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Screening for sleep breathing disorder in patients with heart failure – 1 year multidisciplinary team experience
Session:
Comunicações Orais - Sessão 01 - Insuficiência Cardíaca: a clínica primeiro
Speaker:
Mariana Marçal
Congress:
CPC 2023
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mariana Marçal; Vânia Caldeira; Sara Gonçalves; Catarina Rijo; Margarida Castanho; Paula Duarte
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction </strong>Sleep breathing disorders (SBD) are a spectrum of diseases, including obstructive sleep apnea (SA), central SA and sleep-related hypoventilation. SBD are highly prevalent (48-81%) and associated with adverse outcomes in patients with heart failure (HF), including symptom progression, hospitalization and mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aims</strong> To improve awareness and increase diagnosis of SBD in HF patients (pts), estimate prevalence and test the correlation between overnight pulse oximetry (OPO) and home sleep apnea testing (HSAT).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong> Screening of SBD was implemented in pts with recently diagnosed HF and followed by a multidisciplinary HF team. The screening consisted of a survey of symptoms, arterial blood gas sampling (ABGS) and OPO. Pts who had 2 positive answers, oxygen dessaturation index (ODI) > 5/h or <5/h with symptoms/comorbidities, SpO2 time < 90% greater than 20% of total recording or changes in ABGS (HCO<sub>3</sub> > 27, pCO2 > 45 or pO2 <60) were submitted to HSAT and pulmonology evaluation. Descriptive retrospective analysis of data regarding pts identified between January and November 2022 was carried out. Statistical analysis was performed with IBM SPSS Statistics 27. Pearson’s correlation coefficient was used to assess the correlation between ODI in OPO and apnea-hypopnea index (AHI) in HSAT.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results </strong>During this period, 37 pts met the referral criteria (81.1% male, mean age 65.7 ± 12.3 years). Most pts had ischaemic HF (n=12; 34,3%), NYHA=2 (n=20; 54,1%) or ≥ 3 (n=10; 27%), 47.2% with reduced ejection fraction (EF) (n=17) and 30,6% with mildly reduced EF (n=11); main comorbidities were dyslipidemia (n=32; 86.5%), hypertension (n=30; 81.1%), smoking (n=26; 70.2%) and obesity (n=22; 59.4%).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">All pts who underwent a HSAT after positive SBD screening were diagnosed with SA (n=33; 89.2%) and started positive airway pressure therapy, the majority of them with severe disease (n=15; 40.5%; mean AHI 30.9 ± 15.2 events/h) and obstructive events (n=30; 81%). 4 pts are waiting for the HSAT. The ODI values showed a moderate positive correlation with the AHI (r=0.699; p=0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion </strong>The high prevalence of SBD in pts with HF, coupled with evidence of improved HF outcomes after SBD treatment, provides a rationale for SBD screening. OPO seems to have a high sensitivity for screening SA in patients with HF and a high pre-test probability of SBD. However, confirmation of suspected diagnosis through HSAT, essential in grading and characterization of SBD, remains necessary.</span></span></p>
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