Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA.
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA.
Chest. 2014 May;145(5):1032-1038. doi: 10.1378/chest.13-1544.
OSA is associated with increased risks of respiratory complications following surgery. However, its relationship to the outcomes of hospitalized medical patients is unknown.
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.
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).
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.
阻塞性睡眠呼吸暂停（OSA）与手术后呼吸系统并发症的风险增加有关。然而，其与住院内科患者结局的关系尚不清楚。
我们对 347 家美国医院的肺炎住院患者进行了回顾性队列研究。我们比较了同时调整其他患者和医院因素后，患有和不患有 OSA 的患者的特征、治疗方法以及并发症和死亡率风险。
在所研究的 250907 名患者中，有 15569 名（6.2%）被诊断为 OSA。患有 OSA 的患者更年轻（63 岁比 72 岁），更可能为男性（53%比 46%），更可能已婚（46%比 38%），且肥胖（38%比 6%）、慢性肺部疾病（68%比 47%）和心力衰竭（28%比 19%）的发病率更高。入院时，患有 OSA 的患者更可能接受有创（18.1%比 9.3%）和无创（28.8%比 6.8%）通气。经多变量调整后，与无 OSA 患者相比，OSA 患者在住院后第 3 天或之后转入重症监护病房（OR，1.54；95%CI，1.42-1.68）和插管（OR，1.68；95%CI，1.55-1.81）的风险增加，住院时间延长（风险比 [RR]，1.14；95%CI，1.13-1.15），幸存者的医疗费用增加（RR，1.22；95%CI，1.21-1.23），但住院死亡率降低（OR，0.90；95%CI，0.84-0.98）。
在因肺炎住院的患者中，OSA 与更高的初始机械通气率、临床恶化风险增加和更高的资源利用相关，但住院死亡率适度降低。
