SEATTLE — Patients with heart failure or hypertension who answered “Yes” to at least two of three questions had a high likelihood of having obstructive sleep apnea, Cheryl L. Bartone reported in a poster presentation at the annual meeting of the Heart Failure Society of America.
She and associates compared responses to the screening questionnaire with polysomnography results in 70 outpatients with heart failure or hypertension seen at a cardiology office.
The three-question screening tool was 90% sensitive and 45% specific in detecting obstructive sleep apnea, said Ms. Bartone of the Ohio Heart and Vascular Center, Cincinnati.
The tool had a positive predictive value of 67% and a negative predictive value of 78%.
Patients were asked:
▸ Do you snore loudly?
▸ Do you wake up more than once a night?
▸ Do you have morning fatigue?
Polysomnograms showed that 67 patients had some degree of obstructive sleep apnea, defined as an apnea-hypopnea index of 5 or greater. The obstructive sleep apnea was considered significant in 39 patients who had moderate or severe obstructive sleep apnea, defined as an apnea-hypopnea index of 20 or greater.
Of the 52 patients who answered “Yes” to at least two questions, 32 had significant obstructive sleep apnea. Among the 18 patients who answered “Yes” to only one or none of the questions, 4 had significant obstructive sleep apnea.
Patients with significant obstructive sleep apnea were more likely to be on β-blockers than were those without significant obstructive sleep apnea (82% vs. 74%) and less likely to be on an ACE inhibitor or angiotensin receptor blocker (74% vs. 77%).
Obstructive sleep apnea is a significant contributor to morbidity and mortality in patients with heart failure or hypertension, the investigators said.
There is no other easily applicable screening tool for effective detection of obstructive sleep apnea in these patients, they added. The investigators have no financial conflicts of interest in the study.
The groups with and without significant obstructive sleep apnea did not differ by age, sex, left ventricular ejection fraction, weight, body mass index, or morning fatigue.