Diagnosis and Treatment of Sleep Disordered Breathing in Hospitalized Cardiac Patients: A Reduction in 30-Day Hospital Readmission Rates

Study Questions:

What is the impact of unattended sleep studies and treatment with positive airway pressure (PAP) in hospitalized cardiac patients with symptoms consistent with sleep-disordered breathing (SDB) on readmission rates 30 days after discharge?

Methods:

A total of 106 consecutive cardiac patients hospitalized for heart failure, arrhythmias, and myocardial infarction, and who reported symptoms of SDB, were evaluated. Patients underwent a type III portable sleep study, and those patients diagnosed with sleep apnea were started on PAP. Demographic data, SDB type, PAP adherence, and data regarding 30-day hospital readmission/emergency department visits were collected.

Results:

Of 106 patients, 104 had conclusive diagnostic studies using portable monitoring systems. Seventy-eight percent of patients (81/104) had SDB (apnea-hypopnea index [AHI] ≥5 events/hour). Eighty percent (65/81) had predominantly obstructive sleep apnea, and 20% (16/81) had predominantly central sleep apnea. None of 19 (0%) patients with adequate PAP adherence, 6 of 20 (30%) with partial PAP use, and 5 of 17 (29%) patients who did not use PAP were readmitted to the hospital or visited the emergency department for a cardiac issue within 30 days from discharge (p = 0.025).

Conclusions:

The authors concluded that performing diagnostic unattended sleep studies and initiating PAP treatment in hospitalized cardiac patients was feasible and provided important clinical information.

Perspective:

This study reports that SDB is common in hospitalized cardiac patients with symptoms but no previous SDB diagnosis, and that cardiac patients with SDB who are adherent to treatment with PAP therapy have a lower 30-day hospital readmission rate than similar subjects who are not adherent to PAP. Identifying patients with SDB and promoting compliance with prescribed PAP treatment appear to be important components in the medical management of these individuals.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Acute Heart Failure, Sleep Apnea

Keywords: Myocardial Infarction, Polysomnography, Demography, Patient Readmission, Sleep Apnea, Central, Heart Failure, Sleep Apnea, Obstructive, Sleep Apnea Syndromes, Arrhythmias, Cardiac


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