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Medline ® Abstract for Reference 45

of 'Sleep disorders in hospitalized adults: Evaluation and management'

Very early screening for sleep-disordered breathing in acute coronary syndrome in patients without acute heart failure.
Van den Broecke S, Jobard O, Montalescot G, Bruyneel M, Ninane V, Arnulf I, Similowski T, Attali V
Sleep Med. 2014 Dec;15(12):1539-46. Epub 2014 Aug 26.
BACKGROUND: Obstructive sleep apnea (OSA) is frequently associated with acute coronary syndrome (ACS). Screening of sleep-disordered breathing (SDB) has not been previously evaluated in ACS within 72 h in intensive care settings and its management could potentially enhance patients' prognosis. This pilot study assessed the feasibility of SDB screening at the early phase of ACS.
METHODS: All consecutive patients admitted to the coronary care unit (CCU) for ACS without acute heart failure underwent one overnight-attended polysomnography (PSG) within 72 h after admission. A telemonitoring (TM) system was set up to remotely monitor the signals and repair faulty sensors. The 27 recordings were analyzed as respiratory polygraphy (RP) and as PSG, and the results were compared.
RESULTS: The TM system allowed successful intervention in 48% of recordings, resulting in excellent quality PSG for 89% of cases. The prevalence of SDB [apnea-hypopnea index (AHI) ≥ 15/h]was 82% and mainly consisted of central SDB and periodic breathing, except three patients with OSA. Compared with PSG, RP underestimated AHI, probably due to the poor sleep efficiency, reduction of slow-wave sleep, and alteration of rapid eye movement sleep.
CONCLUSION: An early SDB screening by remote-attended PSG is feasible in ACS patients shortly after admission to CCU. The TM enhanced the quality of PSG. A high prevalence of central SDB was noticed, for which the etiology remains unknown. Further large-scale studies are needed to determine whether central SDB is an incidental finding in early ACS and whether the presence and severity of SDB have a prognostic impact.
AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service des Pathologies du Sommeil, Paris, France; Service de Pneumologie, CHU St Pierre, UniversitéLibre de Bruxelles, Brussels, Belgium. Electronic address: sandra_vandenbroecke@stpierre-bru.be.