock A, Mokaya E, Azzouz M, Olgers K, Knollinger S, Wen S. Early screening of sleep disordered breathing in hospitalized stroke patients high-resolution pulse oximetry as prognostic and early intervention tools in patients with acute stroke and sleep apnea (HOPES TRIAL). Sleep Breath 2024; 28:2081-2088. [PMID: 39085560 DOI: 10.1007/s11325-024-03123-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 06/25/2024] [Accepted: 07/26/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Sleep Disordered Breathing (SDB) has been shown to increase the risk of stroke and despite recommendations, routine evaluation for SDB in acute stroke is not consistent across institutions. The necessary logistics and expertise required to conduct sleep studies in hospitalized patients remain a significant barrier. This study aims to evaluate the feasibility of high-resolution pulse-oximetry (HRPO) for the screening of SDB in acute stroke. Secondarily, considering impact of SDB on acute stroke, we investigated whether SDB at acute stroke predicts functional outcome at discharge and at 3 months post-stroke. METHODS Patients with acute mild to moderate ischemic stroke underwent an overnight HRPO within 48 h of admission. Patients were divided into SDB and no-SDB groups based on oxygen desaturations index(ODI > 10/h). Stepwise multivariate logistic regression analysis was applied to identify the relevant predictors of functional outcome (favorable [mRS 1-2 points] versus unfavorable [mrS > = 3 points]). RESULTS Of the 142 consecutively screened patients, 96 were included in the analysis. Of these, 33/96 (34%) were identified as having SDB and were more likely to have unfavorable mRS scores as compared to those without SDB (odds ratio = 2.70, p-value = 0.032). CONCLUSION HRPO may be a low-cost and easily administered screening method to detect SDB among patients hospitalized for acute ischemic stroke. Patients with SDB (as defined by ODI) have a higher burden of neurological deficits as compared to those without SDB during hospitalization.
Collapse
Affiliation(s)
- Sunil Sharma
- N. Leroy Lapp Professor and Chief, Division of Pulmonary, Critical Care and Sleep Medicine, Director of MICU and Pulmonary and Sleep Medicine Program Development, Department of Medicine, WVU School of Medicine, Health Science Center North, Room 4075A, PO Box 9166, Morgantown, WV, 26506, USA.
| | - Robert Stansbury
- N. Leroy Lapp Professor and Chief, Division of Pulmonary, Critical Care and Sleep Medicine, Director of MICU and Pulmonary and Sleep Medicine Program Development, Department of Medicine, WVU School of Medicine, Health Science Center North, Room 4075A, PO Box 9166, Morgantown, WV, 26506, USA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amelia Adcock
- Department of Neurology, WVU School of Medicine, Morgantown, WV, USA
| | | | - Mouhannad Azzouz
- Department of Neurology, WVU School of Medicine, Morgantown, WV, USA
| | - Kassandra Olgers
- N. Leroy Lapp Professor and Chief, Division of Pulmonary, Critical Care and Sleep Medicine, Director of MICU and Pulmonary and Sleep Medicine Program Development, Department of Medicine, WVU School of Medicine, Health Science Center North, Room 4075A, PO Box 9166, Morgantown, WV, 26506, USA
| | - Scott Knollinger
- Department of Respiratory Care, Ruby Memorial Hospital, Morgantown, WV, USA
| | - Sijin Wen
- School of Public Health, West Virginia University, Morgantown, WV, USA
| |
Collapse
|
2
|
Sharma S, Stansbury R, Srinivasan P, Rojas E, Quan SF, Olgers K, Knollinger S, Seol C, Hardison M, Thompson J, Hansen N, Wen S. Early recognition and treatment of OSA in hospitalized patients and its impact on health care utilization in rural population: a real-world study. J Clin Sleep Med 2024; 20:1313-1319. [PMID: 38557651 PMCID: PMC11294130 DOI: 10.5664/jcsm.11146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is a highly prevalent, yet underdiagnosed, condition. Due to its adverse impact on risk for cardiopulmonary disorders, there is interest in proactive screening of OSA in hospitalized patients. We studied the long-term outcome of such screened patients who were initiated on positive airway pressure therapy. METHODS Hospitalized patients who screened positive for OSA and were confirmed with postdischarge polysomnography were dichotomized by positive airway pressure therapy adherence and followed for a period of 12 months to evaluate for the composite end point of hospital readmissions and emergency department visits for cardiopulmonary reasons. Cost analysis between the 2 groups was also conducted. RESULTS A total of 2,042 hospitalized patients were assessed for OSA as part of a hospital sleep medicine program from August 2019-June 2023. Of these, 293 patients were diagnosed with OSA and prescribed positive airway pressure therapy. Of these 293 patients, 108 were adherent to therapy and 185 were nonadherent. The overall characteristics of the groups included a mean (standard deviation) age of 58 years (12.82), mean body mass index (kg/m2) of 39.72 (10.71), 57% male sex, and apnea-hypopnea index of 25.49 (26). Of the patients, 78%, 41%, and 43% had hypertension, congestive heart failure, and diabetes mellitus, respectively. The composite end point of hospital readmissions and emergency department visits for cardiovascular and pulmonary reasons was significantly higher in the nonadherent group than in the adherent group (hazard ratio, 1.24; 95% confidence interval, 1-1.54) (P = .03). The cost of care for both hospital billing as well as professional billing was higher for the nonadherent group ($1,455.60 vs $1,723.50, P = .004 in hospital billing cost and $130.90 vs $144.70, P < .001 in professional billing). Length of stay was higher for nonadherent patients (2.7 ± 5.1 days vs 2.3 ± 5.9 days). CONCLUSIONS Hospitalized patients diagnosed with OSA and adherent to therapy have reduced readmissions and emergency department visits for cardiopulmonary reasons 12 months after discharge. Adherent patients have reduced cost of health care and length of stay during hospitalizations. CITATION Sharma S, Stansbury R, Srinivasan P, et al. Early recognition and treatment of OSA in hospitalized patients and its impact on health care utilization in rural population: a real-world study. J Clin Sleep Med. 2024;20(8):1313-1319.
Collapse
Affiliation(s)
- Sunil Sharma
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Robert Stansbury
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Priyanka Srinivasan
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Edward Rojas
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | | | - Kassandra Olgers
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | | | - Calvin Seol
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Malleri Hardison
- Department of Enterprise Finance and Business Planning, Ruby Memorial Hospital, Morgantown, West Virginia
| | - Jesse Thompson
- Department of Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Nicholas Hansen
- School for Environment and Sustainability, University of Michigan, Ann Arbor, Michigan
| | - Sijin Wen
- Department of Public Health, Morgantown, West Virginia
| |
Collapse
|
3
|
Bhatt A, Azam MU, Munagala R, Zetola N, Cho Y, Kwon Y, Healy WJ. The Emergence of Inpatient Sleep Medicine: Screening for Sleep Disordered Breathing to Reduce the Burden of Cardiovascular Disease. CURRENT SLEEP MEDICINE REPORTS 2024; 10:51-61. [PMID: 39185359 PMCID: PMC11343479 DOI: 10.1007/s40675-024-00275-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 08/27/2024]
Abstract
Purpose of Review Treatment of obstructive sleep apnea (OSA) has historically been centered on outpatients given sleep testing is performed on an outpatient basis. Much of this practice originates from insurers only covering sleep testing on an outpatient basis. Over the last decade, there have been innovations made in the portability of sleep monitors which have allowed sleep testing on inpatients to be facilitated. There is also emerging data that inpatient sleep testing may reduce readmissions and healthcare costs in certain cardiovascular conditions. Accordingly, this review aims to provide comprehensive coverage of recent advances in the practice of inpatient sleep medicine and its effect on reducing the burden of cardiovascular disease. Recent Findings Chief cardiovascular diseases that intersect with OSA in inpatients are stroke, atrial fibrillation, and heart failure. There is data from the National Inpatient Sample comparing arrhythmia burdens in patients with OSA and HFpEF showing that OSA patients have higher mortality rates, hospital durations, and medical costs. Also, OSA is associated with higher burdens of arrhythmia. It is currently unknown whether treatment of inpatients with PAP therapy lowers the occurrence of arrhythmias. Recent data suggests that costs for heart failure patients with OSA that are readmitted are higher than those for heart failure patients without OSA. A recent analysis of patients with HFpEF (heart failure with preserved ejection fraction) and OSA showed that the PAP adherent patients had fewer healthcare related costs, lower readmission rates, and fewer emergency room visits than those that were nonadherent. In broader terms, rapid initiation of PAP therapy in a large administration database query of 23 million Medicare patients appears to reduce annual healthcare costs and reduce readmissions although further study is required. Summary OSA is globally underdiagnosed, with an estimated one billion individuals affected. OSA's pathogenesis involves a combination of risk factors, such as obesity, age, and increased neck circumference that contribute to fragmented sleep patterns and in turn, numerous cardiovascular comorbidities, such as stroke, atrial fibrillation, and coronary artery disease. Recently, inpatient sleep medicine programs have emerged as a promising avenue for improving diagnosis, patient safety, and potentially reducing readmissions. Integrating inpatient sleep medicine into healthcare systems to address the significant health and economic burden associated with undiagnosed OSA. Improved coverage of inpatient sleep testing and services will be a key driver of addressing inpatient gaps in sleep medicine care. The current research findings provide a bedrock from which further investigations may proceed in a prospective and randomized, controlled fashion to further clarify the effects of treatment of OSA on cardiovascular outcomes of inpatients.
