By Alyx Arnett
Sleep specialists can increase their role in the early detection of cardiac comorbidities in sleep apnea patients. Sleep Review’s cardiology-sleep solutions column shares new technologies that can help. Email [email protected] with solutions you’d like to see featured here.
A patient admitted to the hospital with congestive heart failure and undiagnosed comorbid sleep apnea faces a complex journey. Typically, they might be discharged with instructions to follow up with various specialists—sleep physicians, cardiologists, and pulmonologists—to undergo multiple tests before starting treatments.
“They have to cross through several different gates to qualify for their therapy,” says Scott Blodgett, national vice president of neurology sales at patient monitoring company Nihon Kohden.
These gates create a “loss of a window of opportunity from when a patient is initially motivated to address their underlying cardiac condition,” says Susheel Patil, MD, PhD, director of the sleep medicine program at University Hospitals in Cleveland.
Nihon Kohden sees a future where this isn’t the case. “The idea is, how can we take technology and get the patient all the things they need to have to qualify for their therapeutic intervention while they’re in the hospital?” he says.
Data is typically recorded over several days while the patient is in the hospital. Nihon Kohden is exploring how that patient monitoring data—such as electrocardiogram (ECG), end-tidal carbon dioxide, blood oxygen saturation, and blood pressure—can be put on a common platform and then run through a software tool (like the company’s Polysmith sleep diagnostics software) to produce a polysomnogram before the patient is ever discharged from the hospital.
This could allow the healthcare team to potentially diagnose sleep apnea—as sleep-disordered breathing is common in heart failure patients and associated with increased morbidity and mortality1—and prescribe treatments right away. This could potentially lower hospital readmission rates, says Blodgett.
“Those are things we’re thinking about and actively working on now,” he says. “There are still FDA [US Food and Drug Administration] considerations. There are still other things we have to work on from a regulatory standpoint.”
Patil advocates for leveraging technology earlier in the patient’s care journey to improve outcomes. “Addressing cardiac conditions and sleep disorders in an integrated approach allows for reduced time to diagnosis and optimization of the disease(s) and risk factors to improve the health of patients,” he says.
Key Takeaway: Nihon Kohden is developing technological solutions to bridge the gaps between sleep and cardiac care for hospital inpatients, potentially reducing delays in treatment.
Leveraging Predictive Technology
These goals build on Nihon Kohden’s acquisition of Advanced Medical Predictive Devices, Diagnostics, and Displays (AMP3D), owners of clinical predictive algorithms and a software-as-a-service platform, in 2021.
AMP3D’s CoMET (Continuous Monitoring of Event Trajectories) decision support software uses patients’ continuous monitoring data, vital signs, medical records, and laboratory tests to display each patient’s real-time risk trajectories.
Nihon Kohden’s Digital Health Solutions, where that intellectual property now rests, is working to integrate this software into its healthcare ecosystem to, as an example, improve sleep for critical care patients. “We are beginning to incorporate many of these predictive analysis technologies into sleep,” says Blodgett. “Literature indicates that poor sleep or rest in critical populations, such as ICU patients, is associated with longer lengths of stay.”
The company seeks to leverage the signals recorded across the patient’s body and overlay its sleep software to provide a polysomnogram to critical care physicians, a collaboration that’s not typical today.
Blodgett highlights this disconnect as a significant challenge in healthcare. “Everybody looks at patients through their own lens,” he says. “Cardiologists are looking at the patient through the cardiology lens, and they’re trying to fix the heart. Pulmonologists are looking at the lungs. Maybe they’re a pulmonology-sleep specialist, so they’re beginning to look at other things. But they’re not really finding that overlap and collaborating well.”
Nihon Kohden intends to create tools and environments where these various specialists can access and interpret a common data set, facilitating better collaboration and patient outcomes.
Key Takeaway: By integrating clinical predictive algorithms, Nihon Kohden plans to facilitate environments where various specialists can interpret a common data set.
Arrhythmia Detection with Polysmith Software
Nihon Kohden’s subsidiary Neurotronics, which develops medical devices for the sleep diagnostic market, created one such tool several years ago when it released arrhythmia detection with its Polysmith 12 software.
Traditionally, arrhythmia detection in sleep studies is performed manually by sleep technologists, who are trained to recognize patterns and interpret ECG channels without automated assistance. “As long as we’ve been recording polysomnograms, this arrhythmia detection was done by the naked eye,” says Blodgett. “There was no automated algorithm helping to look at it.”
Nihon Kohden’s technology changes that by offering real-time monitoring and notification of arrhythmias through the Polysmith software. While it cannot function as an alarm due to FDA regulations, it provides notifications a few seconds after an event, such as a bradycardic or tachycardic episode. “The sleep specialist may note cardiac irregularities captured in the polysomnogram and refer the patient to a cardiologist for further evaluation,” says Jake Johnson, president and CEO of Neurotronics.
This feature is particularly beneficial in modern sleep labs, where technologists often monitor multiple patients simultaneously. “Anecdotally, I can tell you that this type of technology would have been very helpful,” shares Blodgett, who formerly was a registered polysomnographic technologist and ran sleep labs in upstate New York. “There were times when, while monitoring two or three patients a night, something might be going on with one patient that takes our attention away from others.”
Johnson notes that the company is constantly improving its Polysmith software and developing new sleep diagnostic products. Its latest home sleep apnea test, the NomadAir, which was FDA cleared in 2022, allows clinicians to record many parameters in the home environment, including ECG.
Key Takeaway: Polysmith software provides notifications of abnormal heart rhythms, allowing for a sleep specialist to more quickly refer patients with potential cardiac abnormalities for further screening and diagnostic testing.
Reference
- Valika A, Costanzo MR. Sleep-disordered breathing during congestive heart failure: to intervene or not to intervene? Card Fail Rev. 2017 Nov;3(2):134-9.
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