Abstract 3805: Is There a Better Way to Screen for Sleep Disordered Breathing in Adults With Heart Failure?
Sleep disordered breathing (SDB) is common in heart failure (HF), yet fewer than half of expert providers routinely refer HF patients for screening. One reason may be that few adults with HF report feeling sleepy; a complaint of excessive daytime sleepiness (EDS) is the primary stimulus for referral. In other populations, an Epworth Sleepiness Scale (ESS) score ≥11 is a useful measure of EDS. But in HF, ESS scores are rarely that high, suggesting the need for other ways of identifying adults with HF needing testing for SDB. The purpose of this study was to identify the best method of screening for EDS in adults with HF. Objective sleepiness, using lapses on a 10-minute psychomotor vigilance task (PVT), was the gold-standard.
Methods: Baseline data from adults with HF participating in a prospective cohort study were used to determine which of 3 measures of sleepiness was best for identifying EDS. Those with confirmed stage C HF were included, excluding major depression, significant dementia, severe renal failure, night shift work, terminal illness, recent drug or alcohol abuse. To measure EDS, in addition to PVT, behavioral sleepiness was measured using the ESS. State sleepiness was measured using the Stanford Sleepiness Scale (SSS) and a 10-point Likert scale (1 not sleepy, 10 very sleepy). Responses were categorized as EDS or not using established cut-points. The percentage of subjects with EDS was calculated for each measure.
Results: The sample of 179 was 34.5% female, 37.4% African American, mean age 63.2±12.9 years. Most (66.5%) had systolic HF, most (77.1%) were NYHA class III/IV, 99.4% was under the routine care of a cardiologist or HF specialist, 55 (30.7%) had SDB but only 14 (25.7%) used CPAP. On PVT (cut-point ≥2 lapses), 64.8% were sleepy. On the SSS, using a cut-point ≥4, only 6.1% were sleepy. On the Likert scale, using a cut-point ≥6, 29.1% were sleepy. On the ESS, using a cut-point of ≥11, 24.6% were sleepy (40.6% congruence of scores) but when a cut-point of ≥6 was used, 58.1% were sleepy (71.2% congruence).
Conclusion: A large proportion of patients are objectively sleepy on PVT but only the ESS with a cut-point of ≥6 was able to discern EDS in this sample. At clinic visits, adults with HF should routinely complete the ESS and be referred for testing for a score ≥6.