Prevalence, Treatment and Outcomes Associated with Obstructive Sleep Apnea Among Patients Hospitalized with Pneumonia.
Chest. 2013 Dec 26;
Authors: Lindenauer PK, Stefan MS, Johnson KG, Priya A, Pekow PS, Rothberg MB
BackgroundObstructive sleep apnea (OSA) is associated with increased risks of respiratory complications following surgery, however its relationship to the outcomes of hospitalized medical patients is unknown.MethodsWe carried out a retrospective cohort study of patients with pneumonia at 347 US hospitals. We compared the characteristics, treatment and risk of complications and mortality among patients with and without a diagnosis of OSA while adjusting for other patient and hospital factors.ResultsOf the 250,907 patients studied, 15,569 (6.2%) had a diagnosis of OSA. Patients with OSA were younger (63 vs. 72 years), more likely to be male (53% vs. 46%), married (46% vs. 38%), and had a higher prevalence of obesity (38% vs. 6%), chronic pulmonary disease (68% vs. 47%), and heart failure (28% vs. 19%). Patients with OSA were more likely to receive invasive (18.1% vs. 9.3%) and noninvasive (28.8% vs. 6.8%) forms of ventilation upon hospital admission. After multivariable adjustment, OSA was associated with an increased risk of transfer to intensive care (OR 1.54, 95% CI 1.42 - 1.68) and intubation (OR 1.68, 95% CI 1.55 - 1.81) on or after the third hospital day, longer hospital stays (RR 1.14, 95% CI 1.13 - 1.15), and higher costs (RR 1.22, 95% CI 1.21 - 1.23) among survivors but lower mortality (OR 0.90, 95% CI 0.84 - 0.98).ConclusionAmong patients hospitalized for pneumonia, OSA is associated with higher initial rates of mechanical ventilation, increased risk of clinical deterioration and higher resource utilization, yet a modestly lower risk of inpatient mortality.
PMID: 24371839 [PubMed - as supplied by publisher]