The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

VALIDATION OF INPATIENT TESTING FOR SLEEP DISORDERED BREATHING IN HOSPITALIZED PATIENTS WITH HEART FAILURE.

Jenny Hsieh2, Brian Patt1, Angela Sow1, Sarah M. Varekojis2, Khayat N. Rami1; 1The Sleep Heart Program, The Ohio State University Medical Center, Columbus, OH; 2School of Allied Medical Professions, The Ohio State University, Columbus, OH

Background: Sleep disordered breathing (SDB) is present in more than half of patients with heart failure (HF). Screening and expedited treatment for SDB in patients with HF is currently not a standard of practice. SDB worsens HF and may produce decompensation of HF. Screening for SDB during HF hospitalizations may improve post-discharge outcomes. To date there are no studies evaluating inpatient approaches to SDB diagnosis. We evaluated the specificity and sensitivity of inpatient sleep studies compared to the reference standard test, polysomnography (PSG). Methods: Patients underwent a cardiorespiratory sleep test during their hospitalization. Patients had a validation PSG within one year of discharge. SDB was defined as an apnea hypopnea index (AHI) greater than 15 events per hour. Central sleep apnea (CSA) and obstructive sleep apnea (OSA) was defined as having SDB with more than 50% of central events or obstructive events respectively. The outpatient validation PSG was a standard sleep study performed in an accredited sleep laboratory. Results: A total of 193 patients underwent both the inpatient and outpatient sleep studies. Patients had the following characteristics: mean age 55 +/- 14 years, BMI 33 +/- 8 kg/cm2 and left ventricular ejection fraction 36 +/- 17%. Of these patients, 43 had CSA, 123 had OSA, and 27 had AHI < 15 on the inpatient study. Of those with SDB on the inpatient study (n=166), 160 continued to have SDB on validation PSG. Of the 27 patients who were negative for SDB on the inpatient test, only 14 continued to have no SDB on PSG. The sensitivity of the inpatient test for SDB was 92% with a positive predictive value of 96%. The negative predictive value was only 51%. Conclusion: Inpatient testing for SDB in hospitalized HF patients is feasible and has a sufficient positive predictive value. However, inpatient testing is not recommended as a definite method to rule out SDB, as patients in this population have a higher risk of SDB in the course of their HF.
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