Sleep Overnight Monitoring for Apnea in Patients Hospitalized with Heart Failure (SOMA-HF Study)
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Introduction Sleep-disordered breathing (SDB) is highly prevalent in hospitalized patients with congestive heart failure (CHF) and the condition is diagnosed and treated in only a minority of these patients. Portable monitoring (PM) is a screening option, but due to costs and the expertise required, many hospitals may find it impractical to implement. We sought to test the utility of an alternative approach for screening hospitalized CHF patients for SDB, high-resolution pulse oximetry (HRPO).Methods We conducted a prospective controlled trial of 125 consecutive patients admitted to the hospital with CHF. Simultaneous PM and HRPO for a single night was performed. All but one patient were monitored on breathing room air. The HRPO-derived ODI (oxygen desaturation index) was compared with PM-derived respiratory event index (REI) using both receiver operator characteristic (ROC) curve analysis and a Bland-Altman plot.Results Of 105 consecutive CHF patients with analyzable data, 61 (58%) were males with mean age of 64.9 ± 15.1 years and mean body mass index of 30.3 ± 8.3 kg/m 2. Of the 105 patients, 10 (9.5%) had predominantly central sleep apnea (central events > 50% of the total events), although central events were noted in 42 (40%) of the patients. The ROC analysis showed an area under the curve of 0.89 for REI > 5 events/h. The Bland-Altman plot showed acceptable agreement with 95% limits of agreement between -28.5 to 33.7 events/h and little bias.Conclusions We conclude that high-resolution pulse oximetry is a simple and cost-effective screening tool for SDB in CHF patients admitted to the hospital. Such screening approaches may be valuable for large-scale implementation and for the optimal design of interventional trials.
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In the general population, oximetry ODI correlates reasonably well with PSG AHI, primarily when 4% desaturation criteria are used to score respiratory events.
“In the general population, two Level 1b studies,499,616 three Level 2b studies,617–619 and one Level 3b620 found reasonably good correlations between oximetry ODI and PSG AHIs, though primarily when the 4% desaturation criteria was used to score respiratory events.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [619]
The Results (page not available) report a good correlation (Spearman coefficient 0.76) between oximetry ODI and respiratory event index, and the Methods specify 4% desaturation criteria. But the study involved patients hospitalized with heart failure and compared ODI with portable-monitoring REI, not PSG AHI in the general population. (LLM, conf=0.90)
Experimental — accuracy not yet measuredIn 105 inpatients with acute CHF, simultaneous HSAT with ApneaLink and high-resolution pulse oximetry for one night showed an AUC of 0.89 for REI >5, with 88% of moderate-severe REI correctly classified.
“The study by Sharma et al., 2017, was a prospective single center, controlled trial of 105 inpatients with acute CHF, where simultaneous HSAT with ApneaLink and a high-resolution pulse oximetry (HRPO) was performed for a single night.619 The HSAT-derived REI was compared to the HRPO-derived ODI using 30% drop in flow with 4% oxygen desaturations. The receiver operating curve (ROC) analysis showed”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [619]
The Methods describe same-night ApneaLink portable monitoring and HRPO in hospitalized patients with CHF, and the Results report 105 analyzable patients, an AUC of 0.89 at the REI 5-events/hour threshold, and 88% correct classification of moderate-severe REI. The Methods specify hospitalized CHF and testing after stabilization, but do not establish that all 105 patients had acute CHF. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSome oximetry studies were downgraded for using oximetry off the PSG as the comparison to PSG-derived AHI, or for using highly selective populations.
“However, a number of these studies were downgraded for using the oximetry off the PSG as the comparison to the PSG derived AHI,617,618 or for using highly selective populations.619”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [619]
High-resolution pulse oximetry could not reliably differentiate central from obstructive respiratory events in acute CHF.
“However, HRPO was unable to reliably differentiate between central and obstructive respiratory events.”
From International Consensus Statement on Obstructive Sleep Apnea (2023) · cites this paper as [619]
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Self-citation
- Authors
- Sharma, S., Mather, P. J., Chowdhury, A., Gupta, S., Mukhtar, U., Willes, L., Whellan, D. J., Malhotra, A., & Quan, S. F.
- Affiliations
- Jefferson Einstein Philadelphia Hospital (US)
- University of Pennsylvania (US)
- Willes Consulting Group, Inc. Encinitas, California
- Thomas Jefferson University (US)
- University of California San Diego (US)
- Brigham and Women's Hospital (US)
- Corresponding author
- Sharma, Sunil
- Venue
- Journal of Clinical Sleep Medicine
- Published
- 2017-10-15
- Volume
- 13
- Issue
- 10
- Pages
- 1185-1190
- ISSN
- 1550-9389 (ISSN-L)
- 1550-9397
- PMC
- PMC5612634
- OpenAlex
- W2765383815
- Semantic Scholar
- 38852936b123edfbfcc3281b7b832e6fd2f6d07d
- Cited by
- 31
- References
- 24
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 2 · 2022: 5 · 2021: 1 · 2020: 5 · 2019: 2 · 2018: 9
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Sleep Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (T32HL134632, R01HL085188, K24HL132105)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- sleep-disordered breathing, congestive heart failure, central sleep apnea, oxygen desaturation index, respiratory event index, hospitalized patients, portable monitoring
- MeSH terms
- Adult, Aged, Aged, 80 and over, Female, Heart Failure, Humans, Male, Middle Aged, Oximetry, Prospective Studies, Sleep Apnea Syndromes, Reproducibility of Results
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