Association of obstructive sleep apnea with severity of patients hospitalized for acute asthma

Abstract

Background: Studies suggest that obstructive sleep apnea (OSA) is associated with suboptimal disease control and worse chronic severity of asthma. However, little is known about the relations of OSA with acute asthma severity in hospitalized patients.

Objective: To investigate the association of OSA with acute asthma severity.

Methods: This is a retrospective cohort study (2010-2013) using State Inpatient Databases from 8 geographically diverse states in the United States. The outcomes were markers of acute severity, including mechanical ventilation use, hospital length of stay, and in-hospital mortality. To determine the association of interest, we fit multivariable logistic regression models, adjusting for age, sex, race/ethnicity, primary insurance, household income, patient residence, comorbidities, hospital state, and hospitalization year. We repeated the analysis for children aged 6 to 17 years.

Results: Among 73,408 adult patients hospitalized for acute asthma, 10.3% had OSA. Coexistent OSA was associated with a significantly higher risk of noninvasive positive pressure ventilation use (14.9% vs 3.1%; unadjusted odds ratio, 6.48; 95% CI, 5.88-7.13; adjusted odds ratio, 5.20; 95% CI, 4.65-5.80), whereas coexistent OSA was not significantly associated with the risk of invasive mechanical ventilation use. Patients with OSA had 37% longer hospital length of stay (unadjusted incidence rate ratio, 1.37; 95% CI, 1.33-1.40); this significant association persisted in the multivariable model (incidence rate ratio, 1.13; 95% CI, 1.10-1.17). The in-hospital mortality did not significantly differ between groups. These findings were consistent in both obesity and nonobesity groups and in 27,935 children.

Conclusion: Among patients hospitalized for acute asthma, OSA was associated with a higher risk of noninvasive positive pressure ventilation use and longer length of stay compared with those without OSA.

Figure 1.. Unadjusted and adjusted associations between obstructive sleep apnea and acute severity of asthma exacerbation

Obstructive sleep apnea (OSA) was associated with a significantly higher risk of NIPPV use. The patients with OSA had a 37% longer hospital length-of-stay compared to those without OSA in the unadjusted model. The association remained significant after adjusting for age, sex, race/ethnicity, primary insurance, quartiles for median household income, patient residence, 28 Elixhauser comorbidity measures as well as arrhythmia, hospital state, and hospitalization year.