A Heart Failure Patient With Recurrent Admissions to the Hospital for Unrecognized Hypoxic Episodes of Central Sleep Apnea | Patient Case Quiz

Mar 31, 2015   |  Ronaldo Sevilla Berrios, MD; Lisbeth Garcia Arguello, MD; Sean Caples, DO
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A 78-year-old Caucasian man presents with a history of atrial fibrillation on anticoagulation with an oral direct antithrombin inhibitor, heart failure with preserved ejection fraction (HFpEF) of 50% hypertension, dyslipidemia, and obesity (BMI = 32 kg/m2).

He was hospitalized two weeks ago due to heart failure exacerbation. He was treated with intravenous diuresis that improved his hypoxemia, dyspnea, and peripheral edema; however, respiratory assessment during hospitalization showed an asymptomatic on-and-off tachypnea (Figure 1). He was discharged on optimal medical therapy as per guidelines including metoprolol, dabigatran, lisinopril, atorvastatin, furosemide, spironolactone, digoxin, and insulin subcutaneous with plan for follow-up as an outpatient.

Figure 1


Figure 1

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Last week, he was evaluated by his primary physician at the outpatient clinic. He reported no signs of heart failure decompensation. He complained of daytime fatigue and nonrestorative sleep. His primary physician recommended an overnight oximetry, which was completed two nights ago (Figure 2). Unfortunately, today he developed acute shortness of breath that leads him to the emergency department.

Figure 2


Figure 2

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This hospitalization represents the third one in the last six months. He reports dyspnea at rest and worsening bilateral lower extremity edema. His vital signs are heart rate of 115 beats per minute, irregularly irregular pulse, respiratory rate of 24 breaths per minutes, blood pressure of 105/76 mm Hg, and oxyhemoglobin saturation of 85% at room air.

Which of the following statements is TRUE regarding sleep apnea in heart failure?

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