Collapse
Affiliation(s)
- Arjun Bhatt
- Medical College of Georgia School of Medicine, Augusta,
GA
| | - Mohammad Umair Azam
- Division of Pulmonary, Critical Care, and Sleep Medicine,
Medical College of Georgia at Augusta University, Augusta, GA 30912
| | - Rohit Munagala
- Department of Internal Medicine, Northwell Health (NS/LIJ),
Manhasset, New York, NY
| | - Nicola Zetola
- Division of Pulmonary, Critical Care, and Sleep Medicine,
Medical College of Georgia at Augusta University, Augusta, GA 30912
| | - Yeilim Cho
- VA Puget Sound Medical Center, Seattle, WA
| | - Younghoon Kwon
- Division of Cardiology, University of Washington, Seattle,
WA
| | - William J. Healy
- Division of Pulmonary, Critical Care, and Sleep Medicine,
Medical College of Georgia at Augusta University, Augusta, GA 30912
| |
Collapse
|
4
|
Healy WJ, Khayat R, Kwon Y. Breathe Better and Preserve Heart. J Am Heart Assoc 2023:e030806. [PMID: 37421298 PMCID: PMC10382111 DOI: 10.1161/jaha.123.030806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/10/2023]
Affiliation(s)
- William J Healy
- Division of Pulmonary, Critical Care, and Sleep Medicine Medical College of Georgia at Augusta University Augusta GA USA
| | - Rami Khayat
- The University of California-Irvine Sleep Disorders Center and the Division of Pulmonary and Critical Care University of California-Irvine Irvine CA USA
| | - Younghoon Kwon
- Division of Cardiology University of Washington Seattle WA USA
| |
Collapse
|
5
|
Provider Perspectives on Sleep Apnea from Appalachia: A Mixed Methods Study. J Clin Med 2022; 11:jcm11154449. [PMID: 35956065 PMCID: PMC9369967 DOI: 10.3390/jcm11154449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 12/04/2022] Open
Abstract
West Virginia (WV) has the highest rates of obesity and cardiopulmonary disease in the United States (U.S.). Recent work has identified a significant care gap in WV for obstructive sleep apnea (OSA). This OSA care gap likely has significant health implications for the region given the high rates of obesity and cardiopulmonary disease. The purpose of this mix methods study was to identify barriers that contribute to the rural OSA care disparity previously identified in WV. Methods: This study used mixed methods to evaluate the barriers and facilitators to management of OSA at Federally Qualified Health Centers serving communities in southern WV. Focus groups were conducted at federally qualified health centers with providers serving Appalachian communities. Participants also completed the validated Obstructive Sleep Apnea Knowledge and Attitudes (OSAKA) questionnaire to gain insight into provider knowledge and beliefs regarding OSA. EMR analysis using diagnostic codes was completed at the sites to assess OSA prevalence rates. The same individual served as the interviewer in all focus group sessions to minimize interviewer variability/bias. Our team checked to ensure that the professional transcriptions were correct and matched the audio via spot checks. Results: Themes identified from the focus groups fell into three broad categories: (1) barriers to OSA care delivery, (2) facilitators to OSA care delivery, and (3) community-based care needs to optimize management of OSA in the targeted rural areas. Questionnaire data demonstrated rural providers feel OSA is an important condition to identify but lack confidence to identify and treat OSA. Evaluation of the electronic medical record demonstrates an even larger OSA care gap in these rural communities than previously described. Conclusion: This study found a lack of provider confidence in the ability to diagnose and treat OSA effectively and identified specific themes that limit OSA care in the communities studied. Training directed toward the identified knowledge gaps and on new technologies would likely give rural primary care providers the confidence to take a more active role in OSA diagnosis and management. An integrated model of care that incorporates primary care providers, specialists and effective use of modern technologies will be essential to address the identified OSA care disparities in rural WV and similar communities across the U.S. Community engaged research such as the current study will be essential to the creation of feasible, practical, relevant and culturally competent care pathways for providers serving rural communities with OSA and other respiratory disease to achieve health equity.
Collapse
|
6
|
Sharma S, Stansbury R, Badami V, Rojas E, Quan SF. Inpatient CPAP adherence may predict post-discharge adherence in hospitalized patients screened high risk for OSA. Sleep Breath 2022; 27:591-597. [DOI: 10.1007/s11325-022-02659-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/23/2022] [Accepted: 06/09/2022] [Indexed: 11/30/2022]
|
7
|
Sharma S, Stansbury R. Sleep-Disordered Breathing in Hospitalized Patients: A Game Changer? Chest 2022; 161:1083-1091. [PMID: 34673024 DOI: 10.1016/j.chest.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/01/2021] [Accepted: 10/11/2021] [Indexed: 10/20/2022] Open
Abstract
Sleep disorders, including sleep apnea, have become a significant health issue in the United States. It is estimated that 22 million Americans have sleep apnea, with 80% of cases of moderate and severe OSA going undiagnosed. This number continues to increase with the obesity epidemic. Sleep-disordered breathing (SDB) is associated with multiple cardiopulmonary diseases and has been shown to affect disease outcomes adversely. Hospitalized patients have a disproportionately high prevalence of cardiovascular and respiratory diseases. Screening for SDB in hospitalized patients provides an opportunity to identify the disease in individuals whose disease otherwise may go unrecognized. Data suggest that identification of SDB in hospitalized individuals may have a positive impact on a patient's course after hospitalization. Unfortunately, sleep medicine currently remains an ambulatory practice. Hospital sleep medicine addresses this separation. Herein, we discuss our experience and the future potential of hospital sleep medicine programs.
