In-hospital testing for sleep-disordered breathing in hospitalized patients with decompensated heart failure: report of prevalence and patient characteristics

Abstract

Background: Sleep-disordered breathing (SDB) is present in more than 50% of ambulatory patients with chronic heart failure. The prevalence and type of SDB in hospitalized patients with acutely decompensated heart failure (ADHF) are not known.

Methods and results: In-hospital sleep studies were performed on consecutive patients with ADHF who were not previously tested for SDB. A total of 395 consecutive patients with ADHF underwent successful sleep study recording during hospitalization. A total of 298 patients (75%, 95% CI [71-80%] had SDB; of these, 226 (57%, 95% CI [52-62]) had predominantly obstructive SDB and 72 (18%, 95% CI [14-22]) had predominantly central SDB. Only 25% (95% CI 20-29%) of patients were free of SDB. Validation polysomnography between 6 and 8 weeks after discharge on a subgroup of unselected patients with obstructive SDB revealed a 100 % positive predictive value (95% CI 94-100%) for obstructive sleep apnea (OSA).

Conclusions: Similar to stable chronic heart failure, ADHF is associated with a high prevalence of SDB. The prevalence of predominantly obstructive SDB exceeded that of predominantly central SDB in ADHF patients. The presence of obstructive SDB during hospitalization predicted a diagnosis of OSA on polysomnography.

Figures

Figure 1

Disposition of the 395 consecutive patients with acutely decompensated heart failure (ADHF) who underwent successful recording during hospitalization between 12/30/2007 and 1/31/2008. SDB: Sleep Disordered Breathing; OSDB: Obstructive Sleep Disordered Breathing; CSDB: Central Sleep Disordered Breathing; OSA: Obstructive Sleep Apnea; CSA: Central Sleep Apnea; AHI Apnea hypopnea index. The figure includes all patients with ADHF who were screened during the study period (559). Note that there was no difference in any of the characteristics listed in table 1 between the 71 patients with failed sleep studies and the 395 with successful sleep studies.