Hospital outcomes in non-surgical patients identified at risk for OSA

•This study found no significant differences in the composite outcome of respiratory failure by risk of OSA assessed by Berlin Questionnaire in non-surgical patients.•Patients at low-risk for OSA by Berlin Questionnaire had increased need for invasive mechanical ventilation.•Patients at high-risk fo...

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Bibliographic Details
Published in:Heart & lung 2020-03, Vol.49 (2), p.112-116
Main Authors: Khan, Sikandar H, Manchanda, Shalini, Sigua, Ninotchka L, Green, Erika, Mpofu, Philani B, Hui, Siu, Khan, Babar A.
Format: Article
Language:English
Subjects:
Adult
Aged
Comorbidity
Female
Health outcomes
Hospitalization
Humans
Length of Stay
Male
Middle Aged
Obstructive sleep apnea
Oximetry
Respiration, Artificial
Respiratory failure
Respiratory Insufficiency - epidemiology
Retrospective Studies
Risk Factors
Sleep
Sleep Apnea, Obstructive - complications
Stroke - epidemiology
Surveys and Questionnaires
Citations: Items that this one cites
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Summary:•This study found no significant differences in the composite outcome of respiratory failure by risk of OSA assessed by Berlin Questionnaire in non-surgical patients.•Patients at low-risk for OSA by Berlin Questionnaire had increased need for invasive mechanical ventilation.•Patients at high-risk for OSA had longer hospital stays, and decreased odds of hospital mortality. In-hospital respiratory outcomes of non-surgical patients with undiagnosed obstructive sleep apnea (OSA), particularly those with significant comorbidities are not well defined. Undiagnosed and untreated OSA may be associated with increased cardiopulmonary morbidity. Evaluate respiratory failure outcomes in patients identified as at-risk for OSA by the Berlin Questionnaire (BQ). This was a retrospective study conducted using electronic health records at a large health system. The BQ was administered at admission to screen for OSA to medical-service patients under the age of 80 years old meeting the following health system criteria: (1) BMI greater than 30; (2) any of the following comorbid diagnoses: hypertension, heart failure, acute coronary syndrome, pulmonary hypertension, arrhythmia, cerebrovascular event/stroke, or diabetes. Patients with known OSA or undergoing surgery were excluded. Patients were classified as high-risk or low-risk for OSA based on the BQ score as follows: low-risk (0 or 1 category with a positive score on the BQ); high-risk (2 or more categories with a positive score on BQ). The primary outcome was respiratory failure during index hospital stay defined by any of the following: orders for conventional ventilation or intubation; at least two instances of oxygen saturation less than 88% by pulse oximetry; at least two instances of respiratory rate over 30 breaths per minute; and any orders placed for non-invasive mechanical ventilation without a previous diagnosis of sleep apnea. Propensity scores were used to control for patient characteristics. Records of 15,253 patients were assessed. There were no significant differences in the composite outcome of respiratory failure by risk of OSA (high risk: 11%, low risk: 10%, p = 0.55). When respiratory failure was defined as need for ventilation, more patients in the low-risk group experienced invasive mechanical ventilation (high-risk: 1.8% vs. low-risk: 2.3%, p = 0.041). Mortality was decreased in patients at high-risk for OSA (0.86%) vs. low risk for OSA (1.53%, p 
ISSN:0147-9563
1527-3288
DOI:10.1016/j.hrtlng.2019.12.001