Collapse
Affiliation(s)
- Sunil Sharma
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV.
| | - Robert Stansbury
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV
| |
Collapse
|
8
|
Addressing rural health disparity with a novel hospital sleep apnea screening: Precision of a high-resolution pulse oximeter in screening for sleep-disordered breathing. Sleep Breath 2022; 26:1821-1828. [DOI: 10.1007/s11325-021-02559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/15/2021] [Accepted: 12/27/2021] [Indexed: 11/26/2022]
|
9
|
Fan X, He M, Tong C, Nie X, Zhong Y, Lu M. Development and Comparison of Predictive Models Based on Different Types of Influencing Factors to Select the Best One for the Prediction of OSAHS Prevalence. Front Psychiatry 2022; 13:892737. [PMID: 35923456 PMCID: PMC9340571 DOI: 10.3389/fpsyt.2022.892737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/02/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aims to retrospectively analyze numerous related clinical data to identify three types of potential influencing factors of obstructive sleep apnea-hypopnea syndrome (OSAHS) for establishing three predictive nomograms, respectively. The best performing one was screened to guide further clinical decision-making. METHODS Correlation, difference and univariate logistic regression analysis were used to identify the influencing factors of OSAHS. Then these factors are divided into three different types according to the characteristics of the data. Lasso regression was used to filter out three types of factors to construct three nomograms, respectively. Compare the performance of the three nomograms evaluated by C-index, ROC curve and Decision Curve Analysis to select the best one. Two queues were obtained by randomly splitting the whole queue, and similar methods are used to verify the performance of the best nomogram. RESULTS In total, 8 influencing factors of OSAHS have been identified and divided into three types. Lasso regression finally determined 6, 3 and 4 factors to construct mixed factors nomogram (MFN), baseline factors nomogram (BAFN) and blood factors nomogram (BLFN), respectively. MFN performed best among the three and also performed well in multiple queues. CONCLUSION Compared with BAFN and BLFN constructed by single-type factors, MFN constructed by six mixed-type factors shows better performance in predicting the risk of OSAHS.
Collapse
Affiliation(s)
- Xin Fan
- Department of Emergency, Shangrao Hospital Affiliated to Nanchang University, Shangrao People's Hospital, Shangrao, China.,Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mu He
- School of Stomatology, Nanchang University, Nanchang, China
| | - Chang Tong
- Pediatric Medical School, Nanchang University, Nanchang, China
| | - Xiyi Nie
- Department of Neurosurgery, Yichun People's Hospital, Yichun, China
| | - Yun Zhong
- The First Clinical Medical College of Nanchang University, Nanchang, China
| | - Min Lu
- Department of Emergency, Shangrao Hospital Affiliated to Nanchang University, Shangrao People's Hospital, Shangrao, China
| |
Collapse
|
10
|
Apnea-Hypopnea Index in Chronic Obstructive Pulmonary Disease Exacerbation Requiring Noninvasive Mechanical Ventilation with Average Volume-Assured Pressure Support. Crit Care Res Pract 2021; 2021:7793657. [PMID: 34873453 PMCID: PMC8643264 DOI: 10.1155/2021/7793657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/02/2021] [Accepted: 11/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction This study intends to determine the Apnea-Hypopnea Index in patients hospitalized with acute hypercapnic respiratory failure from chronic obstructive pulmonary disease exacerbation, who require noninvasive ventilation with average volume-assured pressure support (AVAPS), as well as describes the clinical characteristics of these patients. Materials and Methods We designed a single-center prospective study. The coexistence of Apnea-Hypopnea Index and clinical, gasometric, spirometric, respiratory polygraphy, and ventilatory characteristics were determined. The clinical characteristics found were categorized and compared according to the Apnea-Hypopnea Index (AHI) < 5, AHI 5–15, and AHI >15. A p value <0.05 was considered statistically significant. Results During the study period, a total of 100 patients were admitted to the ICU with a diagnosis of acute hypercapnic respiratory failure due to COPD exacerbation. 72 patients presented with acute respiratory failure and fulfilled criteria for ventilatory support. Within them, 24 received invasive mechanical ventilation and 48 NIV. After applying the inclusion criteria for this study, 30 patients were eligible. An AHI >5 was present in 24 of the 30 patients recruited (80%). Neck circumference (cm), Epworth scale, and Mallampati score evidenced significant differences when compared to the patient's AHI <5, AHI 5–15, and AHI >15 (p < 0.05). Furthermore, patients with an AHI >5 had longer hospital admissions, prolonged periods on mechanical ventilation, and a higher percentage of intubation rates. Conclusion Apnea-Hypopnea Index and chronic obstructive pulmonary disease exacerbation are a frequent association found in patients with acute hypercapnic respiratory failure and COPD exacerbations that require NIV. This association could be a determining factor in the response to NIV, especially when AVAPS is used as a ventilatory strategy.
Collapse
|
11
|
Agrawal R, Jones MB, Spiegelman AM, Bandi VD, Hirshkowitz M, Sharafkhaneh A. Presence of obstructive sleep apnea is associated with higher future readmissions and outpatient visits-a nationwide administrative dataset study. Sleep Med 2021; 89:60-64. [PMID: 34906781 DOI: 10.1016/j.sleep.2021.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/05/2021] [Accepted: 10/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hospital readmissions and outpatient visits contribute to the significant burden on healthcare systems. Obstructive sleep apnea (OSA) is a chronic medical condition that is associated with cardiovascular comorbidities and other chronic conditions. Inpatient and outpatient healthcare utilization rates in patients with OSA following hospitalization are unclear. METHODS This. retrospective case-control cohort study utilized a nationwide database to assess if OSA is associated with higher healthcare utilization post-hospitalization. We compared healthcare utilization among patients with OSA versus without OSA between 2009 and 2014 after matching for demographic variables, geographic location, hospital environment, reason for admission, and severity of illness during hospitalization. We measured future healthcare utilization by the number of ICU admissions, hospital admissions, emergency room visits, and outpatient visits after being discharged from the index hospitalization. RESULTS Two equal-sized cohorts comprised of 85,912 matched pairs were obtained. The OSA cohort demonstrated significantly higher rates of future ICU admissions, hospital admissions, emergency room visits, and outpatient visits. Matching for comorbid cardiovascular conditions continued to demonstrate higher healthcare utilization in the OSA group. Short-term outcomes during the index hospitalization were relatively similar between groups. CONCLUSIONS This retrospective database study demonstrated that OSA may be an independent marker of higher future healthcare utilization. On the other hand, the length of stay during the index hospitalization was not elevated. Prospective studies are needed to confirm these findings and investigate the impact of directing additional resources to inpatients with OSA.
Collapse
Affiliation(s)
- Ritwick Agrawal
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Melissa B Jones
- Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | | | - Venkata D Bandi
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Max Hirshkowitz
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amir Sharafkhaneh
- Medical Care Line, Section of Pulmonary, Critical Care and Sleep Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA; Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
12
|
Chou KT, Tsai YL, Yeh WY, Chen YM, Huang N, Cheng HM. Risk of work-related injury in workers with obstructive sleep apnea: A systematic review and meta-analysis. J Sleep Res 2021; 31:e13446. [PMID: 34384138 DOI: 10.1111/jsr.13446] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/25/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
The objective of this study is to elucidate the relationship between obstructive sleep apnea (OSA) and the risk of work-related injuries (WRIs), synthesize the latest clinical evidence and conduct a systematic review and meta-analysis adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020). Observational studies published before April 2020 in PubMed, Cochrane library, PsycINFO, Scopus, Google Scholar and Web of Science were included. Random-effects Mantel-Haenszel meta-analysis was performed. A total of 15 studies with 21,507 participants were included. Prespecified subgroup analyses based on study design and the characteristics of the enrollees were conducted. Overall, workers with OSA had 1.64-fold increased odds of being involved in WRIs compared to their counterparts (OR = 1.64, 95% CI = 1.24-2.16, p = 0.0005). In addition to the professional drivers that have been studied in the past, such a trend also existed in the general working population (OR = 1.68, 95% CI = 1.14-2.49, p = 0.01). We also found that workers with excessive daytime sleepiness (Epworth Sleepiness Scale score >10) had a 1.68-fold increased risk of WRIs compared to those with lower ESS scores (OR = 1.68, 95% CI = 1.22-2.30, p = 0.002). This study verified that OSA workers had a higher risk of WRIs, and such correlations do not show obvious differences in subgroups with different sample sizes, OSA diagnosis methods, job types or definitions of WRI. Based on the association between OSA and WRIs identified in our study, further studies investigating the protective effects of early identification and management of OSA on WRIs are warranted.
