Abstract
Rationale: Sleep-disordered breathing (SDB) is highly prevalent in adults hospitalized with acute heart failure. Data are limited on the implications of inadvertent opiate use in this population.Objectives: To determine the prevalence and impact of in-hospital opiate use in adults hospitalized for acute heart failure.Methods: From a prospective sleep registry, we selected a sequential group of adult participants who were admitted to the hospital for acute heart failure and received a portable sleep study (PSS) after screening for SDB using the STOP-BANG questionnaire. A retrospective review of charts was performed to assess use of opiates, need for escalation of care (defined as transfer to the intensive care unit [ICU]), 30-day readmission, and length of stay. A logistic regression model was used to calculate propensity scores for each participant with a screening apnea-hypopnea index (AHI) greater than or equal to 10/h. Study endpoints, including escalation of care to the ICU and 30-day hospital readmission, were compared using a χ2 test with stabilized inverse probability-weighted propensity scores to control for potential confounding variables.Results: A total of 301 consecutive adults admitted with acute heart failure between November 2016 and October 2017 underwent PSS after SDB screening. Overall, 125 of 301 (41.5%) received opiates in the hospital, and 149 (49.5%) patients had an AHI greater than or equal to 10/h by PSS (high risk of SDB). In this high-risk group, 47 of 149 (32%) received opiates. Among those with an AHI greater than or equal to 10/h, escalation of care occurred in 12 of 47 (26%) of those who received opiates versus 4 of 102 (4%) of those who did not (P < 0.001; weighted estimate of treatment difference, 23.5%; 95% confidence interval [CI], 9.9 to 37.2). Similarly, readmission within 30 days occurred in 7 of 47 (15%) of those who received opiates versus 9 of 102 (9%) of those who did not (P = 0.14; weighted estimate of treatment difference, 8.3%; 95% CI, -4.0 to 20.6). Mean length of stay (days) did not differ between groups (P = 0.61; weighted estimate of treatment difference, -0.3 d; 95% CI, -1.4 to 0.8).Conclusions: In adults admitted with acute heart failure and found to be at high risk of SDB, opiate use in the hospital was highly prevalent and was associated with a greater likelihood of escalation of care.
Highlights
Sleep disordered breathing (SDB) is a highly prevalent disorder that is associated with significant cardiovascular mortality and morbidity [1,2,3,4]
We studied the prevalence of opiate use in patients admitted with acute heart failure who were identified as having SDB to determine whether opiate use adversely impacted escalation of care, 30-day readmission rates and length of stay
A total of 1511 consecutive adult participants admitted to the cardiology telemetry services at Einstein Medical Center, Philadelphia, PA with a history of congestive heart failure were screened for SDB using the STOP-BANG questionnaire from November 2016 through October 2017 as part of our standard of care clinical practice guidelines
Summary
Sleep disordered breathing (SDB) is a highly prevalent disorder that is associated with significant cardiovascular mortality and morbidity [1,2,3,4]. Recent data suggest that there is a high prevalence of SDB in patients admitted to the hospital with acute heart failure [5,6,7]. A recent retrospective study of congestive heart failure patients using opiates either on admission or at discharge did not find an increased readmission rate or mortality risk [16]. Opiates have been shown to induce or worsen central sleep apnea [20] Given these negative physiologic consequences of opiates, it is possible that their use in conjunction with undiagnosed SDB may be a factor contributing to adverse events in patients hospitalized with acute heart failure [21,22]. We hypothesized that administration of opiates in patients admitted for acute heart failure with undetected SDB may adversely impact patient outcomes during hospitalization.
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