Central Sleep Apnea is a Predictor of Cardiac Readmission in Hospitalized Patients with Systolic Heart Failure

Overview

Journal J Card Fail

Specialty Cardiology & Vascular Diseases

Date 2012 Jul 4

PMID 22748486

Citations 52

Authors

Rami Khayat

William Abraham

Brian Patt

Vincent Brinkman

Jacob Wannemacher

Kyle Porter

David Jarjoura

Affiliations

Soon will be listed here.

Abstract

Background: Hospitalized heart failure patients have a high readmission rate. We sought to determine the independent risk due to central sleep apnea (CSA) of readmission in patients with systolic heart failure (SHF).

Methods And Results: This was a prospective observational cohort study of hospitalized patients with SHF. Patients underwent sleep studies during their hospitalization and were followed for 6 months to determine their rate of cardiac readmissions; 784 consecutive patients were included; 165 patients had CSA and 139 had no sleep-disordered breathing (SDB); the remainder had obstructive sleep apnea (OSA). The rate ratio for 6 months' cardiac readmissions was 1.53 (95% confidence interval 1.1-2.2; P = .03) in CSA patients compared with no SDB. This rate ratio was adjusted for systolic function, type of cardiomyopathy, age, weight, sex, diabetes, coronary disease, length of stay, admission sodium, creatinine, hemoglobin, blood pressure, and discharge medications. Severe OSA was also an independent predictor of readmissions with an adjusted rate ratio of 1.49 (P = .04).

Conclusion: In this first evaluation of the impact of SDB on cardiac readmissions in heart failure, CSA was an independent risk factor for 6 months' cardiac readmissions. The effect size of CSA exceeded that of all known predictors of heart failure readmissions.

Citing Articles

Association between hypoxemia and quality of life in patients with heart failure with preserved ejection fraction and sleep-disordered breathing.

Sawatari H, Magota C, Kadokami T, Nakamura R, Hayashi A, Ando S Sleep Biol Rhythms. 2025; 23(1):85-93.

PMID: 39801938 PMC: 11718018. DOI: 10.1007/s41105-024-00554-9.

Identification of Pre-Heart Failure in Early Stages: The Role of Six Stages of Heart Failure.

Jankajova M, Singh R, Hristova K, Elkilany G, Fatima G, Singh J Diagnostics (Basel). 2024; 14(23).

PMID: 39682527 PMC: 11640183. DOI: 10.3390/diagnostics14232618.

Win ratio analysis of transvenous phrenic nerve stimulation to treat central sleep apnoea in heart failure.

Abraham W, Oldenburg O, Lainscak M, Khayat R, Asin J, Ponikowski P ESC Heart Fail. 2024; 12(1):80-86.

PMID: 39422417 PMC: 11769632. DOI: 10.1002/ehf2.15074.

[Arrhythmia in sleep apnea].

Gamer A, Grebmer C Herzschrittmacherther Elektrophysiol. 2024; 35(3):193-198.

PMID: 39110174 DOI: 10.1007/s00399-024-01031-z.

Early recognition and treatment of OSA in hospitalized patients and its impact on health care utilization in rural population: a real-world study.

Sharma S, Stansbury R, Srinivasan P, Rojas E, Quan S, Olgers K J Clin Sleep Med. 2024; 20(8):1313-1319.

PMID: 38557651 PMC: 11294130. DOI: 10.5664/jcsm.11146.

References

Bradley T, Logan A, Kimoff R, Series F, Morrison D, Ferguson K . Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2005; 353(19):2025-33. DOI: 10.1056/NEJMoa051001. View

OConnor C, Hasselblad V, Mehta R, Tasissa G, Califf R, Fiuzat M . Triage after hospitalization with advanced heart failure: the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) risk model and discharge score. J Am Coll Cardiol. 2010; 55(9):872-8. PMC: 3835158. DOI: 10.1016/j.jacc.2009.08.083. View

Barker W, Mullooly J, Getchell W . Changing incidence and survival for heart failure in a well-defined older population, 1970-1974 and 1990-1994. Circulation. 2006; 113(6):799-805. DOI: 10.1161/CIRCULATIONAHA.104.492033. View

From A, Leibson C, Bursi F, Redfield M, Weston S, Jacobsen S . Diabetes in heart failure: prevalence and impact on outcome in the population. Am J Med. 2006; 119(7):591-9. DOI: 10.1016/j.amjmed.2006.05.024. View

