Thomas Jefferson UniversitySidney Kimmel Medical College

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Pulmonary Sleep Medicine Program

Overview

Heart patient Tyrone Conner thanks researchers Paul Mather and Sunil Sharma (right) at the Jefferson Sleep Disorders Center. "I got my life back," Conner says of the ventilation device. ELIZABETH ROBERTSON / Staff Photographer
ELIZABETH ROBERTSON / Staff Photographer

The Jefferson Pulmonary Sleep Center is a multidisciplinary center with specialists from the Pulmonary division, Psychiatry, Neurology and ENT who work closely together to provide comprehensive services.  Jefferson has an active bariatric surgery program, which is supported by the pulmonary and sleep program.

For patient convenience and access, the outpatient facility is in one building which includes the pulmonary outpatient clinic, complete pulmonary function laboratory staffed by respiratory therapists, the outpatient polysomnography sleep lab, the bariatric surgery program, and complete imaging services which are all co-located in one building with an attached garage.

The primary complication of sleep disordered breathing is cardiopulmonary complications.  Sleep centers have traditionally focused on outpatients.  The Jefferson pulmonary sleep medicine program is highly novel in that it specializes in diagnosing sleep related disorders in hospitalized patients with a variety of comorbidities.   Sleep disorders can both be a cause of cardiopulmonary disease as well as exacerbate preexisting cardiopulmonary disorders.  While our knowledge of how sleep and sleep disorders affect the body in general, and heart in particular, has significantly increased, sleep disorders in hospitalized patients are under-recognized and Jefferson is one of a handful of programs which has expertise in this.

Sleep disordered breathing, especially obstructive sleep apnea syndrome (OSAS), has been associated with congestive heart failure, myocardial infarction, atrial fibrillation, stroke and pulmonary hypertension. OSAS can exacerbate many of these conditions, and make them difficult to control, or in some cases result in worse outcome. OSA has been shown to increase mortality mostly due to cardiovascular events.   Early diagnosis and treatment of OSAS has been shown to improve the pump function of the heart, and better control abnormal heart rhythm. Preliminary data suggest that appropriate early diagnosis and treatment may also reduce hospital readmission in cardiac patients.  The most widely used and effective therapy for OSAS is nasal CPAP or BiPAP, which is a respiratory modality typically administered by respiratory therapists.

Central sleep apnea is common in patients with advanced heart failure, stroke,  and patients using narcotics.  These conditions are relatively common in hospitalized setting and impose a significant risk to these patients. Early detection and intervention can mitigate these risks and improve outcome.

High prevalence of sleep disordered breathing is also known to occur in patients with pulmonary disease, including obesity hypoventilation syndrome, hypercapnic respiratory failure, pulmonary hypertension and COPD (overlap syndrome), and neuro-muscular disorders.  These are common causes of morbidity and mortality in hospitalized patients.

Our multi-disciplinary service evaluates and manages patients with the following problems:

  1. Nocturnal desaturations
  2. Pulmonary hypertension
  3. Pulmonary edema / CHF exacerbation
  4. Nocturnal arrhythmias suspected to be due to sleep disordered breathing
  5. Hypercapnic respiratory failure
  6. Obesity hypoventilation syndromes
  7. Respiratory failure due to neuro-muscular disorders
  8. Management of sleep disordered breathing  (OSA and CSA)
  9. Non-invasive ventilation (NIPPV) management of hypoxemic/ hypercapnic patients during peri-operative period.
  10. Stroke/ Epilepsy

Our service collaborates with several specialties including cardiology, internal medicine and family practice, in both identifying and managing high risk population. The care of these patients does not end with discharge from the hospital, but extends to outpatient continuity clinic to monitor progress.

We utilize overnight pulse oximetry, portable sleep testing devices, bed-side ultrasound, echocardiograms and right heart catheterization, in addition to comprehensive history and physical in accurately diagnosing these conditions. We utilize state-of-the-art non-invasive ventilation techniques and protocols, based on best evidence , in management of these conditions.

We are currently enrolling patients for CAT-HF trial which is a multi-centric trial evaluating the use of an advanced ventilator system (ASV) in treating sleep disordered breathing in patients with congestive heart failure.