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Original Research: Sleep Disorders |

Prevalence, Treatment, and Outcomes Associated With OSA Among Patients Hospitalized With PneumoniaSleep Apnea in Pneumonia

Peter K. Lindenauer, MD; Mihaela S. Stefan, MD; Karin G. Johnson, MD; Aruna Priya, MA, MSc; Penelope S. Pekow, PhD; Michael B. Rothberg, MD, MPH
Author and Funding Information

From the Center for Quality of Care Research (Drs Lindenauer, Stefan, and Pekow and Ms Priya), the Division of General Internal Medicine (Drs Lindenauer and Stefan), and the Division of Neurology (Dr Johnson), Baystate Medical Center, Springfield, MA; the Tufts University School of Medicine (Drs Lindenauer, Stefan, and Johnson), Boston, MA; the School of Public Health and Health Sciences (Dr Pekow), University of Massachusetts-Amherst, Amherst, MA; and the Department of Medicine (Dr Rothberg), Medicine Institute, Cleveland Clinic, Cleveland, OH.

Correspondence to: Peter K. Lindenauer, MD, Baystate Medical Center, Center for Quality of Care Research, 280 Chestnut St, Springfield, MA 01199; e-mail: peter.lindenauer@baystatehealth.org


Funding/Support: This study was supported by the Agency for Healthcare Research and Quality [Grant R01HS018723]. Dr Stefan is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health [Grant K01HL114631].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(5):1032-1038. doi:10.1378/chest.13-1544
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Background:  OSA is associated with increased risks of respiratory complications following surgery. However, its relationship to the outcomes of hospitalized medical patients is unknown.

Methods:  We carried out a retrospective cohort study of patients with pneumonia at 347 US hospitals. We compared the characteristics, treatment, and risk of complications and mortality among patients with and without a diagnosis of OSA while adjusting for other patient and hospital factors.

Results:  Of the 250,907 patients studied, 15,569 (6.2%) had a diagnosis of OSA. Patients with OSA were younger (63 years vs 72 years), more likely to be men (53% vs 46%), more likely to be married (46% vs 38%), and had a higher prevalence of obesity (38% vs 6%), chronic pulmonary disease (68% vs 47%), and heart failure (28% vs 19%). Patients with OSA were more likely to receive invasive (18.1% vs 9.3%) and noninvasive (28.8% vs 6.8%) forms of ventilation upon hospital admission. After multivariable adjustment, OSA was associated with an increased risk of transfer to intensive care (OR, 1.54; 95% CI, 1.42-1.68) and intubation (OR, 1.68; 95% CI, 1.55-1.81) on or after the third hospital day, longer hospital stays (risk ratio [RR], 1.14; 95% CI, 1.13-1.15), and higher costs (RR, 1.22; 95% CI, 1.21-1.23) among survivors, but lower mortality (OR, 0.90; 95% CI, 0.84-0.98).

Conclusion:  Among patients hospitalized for pneumonia, OSA is associated with higher initial rates of mechanical ventilation, increased risk of clinical deterioration, and higher resource use, yet a modestly lower risk of inpatient mortality.

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