Albert Einstein Medical Center, Philadelphia, PA.
Willes Consulting Group, Inc, Encinitas, CA.
Chest. 2020 Sep;158(3):1198-1207. doi: 10.1016/j.chest.2020.03.036. Epub 2020 Apr 2.
BACKGROUND: COPD is the second most common cause of hospital admission in the United States. OSA is a highly prevalent and underdiagnosed condition that may affect the outcome of COPD. RESEARCH QUESTION: We hypothesized that presence of unrecognized and untreated OSA will increase hospital readmissions in patients admitted for COPD exacerbation. STUDY DESIGN AND METHODS: We reviewed patients admitted for COPD exacerbation from May 2017 through 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 or portable sleep monitoring 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 (snoring, tiredness during daytime, observed apnea, high BP). Of these, 238 underwent an overnight high-resolution pulse oximetry/portable sleep monitoring. Of the 238 total 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/m) and an increased prevalence of heart failure (19.8% vs 7.1%). For patients with COPD and 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 patients with moderate OSA vs patients without OSA (60.9% vs 18.9%) and 10.01 times high for patients with severe OSA vs 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 < .01). The time to hospital readmission or death was shorter with greater OSA severity (P < .01). INTERPRETATION: 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.
背景：在美国，COPD 是第二大常见的住院原因。OSA 是一种高度普遍但未被充分诊断的疾病，可能会影响 COPD 的预后。
研究问题：我们假设，对于因 COPD 加重而入院的患者，如果存在未经识别和未经治疗的 OSA，将会增加其住院再入院率。
研究设计和方法：我们回顾了 2017 年 5 月至 2018 年 7 月期间因 COPD 加重而入院的患者，这些患者还接受了睡眠问卷筛查，以发现以前未被识别和未经治疗的 OSA，并随后接受了高分辨率脉搏血氧仪或便携式睡眠监测研究。我们比较了 OSA 各分类组在 30、90 和 180 天的再入院或死亡率，并比较了有和无 OSA 患者的总体生存率。
结果：在因 COPD 加重而入院的 380 名患者中，有 256 名患者接受了睡眠问卷筛查 OSA（打鼾、白天嗜睡、观察到的呼吸暂停、高血压）。其中，238 名患者接受了一夜的高分辨率脉搏血氧仪/便携式睡眠监测。在 238 名患者中，有 111 名（46.6%）患有 OSA；28.6%为轻度、9.7%为中度、8.4%为重度。在有 OSA 和无 OSA 的患者队列之间比较了基线特征和人口统计学特征，除了 OSA 患者的平均 BMI（33.9 比 30.3 kg/m2）更高和心力衰竭的发生率（19.8%比 7.1%）更高外，这些特征和特征都相似。对于患有 COPD 和轻度 OSA 的患者，30 天再入院的几率是无 OSA 患者的 2.05 倍（32.4%比 18.9%）。此外，中度 OSA 患者 30 天再入院的几率是无 OSA 患者的 6.68 倍（60.9%比 18.9%），重度 OSA 患者是无 OSA 患者的 10.01 倍（70%比 18.9%）。90 天和 180 天的再入院率也更高。无 OSA 患者的全因死亡率低于有 OSA 患者（P<.01）。OSA 严重程度越高，住院再入院或死亡的时间越短（P<.01）。
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