Submission
| Title: |
Central Apnea with Severe Oxygen Desaturation is Common but Underrecognized During Hospitalization for Heart Failure |
| Co-Authors: |
Harrison, Nicholas, Indiana University School of Medicine; Shalini Manchanda, Department of Medicine, Division of Sleep Medicine, Indiana University School of Medicine; Nicholas Montelauro, Department of Emergency Medicine, Indiana University School of Medicine; Trenton Line, MS-2, Indiana University School of Medicine; Peter Pang, Department of Emergency Medicine, Indiana University School of Medicine; Ankit Desai, Department of Medicine, Division of Cardiology, Indiana University School of Medicine |
Abstract
Background/Significance/Rationale: Cheyne-Stokes Central Apnea (CA) is a comorbidity associated with poor prognosis in patients with heart failure, thought to occur in <10-30% of cases. We hypothesized that CA with hypoxemia are more common but underrecognized among inpatients with acute heart failure (AHF) due to high levels of congestion and a lack of available testing for CA during hospitalization.
Methods: Patients admitted with an AHF diagnosis and evidence of pulmonary edema on lung ultrasound >3 hours of first intravenous diuresis were enrolled prospectively from the emergency department (ED). Each day until hospital discharge patients wore a sleep monitor validated for inpatient detection of central apneas and hypopneas, including respiratory inspiratory effort plethysmography (RIP), heart rate, and pulse oximetry (SpO2) channels. A board-certified sleep medicine clinician blinded to patient characteristics interpreted each day’s sleep data for central apneas, hypopneas, and desaturations by American Association of Sleep Medicine guidelines. Attending clinicians were asked in the ED and at inpatient discharge whether sleep disordered breathing (SDB) was present during hospitalization. Follow-up referrals for evaluation, testing, and/or treatment of SDB at hospital discharge were recorded.
Results/Findings: 11 patients with 31 inpatient days had analyzed sleep data by August 2022. 100% of patients had CA, on 29/31 (93.5%) inpatient days. Median {interquartile range} daily central apnea index was 5.29 {0.77–9.17}, with 31 {17.7-52.8) oxygen desaturations per hour, and nadir oxygen saturation during a desaturation of 76% {68%-82%}. 2/11 treating ED physicians and 1/11 inpatient physicians recognized sleep disordered breathing during the hospitalization. No patients had prior known history of CSA or were referred for evaluation or treatment after discharge.
Conclusions/Discussion: Preliminary data from this ongoing prospective study suggests that CA, with concomitant severe hypoxia, is highly prevalent but rarely recognized and treated during AHF hospitalization.
Translational/Human Health Impact: Improved Identification could facilitate treatment and improve patient outcomes.
