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Sleep Apnea Should Be Addressed in Heart Failure Population

Before you fall asleep at the thought, consider the fact that sleep apnea has been identified as a major contributing factor in new onset atrial fibrillation (Afib), acute ischemic stroke, and heart failure. How well are inpatients, in particular those with heart failure, being screened and treated for sleep apnea?

To answer this question, the charts of 100 patients admitted with a known diagnosis of heart failure were retrospectively reviewed. Screening for sleep apnea was defined as the mention of the condition on a patient’s admitting history and physical. The average age was 73 years; two-thirds were male. Thirty-nine percent were identified as already having sleep apnea. Interestingly, 42% had a concurrent diagnosis of Afib; this group also had a higher 30-day readmission rate of 11%, versus 9% for the heart failure alone group.

While inpatient, approximately one-quarter of the sample used continuous positive airway pressure (CPAP) during their admission, with two thirds of these being previous users. Twenty patients had overnight oximetry testing; most often these tests were triggered by history and ordered by cardiology. A little over half of these tests were positive for sleep-disordered breathing, prompting recommendations for CPAP, nocturnal oxygen, and outpatient polysomnograms and lending support for testing in this heart failure population.

At discharge, how well were these sleep apnea test results and recommendations communicated to the primary care provider? Only half of patients with known or newly diagnosed sleep apnea had the diagnosis mentioned on their discharge summaries or received recommendations for further management.

From this review, one could conclude that sleep apnea is prevalent in the heart failure population and in those with concurrent Afib; that over half of those tested for sleep apnea while inpatient were found to have an indication for therapy or further testing, and that communication to primary providers is not sufficient.

Sleep apnea should be routinely addressed in the heart failure population, as it contributes to morbidity and is responsive to treatment. Improvements in the screening process could include adding a dedicated section on the electronic medical record to screen for sleep apnea on admission and a second section to track inpatient CPAP and nocturnal oxygen use.

Finally, a discharge section could identify those patients with new or previous sleep apnea to note any changes in their CPAP or oxygen therapy and to identify patients needing formal outpatient testing. Coordinating with primary care providers is essential for continuity and to reduce readmissions.

With these types of improvements, detection and treatment of sleep apnea can then become a standard target on the hospitalists’ radar.

–Rita McGauvran, CNP

Rapid City (S.D.) Regional Hospitalists

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