Collapse
Affiliation(s)
- Kun-Ta Chou
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Yu-Lun Tsai
- International Health Program, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wan-Yu Yeh
- Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuh-Min Chen
- Center of Sleep Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.,Center for Evidence-based Medicine, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health and Community Medicine Research Center, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| |
Collapse
|
13
|
Orbea CP, Jenad H, Kassab LL, St Louis EK, Olson EJ, Shaughnessy GF, Peng LT, Morgenthaler TI. Does testing for sleep-disordered breathing pre-discharge versus post-discharge result in different treatment outcomes? J Clin Sleep Med 2021; 17:2451-2460. [PMID: 34216199 DOI: 10.5664/jcsm.9450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Treatment of sleep-disordered breathing (SDB) may improve health related outcomes post-discharge. However timely definitive sleep testing and provision of ongoing therapy has been a challenge. Little is known about how the time of testing-during hospitalization vs. after discharge-affects important outcomes such as treatment adherence. METHODS We conducted a 10-year retrospective study of hospitalized adults who received an inpatient sleep medicine consultation for SDB and subsequent sleep testing. We divided them into inpatient and outpatient sleep testing cohorts and studied their clinical characteristics, follow-up and PAP adherence, and hospital readmission. RESULTS Of 485 patients, 226 (47%) underwent inpatient sleep testing and 259 (53%) had outpatient sleep testing. The median age was 68 years old (IQR=57-78), and 29.6% were females. The inpatient cohort had a higher Charlson Comorbidity Index (CCI) (4 [3-6] vs 3[2-5], p=<0.0004). A higher CCI (HR=1.14, 95%CI:1.03-1.25, p=0.001), BMI (HR=1.03, 95%CI:1.0-1.05, p=0.008) and stroke (HR=2.22, 95%CI:1.0-4.9, p=0.049) were associated with inpatient sleep testing. The inpatient cohort kept fewer follow-up appointments (39.90% vs 50.62%, p=0.03) however PAP adherence was high among those keeping follow-up appointments (88.9% [inpatient] vs 85.71% [outpatient], p=0.55). The inpatient group had an increased risk for death (HR: 1.82 95%CI 1.28-2.59, p=<0.001) but readmission rates did not differ. CONCLUSIONS Medically complex patient were more likely to receive inpatient sleep testing but less likely to keep follow-up, which could impact adherence and effectiveness of therapy. Novel therapeutic interventions are needed to increase sleep medicine follow-up post-discharge which may result in improvement in health outcomes in hospitalized patients with SDB.
Collapse
Affiliation(s)
- Cinthya Pena Orbea
- Sleep Disorders Center, Neurological Institute, Cleveland Clinic, Cleveland OH
| | - Hussam Jenad
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN
| | | | - Erik K St Louis
- Department of Neurology, Mayo Clinic, Rochester, MN.,Center for Sleep Medicine, Mayo Clinic, Rochester MN
| | - Eric J Olson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN.,Center for Sleep Medicine, Mayo Clinic, Rochester MN
| | - Gaja F Shaughnessy
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN
| | | | - Timothy I Morgenthaler
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester MN.,Center for Sleep Medicine, Mayo Clinic, Rochester MN
| |
Collapse
|
14
|
Opiate Use and Escalation of Care in Hospitalized Adults with Acute Heart Failure and Sleep-disordered Breathing (OpiatesHF Study). Ann Am Thorac Soc 2020; 16:1165-1170. [PMID: 31184503 DOI: 10.1513/annalsats.201902-100oc] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Sleep-disordered breathing (SDB) is highly prevalent in adults hospitalized with acute heart failure. Data are limited on the implications of inadvertent opiate use in this population.Objectives: To determine the prevalence and impact of in-hospital opiate use in adults hospitalized for acute heart failure.Methods: From a prospective sleep registry, we selected a sequential group of adult participants who were admitted to the hospital for acute heart failure and received a portable sleep study (PSS) after screening for SDB using the STOP-BANG questionnaire. A retrospective review of charts was performed to assess use of opiates, need for escalation of care (defined as transfer to the intensive care unit [ICU]), 30-day readmission, and length of stay. A logistic regression model was used to calculate propensity scores for each participant with a screening apnea-hypopnea index (AHI) greater than or equal to 10/h. Study endpoints, including escalation of care to the ICU and 30-day hospital readmission, were compared using a χ2 test with stabilized inverse probability-weighted propensity scores to control for potential confounding variables.Results: A total of 301 consecutive adults admitted with acute heart failure between November 2016 and October 2017 underwent PSS after SDB screening. Overall, 125 of 301 (41.5%) received opiates in the hospital, and 149 (49.5%) patients had an AHI greater than or equal to 10/h by PSS (high risk of SDB). In this high-risk group, 47 of 149 (32%) received opiates. Among those with an AHI greater than or equal to 10/h, escalation of care occurred in 12 of 47 (26%) of those who received opiates versus 4 of 102 (4%) of those who did not (P < 0.001; weighted estimate of treatment difference, 23.5%; 95% confidence interval [CI], 9.9 to 37.2). Similarly, readmission within 30 days occurred in 7 of 47 (15%) of those who received opiates versus 9 of 102 (9%) of those who did not (P = 0.14; weighted estimate of treatment difference, 8.3%; 95% CI, -4.0 to 20.6). Mean length of stay (days) did not differ between groups (P = 0.61; weighted estimate of treatment difference, -0.3 d; 95% CI, -1.4 to 0.8).Conclusions: In adults admitted with acute heart failure and found to be at high risk of SDB, opiate use in the hospital was highly prevalent and was associated with a greater likelihood of escalation of care.
Collapse
|
15
|
Stansbury R, Abdelfattah M, Chan J, Mittal A, Alqahtani F, Sharma S. Hospital screening for obstructive sleep apnea in patients admitted to a rural, tertiary care academic hospital with heart failure. Hosp Pract (1995) 2020; 48:266-271. [PMID: 32715796 DOI: 10.1080/21548331.2020.1799601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Rural communities represent a vulnerable population that would significantly benefit from hospital-based OSA screening given these areas tend to have significant health-care disparities and poor health outcomes. Although inpatient screening has been studied at urban hospitals, no study to date has assessed this approach in rural populations. METHODS This study utilized the Electronic Medical Record (EMR) to generate a list of potential candidates by employing inclusion/exclusion criteria as screening. Subjects identified were then approached and offered information regarding the study. Screening for OSA entailed a tiered approach utilizing the sleep apnea clinical score (SAC) and portable sleep testing. Individuals identified as high risk (SAC ≥ 15) for OSA underwent evaluation with a portable sleep testing system while hospitalized. All participants with an apnea-hypopnea index (AHI) ≥5 events/h confirmed by a sleep medicine physician were considered screen positive for OSA. If approved/available, subjects screening positive for OSA were provided with an auto-titrating continuous positive airway pressure (PAP). Patient characteristics were analyzed using descriptive statistics. Categorical data were described using contingency tables, including counts and percentages. Continuously scaled measures were summarized by median with range. This study was registered with ClinicalTrials.gov. Identifier: NCT03056443. RESULTS Nine hundred and fifty-eight potential subjects were identified. The three most common reasons for exclusion included previous OSA diagnosis or exposure to PAP therapy (n = 357), advanced illness (n = 380), and declined participation by the individual (n = 68). The remaining 31 subjects underwent further evaluation for obstructive sleep apnea. Twenty-three subjects had a high sleep apnea clinic score. Per our study protocol, 13 subjects who screened positive for OSA were initiated on APAP therapy. Conclusion: Our study provides important insight into the burden of sleep-disordered breathing (SDB) and unique challenges of hospital-based OSA screening/treatment in a rural setting. Our study identified barriers to successful screening in a rural population that may be well addressed by adapting previous research in hospital sleep medicine.
