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Sleep-Disordered Breathing May Be Under-Recognized in Patients Who Wean From Prolonged Mechanical Ventilation

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Abstract:

BACKGROUND: The prevalence of sleep-disordered breathing (SDB) in patients with prolonged mechanical ventilation (PMV) is unknown. The aim of this study was to assess the frequency of SDB in patients admitted to a long-term acute care (LTAC) hospital who weaned from PMV. METHODS: Retrospective chart review was conducted of all PMV patients who had in-patient polysomnography (PSG) between January 2007 and May 2010. Main outcome measures included the frequency of SDB and tracheostomy decannulation. RESULTS: Nineteen patients were studied, age 53.4 ± 13.4 years, 11 males (57.9%), with mean body mass index of 44.0 ± 12.7 kg/m2 (range 27.3‐75.7). Eighteen patients (94.7%) demonstrated SDB as evidenced by obstructive sleep apnea (OSA), with a median respiratory disturbance index (RDI) of 24.2 events/h (range 5.9‐82.0 events/h). Fourteen patients underwent successful positive airway pressure titration, with improvement in the median RDI to 0.9 events/h (range 0.0‐9.1 events/h) (P < .001). Seventeen patients (89.5%) were decannulated without adverse event. CONCLUSIONS: There may be a high prevalence of unrecognized SDB in patients who are candidates for decannulation after weaning from PMV.

Keywords: long-term acute-care hospital; obstructive sleep apnea; polysomnography; prolonged mechanical ventilation; respiratory failure; sleep-disordered breathing; tracheostomy decannulation

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.01260

Affiliations: Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA

Publication date: February 1, 2012

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