Outcomes of Admission Screening for Obstructive Sleep Apnea in Hospitalized Patients with Cardiovascular Disease

Abstract

The purpose of this literature review was to assess the prevalence and impact of undiagnosed obstructive sleep apnea (OSA) in patients admitted to the hospital with a cardiovascular diagnosis, and to assess whether the data support the use of an OSA screening tool.  An electronic data base literature search of English language publications between 2008 and 2013 was conducted.  Study findings supported the use of screening tools to identify hospitalized patients with acute coronary syndrome (ACS), atrial fibrillation (AF), heart failure (HF) and coronary artery disease requiring coronary artery bypass graft (CABG) at high risk for OSA.  In patients without a prior OSA diagnosis who were screened for OSA using the Berlin Questionnaire, rates for high probability of OSA were as high as 73.2% in patients hospitalized with ACS and 43.8% in patients with AF.  Prevalence rates for previously undiagnosed OSA in studies utilizing a formal sleep study were as high as 65.7% in patients hospitalized with ACS, and 62.5% in patients with acute decompensated heart failure.  Results also provided evidence of an increased rate of adverse hospital outcomes, including death, refractory unstable angina, bradycardia during percutaneous coronary intervention, residual ST-segment elevation and systolic retrograde flow after acute myocardial infarction, failed ablation for AF, and post-operative AF after CABG surgery, as well as long-term outcomes, such as death, reinfarction, stroke, unplanned target vessel revascularization, and HF in patients newly identified as having OSA compared to patients who were not identified as having OSA.  Among hospitalized patients with HF, results showed an improvement in heart function in patients who received in-hospital treatment for newly identified OSA compared to those who did not receive treatment.  Given the high prevalence of previously undiagnosed OSA in patients hospitalized for ACS, AF, and HF, and data suggesting OSA treatment improves hospital outcomes, it appears justified to include OSA screening as part of the nursing admission assessment in this patient population.  However, future studies are needed to confirm the advantages of in-hospital identification and treatment of previously undiagnosed OSA in relation to short-term hospitalization outcomes as well as long-term outcomes and cost-effectiveness.