Sleep Disorders |

A New Category: Very Severe Obstructive Sleep Apnea Has Worse Outcomes on Morbidity and Mortality FREE TO VIEW

Dennis Jurcevic*, MD; Ziad Shaman, MD; Vidya Krishnan, MD
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MetroHealth Medical Center, Cleveland, OH

Chest. 2012;142(4_MeetingAbstracts):1075A. doi:10.1378/chest.1389995
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PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM

PURPOSE: Obstructive sleep apnea severity is a known to cause increased mortality. However there is only one other known study to demonstrate that very severe sleep apnea (AHI > 60) has a worse outcome. Our goal is to characterize the demographics and sleep characteristics of patients with very severe OSA, and to determine whether this additional class of OSA severity predicts worse outcomes.

METHODS: Retrospective analysis with patients > 18 years who underwent diagnostic polysomnography between January and December 2010. Data were collected using the clinical sleep database at our facility and electronic medical record queries for number of demographics, insurance status, hospitalizations, and mortality up until October 2011. Categories of OSA severity were defined by AHI 5-<60, >= 60 (OSA, very severe OSA (VSOSA)). Primary outcome was mortality. Secondary outcomes were hospitalization and number of hospitalizations. Data were analyzed by Student’s t-tests and Pearson’s chi-squared tests, as appropriate.

RESULTS: 1464 patients were included, of which 1305 had OSA at baseline, 14 patients died and 725 patients were hospitalized during the study period. As compared to patients with lower severity OSA, patients with VSOSA were more likely to be older (53 vs. 49, p=0.01), male (61% vs. 36%, p<0.01), and more obese (BMI 40 vs. 37, p<0.01), but no different by insurance status. Sleep architecture revealed lower sleep efficiency, longer sleep latency, and lower stage N3 and R sleep in patients with VSOSA. Mean SaO2 and total sleep time with SaO2<90% were significantly lower in patients with VSOSA, but not lowest SaO2. Mortality was significantly higher in patients with VSOSA (3.6% vs. 0.9%, p<0.01), but not hospitalizations.

CONCLUSIONS: VSOSA patients, as expected, are more likely to be older obese men. The subset of patients with an AHI >= 60 have an even greater risk of mortality than other patients with OSA. This being said, we may need to re-evaluate the way sleep apnea severity is categorized to include a Very Severe OSA group.

CLINICAL IMPLICATIONS: Patients with higher AHI >= 60 have increased mortality that is statistically significant. These patients need to be identified and have more aggressive interventions and earlier institution of therapy.

DISCLOSURE: The following authors have nothing to disclose: Dennis Jurcevic, Ziad Shaman, Vidya Krishnan

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MetroHealth Medical Center, Cleveland, OH




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