Collapse
Affiliation(s)
- Robert Stansbury
- Medicine/Section Pulmonary, Critical Care and Sleep Medicine, Medical Center Drive Health Sciences Center, West Virginia University School of Medicine , Morgantown, West Virginia, United States
| | - Mohamad Abdelfattah
- Medicine/Section Pulmonary, Critical Care and Sleep Medicine, Medical Center Drive Health Sciences Center, West Virginia University School of Medicine , Morgantown, West Virginia, United States
| | - Jonathan Chan
- Medicine/Section Pulmonary, Critical Care and Sleep Medicine, Medical Center Drive Health Sciences Center, West Virginia University School of Medicine , Morgantown, West Virginia, United States
| | - Abhinav Mittal
- Medicine/Section Pulmonary, Critical Care and Sleep Medicine, Medical Center Drive Health Sciences Center, West Virginia University School of Medicine , Morgantown, West Virginia, United States
| | - Fahad Alqahtani
- Division of Cardiovascular Medicine, Department of Medicine, University of Kentucky College of Medicine , Lexington, Kentucky, United States
| | - Sunil Sharma
- Medicine/Section Pulmonary, Critical Care and Sleep Medicine, Medical Center Drive Health Sciences Center, West Virginia University School of Medicine , Morgantown, West Virginia, United States
| |
Collapse
|
16
|
Sleep Disordered Breathing in Hospitalized African-Americans. J Natl Med Assoc 2020; 112:262-267. [PMID: 32305125 DOI: 10.1016/j.jnma.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/20/2020] [Accepted: 03/13/2020] [Indexed: 11/23/2022]
Abstract
RATIONALE Sleep-disordered breathing (SDB) is a common disorder in general population, with higher prevalence in population with comorbid cardiovascular disease, and yet it remains frequently undiagnosed. Prior published data show that hospitalized obese patients have a high incidence of unrecognized SDB. However, limited data exists on the incidence, prevalence, and impact of SDB in hospitalized obese African-American (AA) patients. This study was performed to better understand the burden of undiagnosed SDB in hospitalized AA patients and its implications on readmission. METHODS A total of 1243 consecutive obese AA patients admitted to medical or telemetry service were screened utilizing a screening questionnaire (STOP/STOPBANG) from October 2016 to October 2017. If the results of the screening questionnaire were positive, the patients were offered inpatient testing with either High Resolution Pulse Oximetry (HRPO), or a type 3 portable monitor (PM). SDB was suspected if the Oxygen Desaturation Index (ODI) or Apnea Hypopnea Index (AHI) ≥ 5. We collected 30-day readmission and emergency department (ED) visit data on all patients and requested a formal outpatient sleep study for patients identified as SDB positive. RESULTS Of the 1243 AA patients screened, 852 (68.5%) patients screened positive for SDB. Of these high-risk screens, 538 (63.1%) patients underwent inpatient testing with either High Resolution Pulse Oximetry (HRPO) or PM. Of these 538 patients, 319 (59.3%) were found to have suspected obstructive sleep apnea (OSA) based on ODI/AHI >5. Mild SDB (AHI 5-14) was present in 149 (46.7%) patients; moderate (AHI 15-29) in 74 (23.2%) patients; and severe (AHI >30) in 96 (30.1%) patients. The patients with suspected SDB were educated and encouraged to get an out-patient polysomnogram (PSG) but only 32 (10.0%) returned to undergo a formal PSG. The 30-day readmission rate/ED visits for patient with SDB was 13.5% compared to 13.7% of patients without SDB. CONCLUSION This is the largest SDB registry that included obese hospitalized AA patients in a tertiary care academic center and reveals a high prevalence of undiagnosed SDB in this cohort. Despite proactive screening and patient education only 3.8% (32/852) of patients returned post-discharge for formal polysomnography. The presence of SDB did not impact the 30-day readmission rate/ED visit rate in this cohort.
Collapse
|
17
|
Naranjo M, Willes L, Prillaman BA, Quan SF, Sharma S. Undiagnosed OSA May Significantly Affect Outcomes in Adults Admitted for COPD in an Inner-City Hospital. Chest 2020; 158:1198-1207. [PMID: 32247716 DOI: 10.1016/j.chest.2020.03.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 03/01/2020] [Accepted: 03/19/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND COPD is the second most common cause of hospital admission in the United States. OSA is a highly prevalent and underdiagnosed condition that may affect the outcome of COPD. RESEARCH QUESTION We hypothesized that presence of unrecognized and untreated OSA will increase hospital readmissions in patients admitted for COPD exacerbation. STUDY DESIGN AND METHODS We reviewed patients admitted for COPD exacerbation from May 2017 through July 2018 who were also screened for previously unrecognized and untreated OSA with a sleep questionnaire, and who subsequently underwent a high-resolution pulse oximetry or portable sleep monitoring study. We compared the rates of 30-, 90-, and 180-day readmission or death across OSA categories and compared overall survival in patients with and without OSA. RESULTS Of 380 patients admitted for COPD exacerbation, 256 were screened for OSA with a sleep questionnaire (snoring, tiredness during daytime, observed apnea, high BP). Of these, 238 underwent an overnight high-resolution pulse oximetry/portable sleep monitoring. Of the 238 total patients, 111 (46.6%) were found to have OSA; 28.6% had mild, 9.7% moderate, and 8.4% severe OSA. Baseline characteristics and demographics were compared between the cohorts of participants with OSA and without OSA and were similar except that patients with OSA had a higher mean BMI (33.9 vs 30.3 kg/m2) and an increased prevalence of heart failure (19.8% vs 7.1%). For patients with COPD and mild OSA, odds of 30-day readmission were 2.05 times higher than for patients without OSA (32.4% vs 18.9%). Additionally, odds of 30-day readmission were 6.68 times higher for patients with moderate OSA vs patients without OSA (60.9% vs 18.9%) and 10.01 times high for patients with severe OSA vs patients without OSA (70% vs 18.9%). Readmission rates were also greater at 90 and 180 days. All-cause mortality was lower for patients without OSA than for patients with OSA (P < .01). The time to hospital readmission or death was shorter with greater OSA severity (P < .01). INTERPRETATION Patients hospitalized for COPD exacerbation and who have unrecognized OSA; 30-, 90-, and 180-day readmission rates; and 6-month mortality rates are higher than in those without OSA.
Collapse
Affiliation(s)
| | | | - Barbara A Prillaman
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ
| | - Sunil Sharma
- Division of Pulmonary, Critical Care and Sleep Medicine, West Virginia University, Morgantown, WV.
| |
Collapse
|
18
|
Poka-Mayap V, Balkissou Adamou D, Massongo M, Voufouo Sonwa S, Alime J, Moutlen BPM, Kongnyu Njamnshi A, Noseda A, Pefura-Yone EW. Obstructive sleep apnea and hypopnea syndrome in patients admitted in a tertiary hospital in Cameroon: Prevalence and associated factors. PLoS One 2020; 15:e0227778. [PMID: 31945127 PMCID: PMC6964861 DOI: 10.1371/journal.pone.0227778] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Obstructive sleep apnea and hypopnea syndrome (OSAHS) is poorly documented in Sub-Saharan Africa, especially in the hospital setting. The aim of this study was to determine its prevalence and to investigate the associated factors in patients admitted in a tertiary referral hospital in Cameroon. METHODS In this cross-sectional study conducted in the Cardiology, Endocrinology and Neurology departments of the Yaounde Central Hospital; all patients aged 21 and older were included consecutively. A sample of randomly selected patients was recorded using a portable sleep monitoring device (PMD). OSAHS was defined as apnea-hypopnea index (AHI) ≥ 5/hour (with > 50% of events being obstructive) and moderate to severe OSAHS as an AHI > 15/hour. Logistic regression was used to identify factors associated to OSAHS. RESULTS Of the 359 patients included, 202 (56.3%) patients were women. The mean age (standard deviation) was 58 (16) years. The prevalence of OSAHS assessed by PMD (95% CI) was 57.7% (48.5-66.9%), 53.8% in men and 62.7% in women (p = 0.44). The median (25th-75th percentiles) AHI, body mass index and Epworth Sleepiness Scale score of OSAHS patients were 17 (10.6-26.9)/hour, 27.4 (24.7-31.6) kg/m2 and 7 (5-9) respectively. The only factor associated to moderate to severe OSAHS was hypertension [odds ratio (95% CI)]: 3.24 (1.08-9.72), p = 0.036. CONCLUSION OSAHS is a common condition in patients in this health care centre of Cameroon. In the hospital setting, screening for OSAHS in patients with hypertension is recommended.
