Undiagnosed Obstructive Sleep Apnea May Significantly Impact Outcomes in Adults Admitted for COPD in an Inner-City Hospital.

2020 
Abstract Background Chronic Obstructive Pulmonary Disease (COPD) is the second most common cause of hospital admission in the United States. Obstructive sleep apnea (OSA) is a highly prevalent and underdiagnosed condition which may impact the outcome of COPD. We hypothesized that presence of unrecognized and untreated OSA will increase hospital readmissions in patients admitted for COPD exacerbation. Methods We reviewed patients admitted for COPD exacerbation from May 2017- July 2018 who were also screened for previously unrecognized and untreated OSA with a sleep questionnaire, and who subsequently underwent a high-resolution pulse-oximetry (HRPO) or portable sleep monitoring (PM) study. We compared the rates of 30, 90 and 180-day readmission or death across OSA categories and compared overall survival in patients with and without OSA. Results Of 380 patients admitted for COPD exacerbation, 256 were screened for OSA with a sleep questionnaire (STOP). Of these, 238 underwent an overnight HRPO/PM. Out of the total 238 patients, 111 (46.6%) were found to have OSA; 28.6% had mild, 9.7% moderate, and 8.4% severe OSA. Baseline characteristics and demographics were compared between the cohorts of participants with OSA and without OSA and were similar except that patients with OSA had a higher mean BMI (33.9 vs 30.3 kg/m2) and an increased prevalence of heart failure (19.8% vs 7.1%). For COPD patients with mild OSA, odds of 30-day readmission were 2.05 times higher than for patients without OSA (32.4% vs 18.9%). Additionally, odds of 30-day readmission were 6.68 times higher for moderate OSA patients versus patients without OSA (60.9% vs. 18.9%) and 10.01 times high for severe OSA patients versus patients without OSA (70 % vs. 18.9%). Readmission rates were also greater at 90 and 180 days. All-cause mortality was lower for patients without OSA than for patients with OSA (p Conclusion Patients hospitalized for COPD exacerbation and who have unrecognized OSA, 30, 90 and 180 day readmission rates, and 6 month mortality rates are higher than in those without OSA.
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