Sleep apnoea and cardiac readmissions

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Early diagnosis and treatment of sleep apnoea may reduce six-month re-admissions for patients hospitalised with heart failure, according recent research. “Our research showed that early recognition and treatment of patients hospitalised with de-compensated congestive heart failure is associated with a reduction in re-admissions, for patients who use their positive airway pressure (PAP) therapy on a regular basis,” said first author Dr Sunil Sharma, associate professor of pulmonary medicine in the Sidney Kimmel Medical College at Thomas Jefferson University. “Importantly, hospitals can implement cost-effective screening programs to catch sleep apnea in hospitalized, high risk patients.”

Sharma and the team screened patients admitted to the hospital with heart failure, for underlying sleep disordered breathing. Of the 75 patients that followed up with an outpatient polysomnography, the gold standard test, 70 received the diagnosis of sleep disordered breathing. Over the next six months, the team tracked patients’ PAP compliance, emergency room visits and re-admissions.

Compliance was monitored objectively by the device computer and defined as a minimum of four hours of use, 70% of the time, for four weeks consecutively or more during the first three months of therapy.

By comparing pre- and post-treatment re-admissions in compliant (n=37) and non-compliant patients (n=33), the researchers found a reduction in hospital visits for those who used their PAP regularly over a period of six months.

“Physicians should be on the lookout for sleep apnoea in patients with heart failure with the goal of diagnosing and treating early, which might help prevent re-admissions and emergency room visits,” Sharma said. “Multi-centre, randomised studies are needed to replicate and validate these findings.”

Abstract
Re-hospitalization for congestive heart failure (CHF) is high within six months of discharge. Sleep disordered breathing (SDB) is common and under-diagnosed condition in CHF patients. We hypothesized that early recognition and treatment of SDB in hospitalized CHF patients will reduce hospital readmissions and emergency room (ER) visits. Patients admitted for CHF underwent overnight polysomnography within four weeks of discharge. Patients diagnosed with SDB were provided therapy with positive airway pressure (PAP) therapy. Patients were identified as having good compliance if 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 six months before therapy were compared with readmission within six months post therapy in patients with good and poor compliance. A total of 70 patients were diagnosed with sleep disordered breathing post discharge. Of the 70 patients, 37 (53%) were compliant with PAP therapy. Compliant patients were more likely to be older (64±12 vs 58±11 years) and female (54% vs. 33%) and less likely to be diabetic (40 % vs. 67%) versus non-compliant 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 CHF patients 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.

Thomas Jefferson University material
American Journal of Cardiology abstract


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