Collapse
Affiliation(s)
| | | | | | - Steve Voufouo Sonwa
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
| | - Jacqueline Alime
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
| | | | - Alfred Kongnyu Njamnshi
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
- Department of Neurology, Yaounde Central Hospital, Yaounde, Cameroon
- Brain Research Africa Initiative (BRAIN), Yaounde, Cameroon
| | - Andre Noseda
- Pulmonology Department, Brugmann University Hospital U.L.B., Brussels, Belgium
| | - Eric Walter Pefura-Yone
- Pulmonology Department, Yaounde Jamot Hospital, Yaounde, Cameroon
- Department of Internal Medicine and Subspecialties, Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
| |
Collapse
|
19
|
Kum RO, Kundi FCS, Baklacı D, Kum NY, Güler İ, Yılmaz YF, Özcan M. Predicting Severe Sleep Apnea in Patients with Complaints: Pulse Oximetry and Body Mass Index. Turk Arch Otorhinolaryngol 2018; 56:149-154. [PMID: 30319871 DOI: 10.5152/tao.2018.2928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 05/04/2018] [Indexed: 11/22/2022] Open
Abstract
Objective An adequate evaluation combined with an easily accessible test would be a useful way to direct the appropriate patients to sleep centers in circumstances with a limited opportunity for polysomnography (PSG). For this reason, it is necessary to use a screening method prior to PSG evaluation. The aim of the present study was to investigate whether the use of body mass index (BMI) and pulse oximetry is sufficient to predict the severity of obstructive sleep apnea syndrome (OSAS) without PSG. Methods A total of 956 patients who were admitted to a tertiary referral center with complaints of witnessed apnea, excessive daytime sleepiness, and previously performed PSG were included in the study. Data of PSG (included pulse oximetry) and BMI were investigated for the determination of cut-off points for parameters in the patients. Results Based on the presence of severe OSAS, the cut-off points were ≥31.7 kg/m2 for BMI, <81% for minimum oxygen saturation (Min O2), and ≥14.1 min for sleep time with oxygen saturation <90% (ST90). Severe OSAS risk was found to be higher in patients with BMI ≥31.7 kg/m2, ST90 ≥14.1 min, and Min O2 ≤81% than in those without (OR: 37.173; 95% CI: 22.465-61.510, p=0.001). Specificity and accuracy were 94.85% and 72.49%, respectively, when all three cut-off scores were provided. Conclusion The appropriate cut-off values obtained from combining BMI and pulse oximetry data can provide accurate results for predicting the severity of OSAS.
Collapse
Affiliation(s)
- Rauf Oğuzhan Kum
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Fatma Cemre Sazak Kundi
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Deniz Baklacı
- Department of Otorhinolaryngology, Kahramankazan State Hospital, Ankara, Turkey
| | - Nurcan Yurtsever Kum
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - İsmail Güler
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Yavuz Fuat Yılmaz
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Müge Özcan
- Department of Otorhinolaryngology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
20
|
Quintos A, Naranjo M, Kelly C, Quan SF, Sharma S. Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome. J Natl Med Assoc 2018; 111:176-184. [PMID: 30314827 DOI: 10.1016/j.jnma.2018.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 09/16/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The HoSMed Database recently demonstrated a high prevalence of obstructive sleep apnea (OSA) in hospitalized obese patients. Based on a long-term follow-up, this study showed an improved survival among patients who were adherent with the therapy. In this post-hoc analysis we explore the characteristics, associations, and mortality outcome of OSA in the African American (AA) population. METHODS These subset analyses included obese AA patients screened in the hospital as high-risk for OSA. Stepwise logistic regression analysis was used to identify predictors of OSA. Patients who had polysomnography (PSG) and were initiated on positive airway pressure (PAP) therapy were followed and dichotomized to adherent versus non-adherent groups based on compliance data. Mortality rates in both groups were compared. RESULTS Of the total of 2022 AA patients screened, 1370 (60.7% females) were identified as high risk for OSA. Of these, 279 had PSG diagnosed OSA (mean AHI = 36/hour) and were initiated on PAP therapy. Adherence in AAs was significantly lower than for Caucasians (21% versus 45%, Chi-square p < 0.0001). The following statistically significant predictors of OSA were found: heart failure, chronic kidney disease, hypertension and asthma/COPD, BMI and age. A Log-rank survival analysis of AAs on CPAP showed non-significant benefit of adherence (HR: 0.22; 95% CI 0.03-1.7, p = 0.11); a propensity analysis of AAs and Caucasians that adjusted for race and potential confounding variables found a statistically significant benefit of adherence (HR: 0.29; 0.13-0.64; p = 0.002). CONCLUSION This large database of hospitalized patients confirms a high prevalence and lower adherence to PAP therapy in African Americans. Adherent patients, however, showed mortality benefit similar to Caucasians.
Collapse
Affiliation(s)
- Abigail Quintos
- Department of Internal Medicine and the Division of Pulmonary, Allergy and Sleep Medicine, Albert Einstein Medical Center, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Mario Naranjo
- Department of Internal Medicine and the Division of Pulmonary, Allergy and Sleep Medicine, Albert Einstein Medical Center, Sidney Kimmel Medical College, Philadelphia, PA, USA
| | | | - Stuart F Quan
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Asthma and Airways Research Center, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Sunil Sharma
- Department of Internal Medicine and the Division of Pulmonary, Allergy and Sleep Medicine, Albert Einstein Medical Center, Sidney Kimmel Medical College, Philadelphia, PA, USA.
| |
Collapse
|
21
|
High-Resolution Pulse Oximetry (HRPO): A Cost-Effective Tool in Screening for Obstructive Sleep Apnea (OSA) in Acute Stroke and Predicting Outcome. J Stroke Cerebrovasc Dis 2018; 27:2986-2992. [PMID: 30097400 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a well-known risk factor for stroke. This is attributed to multiple mechanisms such as endothelial dysfunction, atrial fibrillation, hypertension, and comorbid obesity. STOP questionnaire alone is unreliable to diagnose OSA and in-hospital sleep study is costly and can be technically challenging. We used high-resolution pulse oximetry (HRPO) to test the feasibility of screening for OSA and predicting outcome. METHODS Data from 115 stroke patients who underwent HRPO was collected including Oxygen desaturation index (ODI) <4%, pulse rate, arterial oxygen saturation (SaO2), and time spent at SaO2 saturation <88%. We also collected data on various confounders. The outcomes measured were NIHSS (National Institutes of Health Stroke Scale), mRS (modified Rankin Score) on discharge, and discharge disposition. RESULTS Overall 115 patients with valid HRPO data were included in the study. Mean age was 64±12years with 68% white, 22% black, and 10% Hispanic population. Of this cohort of 115 patients, 56% were males. Of the subjects enrolled 22 had atrial fibrillation, 27 had type 2 diabetes, 7 had resistant hypertension, and 7 had patient foramen ovale. Of the 115 patients, 75 patients were found to have ODI of >10 and the mean ODI was 29±30. The NIHSS on admission was 6.14±6.93 and on discharge was 4.46±4.59, mRS on discharge was 1.70±1.67 with 52% being discharged home, 43% to rehab, 2% nursing home, and 3% to long-term acute care facility. In this study, we show a strong association between atrial fibrillation and increasing ODI (P<.001, OR 1.01, CI 1.00-1.03). In addition, our study also shows an association between discharges outcome of rehab (more deficits leading to higher disability) versus discharge to home (lesser deficits) if ODI was ≤10 (P = 0.005, OR 3.76, CI 1.49-9.52). CONCLUSIONS Our study showed that there is a significant burden of OSA in acute stroke patients. ODI emerged as a predictor of atrial fibrillation and discharge disposition in our study. HRPO may be a cost-effective tool to screen and evaluate for OSA in acute stroke patients.
