Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia

Abstract

Background: OSA is associated with increased risks of respiratory complications following surgery. However, its relationship to the outcomes of hospitalized medical patients is unknown.

Methods: We 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.

Results: Of the 250,907 patients studied, 15,569 (6.2%) had a diagnosis of OSA. Patients with OSA were younger (63 years vs 72 years), more likely to be men (53% vs 46%), more likely to be 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 (risk ratio [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).

Conclusion: Among patients hospitalized for pneumonia, OSA is associated with higher initial rates of mechanical ventilation, increased risk of clinical deterioration, and higher resource use, yet a modestly lower risk of inpatient mortality.

Figure 1.

Recruitment. ABX = antibiotic; CH CT = chest CT scan; CXR = chest radiograph; ICD = International Classification of Diseases; LOS = length of stay; MS DRG = Medicare Severity Diagnosis-Related Group; PN = pneumonia; POA = present on admission.

Figure 2.

ORs and risk ratios for the association between OSA and patient outcomes. All models account for clustering of patients in hospitals. a: Unadjusted; b: Adjusted for demographics, admitting physician specialty, and hospital characteristics; c: Adjusted for health-care-associated pneumonia vs community-acquired pneumonia, demographics, admitting physician specialty, hospital characteristics, and comorbidities. *OR (95% CI). **Risk ratio (95% CI) among survivors. IMV = invasive mechanical ventilation. See Figure 1 legend for expansion of other abbreviation.