02 Jan Obstructive Sleep Apnea: Outcomes in Hospitalized Pneumonia Patients
MedicalResearch.com Interview Invitation with:
Dr. Peter Lindenauer MD MS
Director, Center for Quality of Care Research
Baystate Medical Center, Springfield, MA, US
MedicalResearch.com: What are the main findings of the study?
Answer: Among a cohort of 250,000 patients hospitalized for pneumonia at 347 US hospitals, those with a diagnosis of obstructive sleep apnea were twice as likely to be intubated at the time of hospital admission than patients without sleep apnea. In addition, patients with sleep apnea had approximately 50% higher risk of needing to be transferred to the ICU after initial admission to a regular bed, and a 70% increased risk of requiring intubation later in the hospital stay. Patients with sleep apnea stayed longer in the hospital and incurred higher costs than those without sleep apnea.
MedicalResearch.com:Were any of the findings unexpected?
Answer: Despite the increased requirement for mechanical ventilation at admission and deterioration later in the hospital stay, sleep apnea was not associated with an increased risk of in-hospital mortality. If anything, even after multivariable adjustment for differences between the patients with and without sleep apnea, sleep apnea was associated with a modestly lower or equivalent risk of mortality. This raises a number of interesting questions, such as whether the clinical significance of intubation among patients with and without sleep apnea differed – perhaps as a result of differences in the pathophysiology driving respiratory failure.
MedicalResearch.com: What should clinicians and patients take away from your report?
Answer: Patients with sleep apnea make up a large fraction of the US adult population. Our results suggest that these patients are at increased risk of respiratory failure when they develop pneumonia. Patients should probably seek medical attention early in the course of lower respiratory tract illnesses like pneumonia, and physicians should be aware of the increased risk of deterioration and may wish to consider placing these patients in setting with greater monitoring capability (like a step-down unit).
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Answer: Additional research is needed to determine whether increased levels of monitoring (as suggested above) will prevent episodes of deterioration that lead to late intubation. More importantly, while intuitively appealing, we don’t know whether routine use of positive airway pressure devices (e.g. CPAP machines) during the hospitalization would be an effective strategy to avoid complications among patients with sleep apnea.