Collapse
|
22
|
Suliman LA, Shalabi NM, Elmorsy AS, Moawed MK. Value of STOP-BANG and Berlin questionnaires in the diagnosis and severity prediction of obstructive sleep apnea hypopnea syndrome. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2017. [DOI: 10.4103/ejb.ejb_25_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
23
|
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; 13:1185-1190. [PMID: 28859720 DOI: 10.5664/jcsm.6768] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
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/m2. 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.
Collapse
Affiliation(s)
- Sunil Sharma
- Einstein Medical Center, Philadelphia, Pennsylvania
| | - Paul J Mather
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Umer Mukhtar
- Einstein Medical Center, Philadelphia, Pennsylvania
| | | | | | | | - Stuart F Quan
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
24
|
Sharma S, Mukhtar U, Kelly C, Mather P, Quan SF. Recognition and Treatment of Sleep-Disordered Breathing in Obese Hospitalized Patients May Improve Survival. The HoSMed Database. Am J Med 2017; 130:1184-1191. [PMID: 28476457 DOI: 10.1016/j.amjmed.2017.03.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE Sleep-disordered breathing is a common sleep disorder. Recent studies have shown that hospitalized obese patients have a high likelihood of unrecognized sleep-disordered breathing. However, no systematic large study has so far evaluated the outcomes of a screening program. This study provides demographic, clinical, and outcome data from a screening program at a tertiary care academic center. METHODS Subjects were 5062 patients screened from March 2013 to July 2016. Of these, 1410 underwent in-hospital overnight high-resolution pulse oximetry and 680 underwent polysomnography post discharge. Patients placed on positive airway therapy were followed in an ambulatory setting. RESULTS The mean age was 60.7 years (SD 15.2), and mean body mass index was 34.8 kg/m2 (SD 8.3), with 2477 (49.0%) males. Of the 1410 high-risk patients who underwent high-resolution plethysmography (HRPO), 1092 were sleep-disordered breathing positive (oxygen desaturation index [ODI] ≥5) and 680 high-risk patients underwent polysomnography. In this latter group, 585 (87%) were found to have sleep-disordered breathing (apnea-hypopnea index [AHI] >5). A receiver operating characteristic curve for ODI derived from HRPO plotted against AHI from polysomnography showed an area under the curve of 0.83 for an ODI of >5. Patients who were adherent to positive airway pressure therapy in the first 3 months had improved survival over a mean follow-up of 609 days compared with those who were nonadherent (P = .01). CONCLUSION This large database of hospitalized patients confirms a high prevalence of undetected sleep-disordered breathing. Long-term follow-up of those compliant with treatment reveals a survival benefit.
Collapse
Affiliation(s)
- Sunil Sharma
- Division of Pulmonary and Critical Care, Einstein Medical Center, Philadelphia, Pa; Sidney Kimmel Medical College, Philadelphia, Pa.
| | - Umer Mukhtar
- Division of Pulmonary and Critical Care, Einstein Medical Center, Philadelphia, Pa
| | | | - Paul Mather
- Heart Failure-Transplant Program, University of Pennsylvania, Philadelphia
| | - Stuart F Quan
- Division of Sleep Medicine, Harvard Medical School, Boston, Mass; Arizona Respiratory Center, University of Arizona College of Medicine, Tucson
| |
Collapse
|
25
|
Nagubadi S, Mehta R, Abdoh M, Nagori M, Littleton S, Gueret R, Tulaimat A. The Accuracy of Portable Monitoring in Diagnosing Significant Sleep Disordered Breathing in Hospitalized Patients. PLoS One 2016; 11:e0168073. [PMID: 27992566 PMCID: PMC5167272 DOI: 10.1371/journal.pone.0168073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 11/27/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Polysomnograms are not always feasible when sleep disordered breathing (SDB) is suspected in hospitalized patients. Portable monitoring is a practical alternative; however, it has not been recommended in patients with comorbidities. OBJECTIVE We evaluated the accuracy of portable monitoring in hospitalized patients suspected of having SDB. DESIGN Prospective observational study. SETTING Large, public, urban, teaching hospital in the United States. PARTICIPANTS Hospitalized patients suspected of having SDB. METHODS Patients underwent portable monitoring combined with actigraphy during the hospitalization and then polysomnography after discharge. We determined the accuracy of portable monitoring in predicting moderate to severe SDB and the agreement between the apnea hypopnea index measured by portable monitor (AHIPM) and by polysomnogram (AHIPSG). RESULTS Seventy-one symptomatic patients completed both tests. The median time between the two tests was 97 days (IQR 25-75: 24-109). Forty-five percent were hospitalized for cardiovascular disease. Mean age was 52±10 years, 41% were women, and the majority had symptoms of SDB. Based on AHIPSG, SDB was moderate in 9 patients and severe in 39. The area under the receiver operator characteristics curve for AHIPM was 0.8, and increased to 0.86 in patients without central sleep apnea; it was 0.88 in the 31 patients with hypercapnia. For predicting moderate to severe SDB, an AHIPM of 14 had a sensitivity of 90%, and an AHIPM of 36 had a specificity of 87%. The mean±SD difference between AHIPM and AHIPSG was 2±29 event/hr. CONCLUSION In hospitalized, symptomatic patients, portable monitoring is reasonably accurate in detecting moderate to severe SDB.
Collapse
Affiliation(s)
- Swamy Nagubadi
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Rohit Mehta
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Mamoun Abdoh
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Mohammedumer Nagori
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Stephen Littleton
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Renaud Gueret
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| | - Aiman Tulaimat
- Division of Pulmonary, Critical Care and Sleep Medicine, Cook County Health and Hospitals System, Chicago, Illinois, United States of America
| |
Collapse
|
26
|
Sharma S, Chakraborty A, Chowdhury A, Mukhtar U, Willes L, Quan SF. Adherence to Positive Airway Pressure Therapy in Hospitalized Patients with Decompensated Heart Failure and Sleep-Disordered Breathing. J Clin Sleep Med 2016; 12:1615-1621. [PMID: 27568891 DOI: 10.5664/jcsm.6344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 07/18/2016] [Indexed: 01/09/2023]
Abstract
STUDY OBJECTIVES Sleep-disordered breathing (SDB) has been implicated as a risk factor for the development of several adverse cardiovascular outcomes, but can be mitigated with positive airway pressure therapy (PAP). The nonadherence of patients with SDB on PAP in the outpatient setting ranges from 29% to 84%. However, adherence of PAP in patients with congestive heart failure (CHF) admitted for decompensated CHF and in whom SDB has been diagnosed in the hospital setting is not known. We hypothesized that despite a diagnosis in the hospital, the compliance of these patients with PAP therapy would not be different from the well-established adherence in patients with a diagnosis and treatment in the outpatient setting. METHODS The study was a retrospective analysis of patients admitted to an academic tertiary care hospital between March 2013 and February 2014. Patients presenting with decompensated CHF were screened and high-risk patients were started on PAP empirically and advised to undergo a postdischarge polysomnogram. Compliance of the patients with PAP was tracked for over 12 mo. Data from a similar outpatient group who underwent polysomnography during the study period were also reviewed. RESULTS Ninety-one patients underwent polysomnograhy postdischarge. Of the 91 patients, 81 patients agreed to PAP therapy. One patient was excluded as data were missing. The adherence at 3, 6, and 12 mo was 52%, 37%, and 27%, which was not significantly different than an outpatient control group. There was a trend for those with CHF plus SDB and compliant with PAP to have a higher probability of survival compared to those who were noncompliant (p = 0.07). CONCLUSIONS Adherence of patients to PAP therapy in whom a SDB diagnosis is made during acute hospitalization for heart failure is comparable to patients in the ambulatory setting. Adherence in first 3 mo is a predictive marker for improved survival trend.
