Sleep-disordered breathing exacerbates obesity, stroke, COPD and heart failure—some of the most prevalent conditions in Appalachia.
Traditionally, healthcare providers have handled sleep-disordered breathing—a condition that affects more than 1 billion people worldwide—on an outpatient basis, but a new sleep medicine program at West Virginia University suggests that addressing the problem in a hospital setting can be more effective.
“When it comes to sleep-disordered breathing, especially in hospitalized patients with congestive heart failure or COPD, we are talking about a very high prevalence rate of 50-70%,” said Sunil Sharma, chief of WVU’s pulmonary, critical care and sleep medicine section, who led the program. “It is almost like the flip of a coin. Chances are one in two that any given heart failure patient has sleep-disordered breathing without knowing it. We are not looking for a needle in a haystack. We are looking at a disease that is staring us in the face, and we do not recognize it.”
As part of the program, Sharma and his team created a novel two-tier screening process for patients. The process included a questionnaire to identify patients at high risk for sleep-disordered breathing. Healthcare providers also used pulse-oxygen-monitor readings to confirm the questionnaire’s results.
To prove that the screening worked, patients deemed to be high risk underwent polysomnography—a gold-standard diagnostic test for sleep-disordered breathing—48 hours after their hospital discharge. The predictive value was found to be over 90%.
The questionnaire alone accurately predicted a sleep-disordered breathing diagnosis only 60-65% of the time; however, in this study, more than 90% of patients screened by high-resolution pulse oxygen monitor and sent for polysomnography were shown to have the underlying condition, validating the screening process.
The program also identified reduced hospital readmission as a benefit of early diagnosis and treatment of sleep-disordered breathing. Many patients admitted to the hospital for stroke, COPD and heart disease had underlying sleep-disordered breathing and were readmitted less when it was treated in the hospital.
The program’s structure and outcome data will be published in the journal CHEST.
“Not surprisingly, people with congestive heart failure—or CHF—who were diagnosed early and started on treatment for a sleep apnea had a greatly reduced readmission rate, lasting almost six months,” Sharma said. “It was not just a short-term gain; it seemed like we were changing the natural progression of the disease.”
The WVU hospital sleep medicine program is the first of its kind and is being replicated in other hospitals.
Sharma and his team are now focusing on researching the program’s use in rural communities, as he believes patients in rural locations are uniquely at risk for late or missed diagnosis of sleep-disordered breathing.
“Rural communities probably need this program even more than urban communities,” he said. “Some people in rural communities do not have a primary care doctor, due to financial or access reasons, and the first time they ever see a doctor is when they get admitted to the hospital.”
Based on the results of WVU’s sleep medicine program, the American Academy of Sleep Medicine has set up a task force on inpatient sleep-disordered breathing. Sharma is a member of the task force and says the data collected from implementation of programs across the country will allow them to provide national-level guidance and recommendations.
“When the barriers to early detection and treatment of sleep-disordered breathing are removed, the patient, the hospital and the community all benefit,” Sharma said. “And I think that is why our program at WVU is such a game changer for this disease.”