title: Photoplethysmographic Signal to Screen Sleep-Disordered Breathing in Hospitalized Heart Failure Patients: Feasibility of a Prospective Clinical Pathway.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the plethysmographic signal-derived oxygen desaturation index (ODI) as an inpatient screening strategy to identify sleep-disordered breathing (SDB) in patients with congestive heart failure (CHF).
  
  
  BACKGROUND
  SDB is highly prevalent among patients hospitalized with CHF but is widely underdiagnosed. We evaluated overnight photoplethysmography as a possible screening strategy for hospitalized patients with CHF.
  
  
  METHODS
  Consecutively admitted heart failure patients with high clinical suspicion of SDB and ODI ≥5 were offered outpatient polysomnography (PSG), which was completed within 4 weeks of discharge. PSG was considered positive if the apnea hypoxia index (AHI) was ≥5. A Bland-Altman plot was used to assess agreement between ODI and AHI. Receiver-operator characteristics were determined for ODI ≥5 and AHI ≥5.
  
  
  RESULTS
  A screening questionnaire identified 246 of 282 consecutive patients with positive symptoms for SDB. Of these patients, 105 patients were offered further evaluation and 86 had ODI ≥5 (mean ODI 17 ± 17). Among these 86 patients, 68 underwent outpatient PSG within 4 weeks of discharge. PSG showed that 64 (94%) had SDB, with a mean AHI of 28. Inpatient ODI correlated well with PSG-derived AHI. The area under the curve was 0.82 for AHI ≥5. The Bland-Altman plot revealed no major bias. Matthew's correlation coefficient revealed that the optimal cut-off for ODI is 5.
  
  
  CONCLUSIONS
  Screening hospitalized patients with heart failure using targeted inpatient ODI identifies a cohort of patients with a high prevalence of SDB. Our screening strategy provides a potentially cost-effective method for early detection and treatment of SDB.
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania. Electronic address: Sunil.Sharma@jefferson.edu.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania.
authors.forename: Paul
authors.initials: P
authors.lastname: Mather
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania; East Carolina University, Greenville, North Carolina.
authors.forename: Jimmy T
authors.initials: JT
authors.lastname: Efird
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania.
authors.forename: Daron
authors.initials: D
authors.lastname: Kahn
authors.affiliation: Jefferson General Hospital, New Orleans, Louisiana.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Cheema
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania.
authors.forename: Sharon
authors.initials: S
authors.lastname: Rubin
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania.
authors.forename: Gordon
authors.initials: G
authors.lastname: Reeves
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania.
authors.forename: Raphael
authors.initials: R
authors.lastname: Bonita
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania.
authors.forename: Raymond
authors.initials: R
authors.lastname: Malloy
authors.affiliation: Thomas Jefferson University and Hospitals, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Whellan
mesh_terms: D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D010991:Plethysmography / Q000379:methods*; D017286:Polysomnography; D011446:Prospective Studies; D012891:Sleep Apnea Syndromes / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires
keywords: acute decompensated heart failure; hospitalized patients; oxygen desaturation index; plethysmography; sleep-disordered breathing