| Abstrakt: |
Background:Previous studies have shown a direct correlation between having obstructive sleep apnea (OSA) and developing cardiovascular disease. Patients with OSA and cardiovascular disease also have higher morbidity and mortality. However, randomized trials have not shown an improvement in cardiovascular outcomes if OSA is better controlled and treated. For this study, the aim was to revisit the impact of OSA on cardiovascular outcomes using a large database.Methods:The Nationwide Inpatient Sample (NIS) is the largest publicly available inpatient database designed to provide information on characteristics and outcomes of patients discharged from US hospitals. The National Inpatient Database (NIS) was sampled using ICD-10 codes for patients (> age 18) with OSA and cardiovascular diseases, which included coronary artery disease (CAD), hypertension (HTN), cerebrovascular accident (CVA), acute myocardial infarction (AMI), peripheral vascular disease (PVD), diabetes, versus patients with only OSA. Data was extracted from 2015 to 2020 and various parameters were analyzed using propensity matching utilizing the Kernel Method. Multivariate logistic regression was used to adjust for confounders. The primary outcome was mortality. Secondary outcomes were hospital length of stay (LOS) and total hospital charges (TOTCHG).Results:This study included 11,701,550 patients had OSA of which there were 4,061,025 with CAD, 1,842,025 with diabetes, 3,677,950 with CHF, 3,257,950 with cardiac arrhythmias, 152,100 with CVA, 339,000 with AMI, 328,300 with PVD, and 4,276,200 with HTN. Patients with OSA and CVA (OR 4.80, CI 4.30-5.37, p<0.0001), AMI (OR 2.67, CI 2.44-2.91, p<0.0001), and cardiac arrhythmias (OR 2.33, CI 2.27-2.40, p<0.0001) had increased mortality compared to those with only OSA. Those with OSA and CVA had higher hospital LOS ( +2.24 days, CI 1.99-2.51, p<0.0001). Finally, patients with OSA and CHF ($1,701, CI $687-$2,715, p<0.0001), cardiac arrhythmias ($15,393, CI $14,152-$16,634, p<0.0001), CVA ($39,339, CI $34,640-$44,037, p<0.0001), and AMI ($36,984, $34,099-$39,870, p<0.0001) increased TOTCHG.Conclusion:Based on our study results, cardiovascular diseases (CVD) such as AMI, CVA, and arrhythmias had significantly increased mortality, hospital LOS, and TOTCHG in patients with OSA. There is still a direct correlation between certain cardiovascular diseases and OSA. Our study shows increased morbidity and mortality as well in this patient population. Thus, OSA remains an important risk factor in CVD and new randomized trials are required to further study the relationship between OSA and cardiovascular disease in order to mitigate and prevent adverse hospital outcomes. |
