title: Diagnosis and treatment of sleep disordered breathing in hospitalized cardiac patients: a reduction in 30-day hospital readmission rates.
abstract: 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.
  
  
  CONCLUSIONS
  A commentary on this article appears in this issue on page 1067.
authors.affiliation: Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Shilpa R
authors.initials: SR
authors.lastname: Kauta
authors.affiliation: Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Brendan T
authors.initials: BT
authors.lastname: Keenan
authors.affiliation: Department of Cardiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Lee
authors.initials: L
authors.lastname: Goldberg
authors.affiliation: Center for Sleep and Circadian Neurobiology, University of Pennsylvania, Philadelphia, PA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schwab
mesh_terms: D000704:Analysis of Variance; D045422:Continuous Positive Airway Pressure / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006331:Heart Diseases / Q000150:complications* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data*; D017286:Polysomnography / Q000379:methods; D012720:Severity of Illness Index; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
keywords: 30-day readmission rate; hospitalized patient testing; portable sleep studies; sleep disordered breathing