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In the hospital for heart failure? Get tested for sleep apnea

Physicians have warned for years about the connection between sleep apnea and heart failure — two dangerous conditions that can contribute to each other.

But one of the two, sleep apnea, often goes undiagnosed.

Sunil Sharma, a sleep medicine specialist at Einstein Medical Center Philadelphia, has a possible solution:  When patients are in the hospital with heart failure, screen them for the sleep disorder.

In a new study, Sharma and colleagues found that heart patients whose apnea was identified in the hospital were just as likely to stick with a treatment plan as those who were diagnosed with the sleep problem on an outpatient basis.

"It is very quickly crystallizing in our brains that this is a missed opportunity," Sharma said of heart-failure patients who are not tested for apnea. "The hospital is a great place for screening."

In obstructive apnea, the most common form of the disease, the person repeatedly stops breathing during the night due to relaxation of the muscles supporting the airway. In addition to interfering with sleep, the disease also deprives the body of oxygen. Physicians often prescribe a pump-like device called a CPAP, so named because it administers continuous positive airway pressure.

Previous research suggests that heart patients who get their apnea under control are less likely to require readmission to the hospital and may even live longer, said Sharma, program director of pulmonary and critical care medicine at Einstein.

In the new study, published in the Journal of Clinical Sleep Medicine, 132 likely apnea patients were identified through a two-step screening process: a questionnaire that asked about symptoms such as a daytime tiredness and snoring, followed by nighttime measurements of oxygen levels in the blood.

Upon further posthospital sleep testing, a final total of 81 agreed to try a CPAP device.

After three months, more than half of those were still using it. At six months, the number of patients who stuck with CPAP dropped to 37 percent, and at 12 months it was down to just 27 percent.

Not great, but about as good as patients who seek treatment for apnea the usual way, through outpatient clinic.

That had been Sharma's question. Would the in-hospital apnea screening be worth it, medically speaking?

That is, if patients come to a hospital seeking treatment for one disease, then learn they have something that may seem entirely unrelated, will they be motivated to deal with both problems when they go home?

"If you're not motivated, it's not going to help," he said.

But for a good portion of the heart-failure patients who discovered they had apnea, the answer was yes.

That may be because doctors and nurses had the time in the hospital to educate the heart patients about their added condition, Sharma said. And also because, while in the hospital, the patients were given a trial run on a CPAP device.

Future efforts will look at other options for patients who refuse the device, both those who are diagnosed inside the hospital and out. Alternative treatments include oral devices to keep the airway open and a new pacemaker-like device that stimulates a nerve governing the movement of certain airway muscles.

Sharma's study involved patients at Thomas Jefferson University Hospital, where he worked until September.

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