Effects of Treating Sleep Apnea in Patients With Congestive Heart Failure

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