Yoshihisa A, Shimizu T, Owada T, Nakamura Y, Iwaya S, Yamauchi H . Adaptive servo ventilation improves cardiac dysfunction and prognosis in chronic heart failure patients with Cheyne-Stokes respiration. Int Heart J. 2011; 52(4):218-23. DOI: 10.1536/ihj.52.218. View

Leung R, Diep T, Bowman M, Lorenzi-Filho G, Bradley T . Provocation of ventricular ectopy by cheyne-stokes respiration in patients with heart failure. Sleep. 2004; 27(7):1337-43. DOI: 10.1093/sleep/27.7.1337. View

Fonarow G, Abraham W, Albert N, Stough W, Gheorghiade M, Greenberg B . Factors identified as precipitating hospital admissions for heart failure and clinical outcomes: findings from OPTIMIZE-HF. Arch Intern Med. 2008; 168(8):847-54. DOI: 10.1001/archinte.168.8.847. View

MacCarthy P, Shah A . Impaired endothelium-dependent regulation of ventricular relaxation in pressure-overload cardiac hypertrophy. Circulation. 2000; 101(15):1854-60. DOI: 10.1161/01.cir.101.15.1854. View

Jencks S, Williams M, Coleman E . Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009; 360(14):1418-28. DOI: 10.1056/NEJMsa0803563. View

10.

Paulino A, Damy T, Margarit L, Stoica M, Deswarte G, Khouri L . Prevalence of sleep-disordered breathing in a 316-patient French cohort of stable congestive heart failure. Arch Cardiovasc Dis. 2009; 102(3):169-75. DOI: 10.1016/j.acvd.2008.12.006. View

11.

Javaheri S, Caref E, Chen E, Tong K, Abraham W . Sleep apnea testing and outcomes in a large cohort of Medicare beneficiaries with newly diagnosed heart failure. Am J Respir Crit Care Med. 2010; 183(4):539-46. DOI: 10.1164/rccm.201003-0406OC. View

12.

Collop N, Anderson W, Boehlecke B, Claman D, Goldberg R, Gottlieb D . Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2008; 3(7):737-47. PMC: 2556918. View

13.

Teschler H, Dohring J, Wang Y . Adaptive pressure support servo-ventilation: a novel treatment for Cheyne-Stokes respiration in heart failure. Am J Respir Crit Care Med. 2001; 164(4):614-9. DOI: 10.1164/ajrccm.164.4.9908114. View

14.

Santos-Silva R, Sartori D, Truksinas V, Truksinas E, Alonso F, Tufik S . Validation of a portable monitoring system for the diagnosis of obstructive sleep apnea syndrome. Sleep. 2009; 32(5):629-36. PMC: 2675898. DOI: 10.1093/sleep/32.5.629. View

15.

Muzzarelli S, Leibundgut G, Maeder M, Rickli H, Handschin R, Gutmann M . Predictors of early readmission or death in elderly patients with heart failure. Am Heart J. 2010; 160(2):308-14. DOI: 10.1016/j.ahj.2010.05.007. View

16.

OConnor C, Abraham W, Albert N, Clare R, Stough W, Gheorghiade M . Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J. 2008; 156(4):662-73. DOI: 10.1016/j.ahj.2008.04.030. View

17.

Fonarow G . The relationship between body mass index and mortality in patients hospitalized with acute decompensated heart failure. Am Heart J. 2007; 154(5):e21. DOI: 10.1016/j.ahj.2007.07.043. View

18.

Abraham W, Fonarow G, Albert N, Stough W, Gheorghiade M, Greenberg B . Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol. 2008; 52(5):347-56. DOI: 10.1016/j.jacc.2008.04.028. View

19.

Xie A, Skatrud J, Khayat R, Dempsey J, Morgan B, Russell D . Cerebrovascular response to carbon dioxide in patients with congestive heart failure. Am J Respir Crit Care Med. 2005; 172(3):371-8. DOI: 10.1164/rccm.200406-807OC. View

20.

Javaheri S, Parker T, Liming J, Corbett W, Nishiyama H, Wexler L . Sleep apnea in 81 ambulatory male patients with stable heart failure. Types and their prevalences, consequences, and presentations. Circulation. 1998; 97(21):2154-9. DOI: 10.1161/01.cir.97.21.2154. View