SESSION TYPE: Sleep II
PRESENTED ON: Monday, October 22, 2012 at 04:00 PM - 05:30 PM
PURPOSE: To determine the frequency and predictors of incorrect CPAP settings on the initial night of hospitalization in patients with obstructive sleep apnea.
METHODS: All patients who underwent either a split-night or CPAP titration study at our center between January 2005 and December 2010 were included in the analysis. Hospitalization records of all included subjects were then retrospectively reviewed for CPAP settings on admission, latency to hospitalization (from sleep study), hospital length of stay, demographic variables, and polysomnographic variables.
RESULTS: 170 subjects were included in the analysis. 51% of patients were male and the average age of the study population was 55.3 ± 13.7 years. Body mass index was 43.7 ± 10.4 kg/m2. Severity of obstructive sleep apnea was generally severe (AHI 52.8 ± 37.3). CPAP setting during in-lab titration was 11.1 ± 3.1 cm H2O and CPAP during the first night of hospitalization was 9.5 ± 2.8 cm H2O. Of 170 subjects, only 71 (42%) received an appropriate laboratory-derived CPAP setting on the first night of hospitalization. In logistic regression analysis, BMI, CPAP level determined during the in-lab study, and latency between in-lab study and hospitalization were independent predictors of appropriate CPAP settings on the first night of hospitalization. There were no in-hospital mortalities.
CONCLUSIONS: Among patients admitted to the hospital, CPAP is frequently incorrectly ordered during the first night of hospitalization. Predictors for incorrectly ordering CPAP include latency from the time of in-laboratory CPAP titration, baseline BMI, and CPAP level. Potential causes of this discrepancy include lack of patient recall and the absence of an electronic medical record.
CLINICAL IMPLICATIONS: Although the clinical implications of treating newly hospitalized patients with an incorrect CPAP setting is unclear, the added stress of continued obstructive respiratory events is likely a risk factor for worse outcomes during hospitalization. Further research into the clinical implications of untreated OSA in a hospitalized patient population is needed.
DISCLOSURE: The following authors have nothing to disclose: Emile Klada, Vishal Patel, Lavanya Irugulapati, Ruchi Bansal, Juan George, Jeremy Weingarten
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