0490 UTILITY OF TYPE 3 PORTABLE MONITORING FOR DIAGNOSIS OF SLEEP APNEA IN ACUTE DECOMPENSATED HEART FAILURE

Abstract

Sleep-disordered breathing (SDB) is a highly prevalent condition affecting up to 70% of patients with congestive heart failure (CHF). Treatment of SDB in CHF has been shown to improve LV function and transplant-free survival. Unfortunately, 80–90% of CHF patients with SDB remain undiagnosed. Portable sleep monitoring has significantly reduced the inconvenience of diagnosing SDB and may be of value in diagnosing SDB in patients admitted for acute decompensated heart failure (ADHF). The overall objective of this study was to examine whether type 3 portable monitoring can be used for diagnosis SDB in patients with ADHF. A cross-sectional study of patients admitted with ADHF to the general medicine and heart failure services at the Johns Hopkins Medical Institutions was conducted. A full-montage unattended polysomnogram (type 2) was conducted using the MPR sleep monitor (Natus Medical; San Carlos, CA). Concurrently, a type 3 portable monitor (Apnealink Plus;Resmed) was used on the same night to collect data on oximetry, nasal airflow, and effort. Scoring of the sleep data from both portable monitors (type 2 and 3) was conducted in a blinded fashion according to standard criteria using 3% and 4% oxyhemoglobin desaturation for defining hypopneas. Agreement between the two monitors was assessed using Pearson’s correlation coefficient and Bland-Altman analysis. The study sample consisted of 43 patients with ADHF and a mean age of 58.9 years (SD: 11.6). Men constituted 55.8% of the sample. The average apnea-hypopnea index (AHI) was 34.5 events/hr (Range: 2.5–92.8). The correlation between the oxygen desaturation index (ODI) between the type 2 and 3 portable monitors was high (r=0.88, p<0.001). Similarly, the overall AHI values derived from the two portable monitors were also highly correlated (r =0.74, p<0.001). Comparison of the obstructive and central AHI values from the two portable monitors revealed a high level of agreement. Severity of SDB and assessing the distribution of events are comparable when comparing type 2 and 3 portable monitors in patients admitted with ADHF. Use of a type 3 portable monitor can identify SDB in a majority of patients with ADHF. The American Sleep Medicine Foundation.