Photoplethysmographic Signal to Screen聽Sleep-Disordered Breathing in聽Hospitalized Heart Failure Patients: Feasibility of a Prospective Clinical Pathway

详细信息    查看全文

• 作者：Sunil Sharma ; MD^&lowast ; ; ^{Sunil.Sharma@jefferson.edu" class="auth_mail" title="E-mail the corresponding author} ; Paul Mather ; MD^&lowast ; ; Jimmy T. Efird ; PhD^&lowast ; ; ^&dagger ; ; Daron Kahn ; MD^&lowast ; ; Mohammed Cheema ; MD^&Dagger ; ; Sharon Rubin ; MD^&lowast ; ; Gordon Reeves ; MD^&lowast ; ; Raphael Bonita ; MD^&lowast ; ; Raymond Malloy ; MS^&lowast ; ; David J. Whellan ; MD^&lowast ;
• 关键词：acute decompensated heart failure ; hospitalized patients ; oxygen desaturation index ; plethysmography ; sleep-disordered breathing
• 刊名：JACC: Heart Failure
• 出版年：2015
• 出版时间：September 2015
• 年：2015
• 卷：3
• 期：9
• 页码：725-731
• 全文大小：530 K

文摘

The purpose of this study was to evaluate the plethysmographic signal-derived oxygen desaturation index (ODI) as an inpatient screening strategy to identify sleep-disordered breathing (SDB) in patients with congestive heart failure (CHF).

Background

SDB is highly prevalent among patients hospitalized with CHF but is widely underdiagnosed. We evaluated overnight photoplethysmography as a possible screening strategy for hospitalized patients with CHF.

Methods

Consecutively admitted heart failure patients with high clinical suspicion of SDB and ODI ≥5 were offered outpatient polysomnography (PSG), which was completed within 4 weeks of discharge. PSG was considered positive if the apnea hypoxia index (AHI) was ≥5. A Bland-Altman plot was used to assess agreement between ODI and AHI. Receiver-operator characteristics were determined for ODI ≥5 and AHI ≥5.

Results

A screening questionnaire identified 246 of 282 consecutive patients with positive symptoms for SDB. Of these patients, 105 patients were offered further evaluation and 86 had ODI ≥5 (mean ODI 17 ± 17). Among these 86 patients, 68 underwent outpatient PSG within 4 weeks of discharge. PSG showed that 64 (94%) had SDB, with a mean AHI of 28. Inpatient ODI correlated well with PSG-derived AHI. The area under the curve was 0.82 for AHI ≥5. The Bland-Altman plot revealed no major bias. Matthew’s correlation coefficient revealed that the optimal cut-off for ODI is 5.

Conclusions

Screening hospitalized patients with heart failure using targeted inpatient ODI identifies a cohort of patients with a high prevalence of SDB. Our screening strategy provides a potentially cost-effective method for early detection and treatment of SDB.