Hospital outcomes in non-surgical patients identified at risk for OSA.

Autor: Khan SH; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202, United States; IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, United States; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address: sikhan@iu.edu., Manchanda S; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202, United States; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address: smanchan@iu.edu., Sigua NL; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202, United States; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address: nsigua@iu.edu., Green E; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address: erikag@iu.edu., Mpofu PB; Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address: phmpofu@iupui.edu., Hui S; Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States. Electronic address: shui@iupui.edu., Khan BA; Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, 1101 West 10th Street, Indianapolis, IN 46202, United States; IU Center of Aging Research, Regenstrief Institute, Indianapolis, IN, United States; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States; Indiana University Center of Health Innovation and Implementation Science, Indianapolis, IN, United States. Electronic address: bakhan@iu.edu.
Jazyk: angličtina
Zdroj: Heart & lung : the journal of critical care [Heart Lung] 2020 Mar - Apr; Vol. 49 (2), pp. 112-116. Date of Electronic Publication: 2019 Dec 24.
DOI: 10.1016/j.hrtlng.2019.12.001
Abstrakt: Background: In-hospital respiratory outcomes of non-surgical patients with undiagnosed obstructive sleep apnea (OSA), particularly those with significant comorbidities are not well defined. Undiagnosed and untreated OSA may be associated with increased cardiopulmonary morbidity.
Study Objectives: Evaluate respiratory failure outcomes in patients identified as at-risk for OSA by the Berlin Questionnaire (BQ).
Methods: This was a retrospective study conducted using electronic health records at a large health system. The BQ was administered at admission to screen for OSA to medical-service patients under the age of 80 years old meeting the following health system criteria: (1) BMI greater than 30; (2) any of the following comorbid diagnoses: hypertension, heart failure, acute coronary syndrome, pulmonary hypertension, arrhythmia, cerebrovascular event/stroke, or diabetes. Patients with known OSA or undergoing surgery were excluded. Patients were classified as high-risk or low-risk for OSA based on the BQ score as follows: low-risk (0 or 1 category with a positive score on the BQ); high-risk (2 or more categories with a positive score on BQ). The primary outcome was respiratory failure during index hospital stay defined by any of the following: orders for conventional ventilation or intubation; at least two instances of oxygen saturation less than 88% by pulse oximetry; at least two instances of respiratory rate over 30 breaths per minute; and any orders placed for non-invasive mechanical ventilation without a previous diagnosis of sleep apnea. Propensity scores were used to control for patient characteristics.
Results: Records of 15,253 patients were assessed. There were no significant differences in the composite outcome of respiratory failure by risk of OSA (high risk: 11%, low risk: 10%, p = 0.55). When respiratory failure was defined as need for ventilation, more patients in the low-risk group experienced invasive mechanical ventilation (high-risk: 1.8% vs. low-risk: 2.3%, p = 0.041). Mortality was decreased in patients at high-risk for OSA (0.86%) vs. low risk for OSA (1.53%, p < 0.001).
Conclusions: Further prospective studies are needed to understand the contribution of undiagnosed OSA to in-hospital respiratory outcomes.
Competing Interests: Declaration of Competing Interest None declared.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: