CHEST/127/5/MAY, 2005
Frederic Series, MD; R. John Kimoff, MD; Debra Morrison, MD; Marie Hene Levlanc, MD; Mark Smilovitch, MD; Jonathan Howlett, MD; Alenander G. Logan, MD; John S. Floras, MD; and T. Douglas Bradley, MD
Because patients with chronic heart failure (CHF) can benefit from specific treatment for coexisting obstructive (OSA) and central sleep apnea (CSA), there is need to develop accurate screening tools to identify or exclude these sleep-related breathing disturbances (SRBDs) in patients with CHF.
The primary aims of the present study were to evaluate the diagnostic value of nocturnal oximetry in the identification of SRBDs in CHF patients, and to compare its reliability during home and laboratory recordings. As a secondary end point, we also evaluated whether CSA and OSA can be reliably distinguished based on the evaluation of the SpO2 desaturation-resaturation pattern.
Discussion
The present results establish that overnight home oximetry is a reliable tool to screen for the presence of SRBDs in patients with CHF. Presently, owing to the limited awareness of SRBDs among physicians caring for patients with CHF, as well as limited access to, and the relatively high cost of in-laboratory polysomnography, only a minority of CHF patients benefit form the diagnosis and treatment of SRBDs. Home oximetry therefore provides a readily available, inexpensive means of detecting SRBDs in these patients. Although it does not rule out OSA in the presence of symmetrical SpO2 fluctuations, a positive oximetry recording would assist in prioritizing patients for full polysomnography based on the severity of their SRBD. In this way, many more CHF patients may benefit from the timely diagnosis and treatment of SRBD than might otherwise be the case.
