WVU study targets undiagnosed sleep disorder

Sleep disordered breathing can cause cardiovascular conditions with fatal implications. To provide critical treatment, West Virginia University School of Medicine faculty members recently conducted a study on hospitalized patients identified as at-risk for the often unrecognized condition.

“It is important to diagnosis and treat sleep disordered breathing because it is a serious condition that is strongly associated with heart attacks, strokes and chronic obstructive pulmonary disease,” said Sunil Sharma, professor and Department of Medicine section chief for Pulmonary Critical Care and Sleep Medicine. “Patients who do not receive sleep disordered breathing treatment often get readmitted to the hospital for other conditions.”

Sharma started a hospital screening program for sleep disordered breathing at WVU Medicine for patients that were admitted in the hospital for acute cardiovascular and cardiopulmonary conditions. It is common for the sleep disordered breathing to be underdiagnosed and unrecognized in this cohort of patients.

The study’s screening program also included a treatment plan to be continued when patients were discharged from the hospital. The goals of the study were to see how many patients accepted the treatment while in the hospital and how compliant patients were to treatment when they returned home.

“We found that 73% of patients determined to be at high risk for obstructive sleep apnea were compliant in the hospital with the use of automatic positive airway pressure machines,” Sharma said. “It was important to educate the patients on understanding the link between sleep disordered breathing and the reason they were admitted to the hospital, whether it be a heart attack or stroke. We also wanted to see once patients were discharged, how would they adhere at home with a continuous positive airway pressure machine. We found that patients who were compliant in the hospital showed high compliance at home.

“We found that you need to first screen, educate and treat these patients while they are in the hospital because they are more likely to get used to the continuous positive airway pressure machine and any troubleshooting can be done while they are in the hospital under care,” Sharma said. “These patients will start to see the link between the condition they were originally admitted for and their sleep disordered breathing because their breathing may get better.”

West Virginia has the highest rate of obesity in the United States, which is the strongest link to sleep disordered breathing. Sleep disordered breathing can lead to heart failure, stroke, arrythmia in addition to other cardio-pulmonary conditions. If patients are aware of the connection between these two conditions, then they can alert their doctor and complete a simple test to determine if they have sleep disordered breathing.

In this study, a sleep disorder was diagnosed through a questionnaire. Following diagnosis, an overnight oxygen test was administered to monitor a patient’s breathing habits to determine severity, including how often they quit breathing during the night. Patients were then sent to an outpatient sleep lab to undergo a polysomnography, a type of sleep study, which is the gold standard for diagnosing sleep disordered breathing, explained Sharma.

“We should not be waiting until someone has a heart attack or stroke to diagnose sleep disordered breathing, everyone should be cognizant of this condition,” Sharma said. “The sooner it is recognized and treated, the less likely a person will be to have complications from this condition. I think screening and spreading awareness of sleep disordered breathing is a vital part of this effort.”

When a patient treats their sleep disordered breathing it will improve other health outcomes. An immediate improvement that patients will recognize is better sleep, including waking up less frequently during the night and fewer instances of not breathing due to airway collapse.

“Our research shows that patients with heart failure and emphysema get readmitted less to the hospital, and this is a big benefit medically, because it means the underlying condition is improving,” said Sharma.

WVU Medicine is the first hospital to analyze the impact of inpatient automatic positive airway pressure machines on post-discharge compliance. WVU Medicine is among the first to implement screening for sleep disordered breathing in hospitalized patients using the screening process Sharma and his team developed. The American Academy of Sleep Medicine has created a task force for hospital sleep medicine screening to analyze the data generated by by physicians nationwide.

“Being the first hospital to use this screening process is great for WVU because we want to be on the cutting edge for technology and science,” Sharma said. “The biggest benefit is for our own patients because we know that our state has the heaviest burden for sleep disordered breathing. Through this research, we can help our patients, our communities and our state.”

For more information on the Department of Medicine, visit medicine.wvu.edu/medicine.