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Education, Teaching, and Quality Improvement |

Obstructive Sleep Apnea as a Predictor of Clinical Deterioration in Hospitalized Patients on the Wards FREE TO VIEW

Patrick Lyons; Matthew Churpek; Frank Zadravecz; Dana Edelson, MS; Babak Mokhlesi
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University of Chicago, Chicago, IL


Chest. 2014;146(4_MeetingAbstracts):502A. doi:10.1378/chest.1990564
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Abstract

SESSION TITLE: Outcomes/Quality Control

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Wednesday, October 29, 2014 at 08:45 AM - 10:00 AM

PURPOSE: It is unclear whether OSA is associated with adverse outcomes for inpatients. We hypothesized OSA would be independently associated with clinical deterioration on the wards.

METHODS: We analyzed a cohort of adults hospitalized from November 1, 2008 to October 1, 2013 at an academic hospital. All patients with vital signs documented on the wards were included. Outcomes were RRT activation, ICU transfer, in-hospital death, and a composite of these outcomes. ICD-9 codes were used to identify patients with OSA and with possible confounding comorbidities, such as arrhythmias, coronary artery disease (CAD), type II diabetes, hypertension, heart failure, and cerebrovascular disease. Logistic regression was used to calculate the odds of adverse events in patients with OSA while controlling for patient characteristics, location prior to ward admission, and admission severity of illness calculated using the CART score, a vital-sign-based early warning score we previously developed.

RESULTS: 93,676 encounters from 53,150 patients resulted in 1,069 RRT activations, 6,305 ICU transfers, and 1,239 in-hospital deaths. A total of 12,745 (13.6%) patient encounters had a diagnosis of OSA. Patients with OSA were more likely to be older (median age 59 vs 55), male (49% vs 42%), overweight or obese (88% vs 62%), and to carry diagnoses of diabetes (53.8% vs 25.5%), hypertension (45.3% vs 18.2%), arrhythmias (44.4% vs 26.7%), CAD (46.8% vs 23.5%), heart failure (35.8% vs 13.5%), and cerebrovascular disease (13.5% vs 8.1%) than those without OSA (P < 0.001 for all comparisons). OSA was associated with increased unadjusted odds for the composite outcome (OR 1.27 [95% CI 1.19-1.36]), RRT activation (OR 1.36 [1.16-1.59]), and ICU transfer (OR 1.28 [1.20-1.38]). None of these associations were significant after controlling for confounders. OSA was associated with decreased unadjusted (OR 0.83 [0.70-0.99]) and adjusted (OR 0.70 [0.58-0.85]) odds of in-hospital mortality.

CONCLUSIONS: In this inpatient sample, OSA diagnosis was not associated with deterioration on the wards after adjusting for demographics, presenting physiology, and comorbidities. Our finding of decreased mortality for inpatients with OSA extends findings from other studies in surgical and pneumonia patients to a well-phenotyped ward population. It is unclear whether this finding signifies a “protective” association or merely indicates unmeasured confounders.

CLINICAL IMPLICATIONS: Further investigation of the association between OSA and in-hospital mortality is needed.

DISCLOSURE: Matthew Churpek: Other: Patent pending (ARCD. P035US.P2), University grant monies: career development award from the National Heart, Lung, and Blood Institute (K08 HL121080) Dana Edelson: University grant monies: K23 HL097157, Consultant fee, speaker bureau, advisory committee, etc.: Philips Healthcare (Andover, MA), Grant monies (from sources other than industry): American Heart Association (Dallas, TX), Consultant fee, speaker bureau, advisory committee, etc.: Laerdal Medical (Stavanger, Norway), Consultant fee, speaker bureau, advisory committee, etc.: Early Sense (Tel Aviv, Israel), Shareholder: Ownership interest in Quant HC (Chicago, IL), which is developing products for risk stratification of hospitalized patients, Other: patent pending (ARCD. P0535US.P2) Babak Mokhlesi: Consultant fee, speaker bureau, advisory committee, etc.: Philips/Respironics The following authors have nothing to disclose: Patrick Lyons, Frank Zadravecz

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