Patients evaluated for ventricular dysfunction (VD) and/or pulmonary artery hypertension (PAH) frequently have co-morbid conditions that impact cardiac function. Some of these are reversible when identified. Sleep disorder breathing (SDB) has been associated with both VD and PAH. Over fifty percent of patients with VD are known to have SDB. Treatment of SDB may reduce cardiovascular complications from these conditions. We hypothesized that patients with VD and/or PAH were not being routinely screened for SDB by Cardiologists.
A retrospective chart review was carried out on 100 randomly selected patients with VD (ejection fraction (EF) <45%) and/or PAH (systolic pulmonary artery pressure >40 mmHg), as documented by 2D echocardiograms between 06/01/01 to 06/30/02. Data collected: demographics, body mass index (BMI), and documentation of screening for SBD (nocturnal pulse oximetry, Epworth Sleepiness Score, and questions pertaining to the presence of SDB).
Ninety-six patients were seen by Cardiologists. Demographics: age 62 ± 17 years, gender 50% male, ethnicity 64% Caucasian / 29% African-American. Co-morbidities: 34% coronary artery disease, 61% hypertension, and 32% diabetes. Cardiac status: ejection fraction (EF) 27% ± 11%, systolic pulmonary artery pressure (SPAP) 46 ± 16 mmHg. Eighty-four of 89 patients with an EF < 45% and 43 of 47 patients with PAH were seen by Cardiologists. Weight: BMI 28±8 kg/m2, 30% with BMI > 30 kg/m2. Six individuals were screened for SDB and, of these, only 3 were screened by Cardiologists. Screening included nocturnal pulse oximetry in 3, polysomnography in 1 and history in 2. There were no statistically significant differences in BMI, EF or SPAP between those who were screened and those that were not screened.
Cardiologists do not appear to be routinely screening patients with VD and/or PAH for SDB.
The reason for this low rate of screening, in such a high-risk group, should be addressed, as the diagnosis and management of SDB could potentially result in a significant reduction in cardiovascular morbidity and mortality.
C.D. Southwell, None.