住院心脏病患者睡眠呼吸障碍的诊断与治疗：30天再入院率的降低
Diagnosis and treatment of sleep disordered breathing in hospitalized cardiac patients: a reduction in 30-day hospital readmission rates.
作者信息
Kauta Shilpa R, Keenan Brendan T, Goldberg Lee, Schwab Richard J
机构信息
Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.
Department of Cardiology, University of Pennsylvania, Philadelphia, PA.
出版信息
J Clin Sleep Med. 2014 Oct 15;10(10):1051-9. doi: 10.5664/jcsm.4096.
BACKGROUND
Sleep disordered breathing (SDB) is associated with significant cardiovascular sequelae and positive airway pressure (PAP) has been shown to improve heart failure and prevent the recurrence of atrial fibrillation in cardiac patients with sleep apnea. Patients who are hospitalized with cardiac conditions frequently have witnessed symptoms of SDB but often do not have a diagnosis of sleep apnea. We implemented a clinical paradigm to perform unattended sleep studies and initiate treatment with PAP in hospitalized cardiac patients with symptoms consistent with SDB. We hypothesized that PAP adherence in cardiac patients with SDB would reduce readmission rates 30 days after discharge.
METHODS
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/ED 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 (AHI ≥ 5 events/h). Eighty percent (65/81) had predominantly obstructive sleep apnea, and 20% (16/81) had predominantly central sleep apnea. None of 19 patients (0%) with adequate PAP adherence, 6 of 20 (30%) with partial PAP use, and 5 of 17 (29%) of patients who did not use PAP were readmitted to the hospital or visited the emergency department (ED) for a cardiac issue within 30 days from discharge (p = 0.025).
CONCLUSIONS
Performing diagnostic unattended sleep studies and initiating PAP treatment in hospitalized cardiac patients was feasible and provided important clinical information. Our data indicate that hospital readmission and ED visits 30 days after discharge were significantly lower in patients with cardiac disease and SDB who adhered to PAP treatment than those who were not adherent.
COMMENTARY
A commentary on this article appears in this issue on page 1067.
背景
睡眠呼吸紊乱（SDB）与严重的心血管后遗症相关，且已证明持续气道正压通气（PAP）可改善心力衰竭并预防患有睡眠呼吸暂停的心脏病患者房颤复发。因心脏疾病住院的患者经常出现SDB症状，但往往未被诊断为睡眠呼吸暂停。我们实施了一种临床模式，对住院的有SDB相关症状的心脏病患者进行无人值守睡眠研究并启动PAP治疗。我们假设，患有SDB的心脏病患者坚持使用PAP可降低出院后30天的再入院率。
方法
对106例因心力衰竭、心律失常和心肌梗死住院且报告有SDB症状的连续心脏病患者进行评估。患者接受III型便携式睡眠研究，那些被诊断为睡眠呼吸暂停的患者开始使用PAP。收集人口统计学数据、SDB类型、PAP依从性以及关于30天内再次住院/急诊就诊的数据。
结果
106例患者中，104例使用便携式监测系统进行了确定性诊断研究。78%的患者（81/104）患有SDB（呼吸暂停低通气指数≥5次/小时）。80%（65/81）主要为阻塞性睡眠呼吸暂停，20%（16/81）主要为中枢性睡眠呼吸暂停。在出院后30天内，19例坚持充分使用PAP的患者中无一例（0%）因心脏问题再次住院或前往急诊科（ED），20例部分使用PAP的患者中有6例（30%），17例未使用PAP的患者中有5例（29%）（p = 0.025）。
结论
对住院心脏病患者进行无人值守诊断性睡眠研究并启动PAP治疗是可行的，并提供了重要的临床信息。我们的数据表明，患有心脏病和SDB且坚持PAP治疗的患者出院后30天的再次住院和急诊就诊率明显低于未坚持治疗的患者。
评论
关于本文的一篇评论发表在本期第1067页。
Zotero 插件