Effects of Treating Sleep Apnea in Patients With Congestive Heart Failure

Study Overview
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Brief Summary
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Patients with Congestive Heart Failure (CHF) on non-Intensive Care Unit medical services and/or visiting our outpatient Congestive Heart Failure Clinic will be screened using the STOP-BANG Scoring Model. (STOP-BANG stands for Snoring, Tiredness, Observed Apnea, Blood Pressure, Body Mass Index, Age, Neck Circumference, Gender.) Patients with high risk of Obstructive Sleep Apnea (OSA) will be referred for evaluation and treatment of Sleep Apnea. They will be followed to determine if treatment of Sleep Apnea improves their quality of life and decreases their utilization of the Hospital and Emergency Department (ED).

Detailed Description
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Patients with Congestive Heart Failure on non-Intensive Care Unit Medical Services and/or visiting our outpatient Congestive Heart Failure clinic will be screened using the STOP-BANG Scoring Model. Patients with high risk of Obstructive Sleep Apnea will be referred to the Sleep Center physicians for evaluation and treatment. Patients will be followed for one year to determine if the treatment for Sleep Apnea improves their Quality of Life and decreases Hospital and Emergency Department utilization.

Official Title
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Effects of Treating Sleep Apnea in Patients With Congestive Heart Failure

Conditions
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Obstructive Sleep Apnea, Sleep Apnea, Congestive Heart Failure, Heart Failure

Intervention / Treatment
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* Other: STOP-BANG Scoring Model
* Other: Polysomnogram Sleep Study


Participation Criteria
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Eligibility Criteria
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Inclusion criteria: Patient has: CHF (systolic, diastolic, any etiology), or Normal Ejection Fraction (EF) and most recent: Age less than 50: N-Terminal Pro Brain Natriuretic Peptide (NTPBNP) > 400, Age 50 and older: NTPBNP > 750, If no NTPBNP done: then Brain Natriuretic Peptide (BNP) > 200 (some newly referred patients will only have this available at their first visit, or Normal EF, no BNP done, and CHF documented in History or Problem List Admitted to the Hospital Medicine service, General Medicine Teaching service, Medicine Cardiology Team (MCT) service, Heart Failure service, or Community Health and Family Medicine (CHFM) service, OR Patient of the Congestive Heart Failure Clinic Patient has had at least 2 encounters (hospital inpatient admission, hospital observation admission, or ED visit) with University of Florida (UF) Health during the 12-month period immediately prior to the current admission (not including the current admission). English Speaking Males & Females Age 18 to 110 Agreement to return to Gainesville for regular follow-up visits Exclusion criteria: Decisionally impaired, cognitively impaired, or demented patient who has a surrogate, proxy, or guardian Current Drug/Alcohol abuse as evidenced by a) positive urine toxicology screen for cocaine or amphetamines during current admission, b) positive blood alcohol level upon admission, or c) documentation by current providers of continued abuse of alcohol or drugs Previous diagnosis of sleep apnea and on current treatment Uncontrolled Ventricular Dysrhythmias; sustained episodes of ventricular tachycardia or ventricular fibrillation in the hospital Evidence of current ischemia evidenced by elevated Troponin unrelated to Chronic Kidney Disease, or < 6 weeks since Myocardial Infarction (MI) Palliative care or Life expectancy < 6 months Isolated Cor Pulmonale - predominantly right ventricular dysfunction, Right Ventricular Systolic Pressure (RVSP) >50 and/or on the following medications for pulmonary hypertension: sildenafil (Viagra®), tadalafil (Adcirca®, Cialis®), IV or sub-cutaneous (SC) treprostinil (Remodulin®; Tyvaso™), ambrisentan (Letairis®), bosentan (Tracleer®), IV epoprostenol, inhaled iloprost (Ventavis®) On 5 liters or greater of O2 Self-Pay Status Known Pregnancy Vulnerable Subjects such as prisoners, decisionally impaired/comatose individuals, terminally ill patients, UF/Shands/Veterans Administration (VA) staff, UF students

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 110 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Patients with Congestive Heart Failure<br>STOP-BANG Scoring Model Polysomnogram Sleep Study | Other: STOP-BANG Scoring Model<br>* Patients with Congestive Heart Failure on non-Intensive Care Unit Medical Services and/or visiting our outpatient Congestive Heart Failure Clinic will be administered the STOP-BANG Scoring Model to determine whether they are considered high-risk or low-risk for Sleep Apnea.<br>Other: Polysomnogram Sleep Study<br>* Patients determined by the STOP-BANG Scoring Model to be high-risk for Sleep Apnea will be referred to the Sleep Center physicians for evaluation and treatment. If medically indicated, a Polysomnogram Sleep Study will be performed.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Hospital Admissions |  | Compare the number of Hospital Admissions during the 12-month period immediately prior to the index admission to the number of Hospital Admissions during the 12-month period immediately following the study intervention | 
| Number of Hospitalized Days |  | Compare the number of Hospitalized Days during the 12-month period immediately prior to the index admission to the number of Hospitalized Days during the 12-month period immediately following the study intervention | 
| Number of Emergency Department Visits |  | Compare the number of Emergency Department Visits during the 12-month period immediately prior to the index admission to the number of Emergency Department Visits during the 12-month period immediately following the study intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Epworth Sleepiness Scale | Chance of Dozing Off - Scale: Never, Slight, Moderate, High | Change from Baseline to 6 weeks | 
| Epworth Sleepiness Scale | Chance of Dozing Off - Scale: Never, Slight, Moderate, High | Change from Baseline to 12 months | 
| Functional Outcome of Sleep Quality | Level of Difficulty Performing Everyday Activities - Scale: Don't do this activity, No difficulty, A little difficulty, Moderate difficulty, Extreme difficulty | Change from Baseline to 3 months | 
| Functional Outcome of Sleep Quality | Level of Difficulty Performing Everyday Activities - Scale: Don't do this activity, No difficulty, A little difficulty, Moderate difficulty, Extreme difficulty | Change from Baseline to 12 months | 
| Residual Apnea Hypopnea Index | This is a data download from the Continuous Positive Airway Pressure machine, indicating the effectiveness of the patient's breathing while wearing the machine. | at 6 weeks | 
| Epworth Sleepiness Scale | Chance of Dozing Off - Scale: Never, Slight, Moderate, High | Change from Baseline to 3 months | 
| Functional Outcome of Sleep Quality | Level of Difficulty Performing Everyday Activities - Scale: Don't do this activity, No difficulty, A little difficulty, Moderate difficulty, Extreme difficulty | Change from Baseline to 6 weeks | 
| Residual Apnea Hypopnea Index | This is a data download from the Continuous Positive Airway Pressure machine, indicating the effectiveness of the patient's breathing while wearing the machine. | at 3 months | 
| Residual Apnea Hypopnea Index | This is a data download from the Continuous Positive Airway Pressure machine, indicating the effectiveness of the patient's breathing while wearing the machine. | at 12 months | 
| % of nights with greater than 4 hours use of Continuous Positive Airway Pressure | Compliance for a given night would be 4 hours use or more. | at 6 weeks | 
| % of nights with greater than 4 hours use of Continuous Positive Airway Pressure | Compliance for a given night would be 4 hours use or more. | at 3 months | 
| % of nights with greater than 4 hours use of Continuous Positive Airway Pressure | Compliance for a given night would be 4 hours use or more. | at 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Obstructive Sleep Apnea, Sleep Apnea, Congestive Heart Failure, Heart Failure