Collapse
Affiliation(s)
- Sunil Sharma
- Division of Pulmonary and Critical Care, Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Anasua Chakraborty
- Division of Pulmonary, Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Anindita Chowdhury
- Division of Pulmonary, Critical Care Medicine, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Umer Mukhtar
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA
| | | | - Stuart F Quan
- Division of Sleep Medicine, Harvard Medical School, Boston, MA.,Arizona Respiratory Center, University of Arizona College of Medicine, Tucson, AZ
| |
Collapse
|
27
|
Sharma S, Chowdhury A, Tang L, Willes L, Glynn B, Quan SF. Hospitalized Patients at High Risk for Obstructive Sleep Apnea Have More Rapid Response System Events and Intervention Is Associated with Reduced Events. PLoS One 2016; 11:e0153790. [PMID: 27168330 PMCID: PMC4864239 DOI: 10.1371/journal.pone.0153790] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/04/2016] [Indexed: 01/09/2023] Open
Abstract
Background Rapid response system (RRS) is a safety tool designed for early detection and intervention of a deteriorating patient on the general floor in the hospital. Obstructive sleep apnea (OSA) has been associated with significant cardiovascular complications. We hypothesized that patients with high-risk of OSA have higher rate of RRS events and intervention with positive airway pressure therapy in these patients can mitigate the RRS events. Methods As part of a clinical pathway, during a 15 month period, patients with BMI ≥ 30 kg/m2 in select medical services were screened with a validated sleep questionnaire. Patients were characterized as high or low risk based on the screening questionnaire. RRS rates were compared between the groups. Subsequently the impact of PAP therapy on RRS events was evaluated. Results Out of the 2,590 patients screened, 1,973 (76%) were identified as high-risk. RRS rates calculated per 1,000 admissions, were 43.60 in the High-Risk OSA group versus 25.91 in the Low-Risk OSA Group. The PAP therapy compliant group had significantly reduced RRS event rates compared to non-compliant group and group with no PAP therapy (16.99 vs. 53.40 vs. 56.21) (p < 0.01). Conclusion In a large cohort of patients at a tertiary care hospital, we show an association of increased rate of RRS events in high-risk OSA patients and reduction of the risk with PAP intervention in the compliant group.
Collapse
Affiliation(s)
- Sunil Sharma
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
- * E-mail:
| | - Anindita Chowdhury
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Lili Tang
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Leslee Willes
- Willes Consulting Group Inc., Encinitas, California, United States of America
| | - Brian Glynn
- Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America
| | - Stuart F. Quan
- Harvard Medical School, Boston, Massachusetts, United States of America
- University of Arizona College of Medicine, Tucson, Arizona, United States of America
| |
Collapse
|
28
|
Sharma S, Mather P, Gupta A, Reeves G, Rubin S, Bonita R, Chowdhury A, Malloy R, Willes L, Whellan D. Effect of Early Intervention With Positive Airway Pressure Therapy for Sleep Disordered Breathing on Six-Month Readmission Rates in Hospitalized Patients With Heart Failure. Am J Cardiol 2016; 117:940-5. [PMID: 26830259 DOI: 10.1016/j.amjcard.2015.12.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 12/25/2022]
Abstract
Rehospitalization for congestive heart failure (CHF) is high within 6 months of discharge. Sleep disordered breathing (SDB) is common and underdiagnosed condition in patients with CHF. We hypothesized that early recognition and treatment of SDB in hospitalized patients with CHF will reduce hospital readmissions and emergency room visits. Patients admitted for CHF underwent overnight polysomnography within 4 weeks of discharge. Patients diagnosed with SDB were provided therapy with positive airway pressure therapy. Patients were identified as having good compliance if the device use was for a minimum of 4 hours 70% of the time for a minimum of 4 weeks during the first 3 months of therapy. Hospital admissions for 6 months before therapy were compared with readmission within 6 months after therapy in patients with good and poor compliance. A total of 70 patients were diagnosed with SDB after discharge. Of the 70 patients, 37 (53%) were compliant with positive airway pressure therapy. Compliant patients were more likely to be older (64 ± 12 vs 58 ± 11 years) and women (54% vs 33%) and less likely to be patient with diabetes (40% vs 67%) versus noncompliant patients. Although both groups experienced a decrease in total readmissions, compliant patients had a significant reduction (mean ± SE: -1.5 ± 0.2 clinical events vs -0.2 ± 0.3; p <0.0001). In this single-center analysis, identification and treatment of SDB in admitted patients with CHF with SDB is associated with reduced readmissions over 6 months after discharge. Adherence to the treatment was associated with a greater reduction in clinical events.
Collapse
Affiliation(s)
- Sunil Sharma
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Paul Mather
- Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ankit Gupta
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Gordon Reeves
- Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sharon Rubin
- Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Raphael Bonita
- Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Anindita Chowdhury
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Raymond Malloy
- Division of Pulmonary and Critical Care, Department of Internal Medicine, Jefferson Sleep Disorders Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Leslee Willes
- Independent Biostatician, Willes Consulting Group, Inc., Encinitas, California
| | - David Whellan
- Division of Cardiology, Department of Internal Medicine, Advanced Heart Failure and Cardiac Transplant Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
| |
Collapse
|
29
|
Konikkara J, Tavella R, Willes L, Kavuru M, Sharma S. Early recognition of obstructive sleep apnea in patients hospitalized with COPD exacerbation is associated with reduced readmission. Hosp Pract (1995) 2016; 44:41-47. [PMID: 26691510 DOI: 10.1080/21548331.2016.1134268] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The combination of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease is known as the "overlap syndrome", and results in frequent hospitalizations and worse prognosis. We hypothesized that early detection and treatment of this condition in hospitalized patients may reduce clinical events (hospital admissions and emergency room visits) Methods: Between April 2013 and January 2014 all patients consulted for COPD exacerbation and having a BMI of > 30 kg/m(2) were screened for OSA. If high risk, patients underwent a polysomnography on discharge. Readmission rate in patients compliant with positive airway pressure was compared to patients who were deemed non-compliant based on objective data from the device. RESULTS Full polysomnogram data and compliance was available on 24 patients. The baseline characteristics were comparable between the compliant and non-compliant groups. The mean change in the total clinical events 6 months prior to intervention compared to 6 months following intervention was -2.1 ± 0.3 in the compliant group, compared to -0.8 ± 0.5 in the non-compliant group (p = 0.01). The mean change in the total clinical events 12 months prior to intervention compared to 12 months following intervention was -2.7 ± 0.5 in the compliant group, compared to -0.8 ± 0.6 in the non-compliant group (p = 0.03) CONCLUSION: In conclusion, our data suggest that early recognition and treatment of OSA in patients admitted with COPD exacerbation and compliant with PAP therapy is associated with reduced 6-month hospital readmission rates and emergency room visits. Screening for OSA in patients admitted with COPD exacerbation is a simple and early intervention that should be encouraged to help reduce hospital readmissions in this patient population.
Collapse
Affiliation(s)
- John Konikkara
- a Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | - Robert Tavella
- a Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | | | - Mani Kavuru
- a Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital , Philadelphia , PA , USA
| | - Sunil Sharma
- a Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital , Philadelphia , PA , USA
| |
Collapse
|