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PARADOX IN OUTCOMES OF PATIENTS ADMITTED FOR ACUTE RESPIRATORY FAILURE WITH AND WITHOUT CONCURRENT OSA: A RETROSPECTIVE NATIONAL DATABASE STUDY

      TOPIC: Sleep Disorders
      TYPE: Original Investigations
      PURPOSE: Obstructive sleep apnea (OSA) is a known to be an important factor in medical morbidity and mortality. Understanding the correlation between obstructive sleep apnea acute respiratory failure (ARF) is important.
      METHODS: This was a population-based, retrospective observational study using data gathered from the Nationwide Inpatient Sample (NIS) for 2018. Hospitalizations of adults greater than or equal to 18 years old with a principal diagnosis of ARF were obtained using ICD-10 codes. Groups were delineated by the presence or absence of a secondary diagnosis of OSA. The primary outcomes were in-hospital mortality, length of stay (LOS), and total hospital charges (THC). Secondary outcomes were sepsis, acute myocardial infarction, mechanical ventilation, and cerebrovascular accident.
      RESULTS: Patients without OSA were found to have a significantly higher in-hospital mortality compared to those with OSA (with OSA vs without OSA: 4.6% vs 9.2%; aOR 0.45 [95% CI 0.41-0.50]; p<0.001). Additionally, patients without OSA had higher prevalences of the following secondary outcomes: sepsis (with OSA vs without OSA: 2.4% vs 3.7%; aOR 0.59 [95% CI 0.52-0.68]; p<0.001), acute myocardial infarction (with OSA vs without OSA: 3.0% vs 4.1%; aOR 0.57 [95% CI 0.50-0.65]; p<0.001), mechanical ventilation (with OSA vs without OSA: 17.4% vs 24.7%; aOR 0.63 [95% CI 0.59-0.67]; p<0.001), cerebrovascular accident (with OSA vs without OSA: 0.6% vs 1.0%; aOR 0.47 [95% CI 0.35-0.63]; p<0.001).
      CONCLUSIONS: Patients hospitalized for ARF without a secondary diagnosis of OSA within the same admission had a statistically significantly higher in-hospital mortality compared to those with OSA.
      CLINICAL IMPLICATIONS: While there is information on the epidemiology, pathophysiology, and conditions that may be comorbid with OSA and on the intensity and mortality of ARF, there is a paucity of objective data that focuses predominantly on the differences in outcomes for hospitalizations for ARF with and without a secondary diagnosis of OSA. We aimed to establish and investigate differences in outcomes between patients with and without a secondary diagnosis of OSA who were admitted for ARF. In this study, we found a higher prevalence of Charlson Comorbidity Index scores greater than or equal to 3 in patent who were obese. We also found higher rates of numerous comorbid conditions, including chronic obstructive pulmonary disease and coronary artery disease, in patients with OSA. Patients without a secondary diagnosis of OSA were found to have higher rates of in-hospital mortality, numerous secondary outcomes, including sepsis, and total hospital charges compared to those with a secondary diagnosis of OSA. In conclusion, we strongly believe that patients hospitalized with ARF without OSA may be at a higher risk of serious complications and death compared to those with OSA. Hence, appropriate yet aggressive monitoring for complications should be considered for patients hospitalized with ARF without OSA.
      DISCLOSURES: No relevant relationships by Zain El-amir, source=Web Response
      No relevant relationships by Asim Kichloo, source=Web Response
      No relevant relationships by Hafeez Shaka, source=Web Response
      No relevant relationships by Farah Wani, source=Web Response
      No relevant relationships by Zhiwei Zhang, source=Web Response