Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
J Asthma. 2021 Sep;58(9):1176-1185. doi: 10.1080/02770903.2020.1781887. Epub 2020 Jun 26.
To investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for asthma exacerbation.
We conducted a retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 to 2013. We identified all adults (aged 18-54 years) hospitalized for asthma exacerbation. The outcome measure was all-cause readmissions within one year after hospitalization for asthma exacerbation. To determine associations between OSA and readmission risk, we constructed negative binomial regression models estimating the incidence rate ratio (IRR) for readmissions and Cox proportional hazards models estimating hazard rate (HR) for the time-to-first readmission.
Among 65,731 patients hospitalized for asthma exacerbation, 6,549 (10.0%) had OSA. Overall, OSA was associated with significantly higher incident rate of all cause readmission (1.36 vs. 0.85 readmissions per person-year; unadjusted IRR 1.60; 95%CI 1.54-1.66). Additionally, OSA was associated with higher incident rates of readmissions for five major diseases-asthma (IRR 1.21; 95%CI 1.15-1.27), COPD (IRR 2.03; 95%CI 1.88-2.19), respiratory failure (IRR 3.04; 95%CI 2.76-3.34), pneumonia (IRR 1.67; 95%CI 1.49-1.88), and congestive heart failure (IRR 3.78; 95%CI 3.36-4.24), compared to non-OSA. The Cox model demonstrated that patients with OSA had significantly higher rates for all-cause readmission compared to those without OSA (HR 1.56; 95% CI 1.50-1.62). These associations remained significant after adjustment for confounders.
The observed association of OSA with a higher risk of readmissions after hospitalization for asthma exacerbation underscores the importance of identifying coexistent OSA in this population and optimizing both OSA and asthma management.
研究阻塞性睡眠呼吸暂停（OSA）与哮喘加重住院后再入院风险之间的关系。
我们使用来自美国七个州（阿肯色州、加利福尼亚州、佛罗里达州、爱荷华州、内布拉斯加州、纽约州和犹他州）的 2010 年至 2013 年的州际住院患者数据库，进行了一项回顾性、基于人群的队列研究。我们确定了所有因哮喘加重而住院的成年人（年龄 18-54 岁）。主要结局是哮喘加重住院后一年内的全因再入院。为了确定 OSA 与再入院风险之间的关联，我们构建了负二项回归模型来估计再入院的发生率比（IRR），以及 Cox 比例风险模型来估计首次再入院的危险率（HR）。
在 65731 名因哮喘加重而住院的患者中，有 6549 名（10.0%）患有 OSA。总体而言，OSA 与全因再入院的发生率显著升高相关（每 1 人年发生 1.36 次 vs. 0.85 次；未调整的 IRR 为 1.60；95%CI 1.54-1.66）。此外，OSA 与五种主要疾病（哮喘、COPD、呼吸衰竭、肺炎和充血性心力衰竭）的再入院发生率升高相关，与非 OSA 患者相比，分别为哮喘（IRR 1.21；95%CI 1.15-1.27）、COPD（IRR 2.03；95%CI 1.88-2.19）、呼吸衰竭（IRR 3.04；95%CI 2.76-3.34）、肺炎（IRR 1.67；95%CI 1.49-1.88）和充血性心力衰竭（IRR 3.78；95%CI 3.36-4.24）。Cox 模型表明，与非 OSA 患者相比，OSA 患者的全因再入院率显著更高（HR 1.56；95%CI 1.50-1.62）。在调整了混杂因素后，这些关联仍然显著。
OSA 与哮喘加重住院后再入院风险升高之间的观察到的关联强调了在该人群中识别并存 OSA 并优化 OSA 和哮喘管理的重要性。
