Department of Neurology, Baystate Medical Center, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts.
Institute for Healthcare Delivery and Population Science and Department of Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts.
J Clin Sleep Med. 2022 Jul 1;18(7):1739-1748. doi: 10.5664/jcsm.9962.
Hypoventilation associated with sleep-disordered breathing in inpatients is associated with higher risk of morbidity, hospitalizations, and death. In-hospital titration polysomnography qualifies patients for positive airway pressure (PAP) therapy and optimizes settings, but impact is unknown. This study describes a process for in-hospital sleep testing and evaluates subsequent PAP adherence and readmission.
A retrospective cohort of patients with hypoventilation and in-hospital titration polysomnography with available PAP data were analyzed to determine whether PAP adherence was associated with 90-day readmission. Absolute differences were obtained using logistic regression models. Models were adjusted for body mass index, age, and Elixhauser index. PAP adherence and nonadherence were defined as ≥ 4 and < 4 hours of daily average use prior to readmission or first 90 days postdischarge.
Eighty-one patients, 50.6% male, with age (mean ± SD) 61.1 ± 13.5 years were included. Comorbid sleep disorders included 91.4% with obstructive sleep apnea and 23.5% with central sleep apnea. Twenty-eight of 52 (53.8%) nonadherent and 6 of 29 (20.7%) adherent patients had 90-day readmissions. Eleven (13.6%) patients (all nonadherent) were readmitted within 2 weeks of discharge. The adjusted model showed a 35.6% (95% confidence interval 15.9-55.2%) reduction in 90-day readmission in the adherent group compared with the nonadherent group ( = .004). Similar reductions in readmission were found with adherence of ≥ 50% and ≥ 70% of days ≥ 4 hours. Male sex, treatment with iVAPS (intelligent volume-assured pressure support), and highest CO ≥ 60 mmHg on polysomnography were associated with the largest differences in readmission rates between adherent and nonadherent patients.
Adherence to optimized PAP therapy after in-hospital titration polysomnography in patients with hypoventilation may decrease readmissions.
Johnson KG, Rastegar V, Scuderi N, Johnson DC, Visintainer P. PAP therapy and readmission rates after in-hospital laboratory titration polysomnography in patients with hypoventilation. . 2022;18(7):1739-1748.
住院患者睡眠呼吸障碍相关的低通气与更高的发病率、住院率和死亡率相关。住院期间的滴定式多导睡眠图可使患者有资格接受正压通气（PAP）治疗并优化治疗设置，但影响尚不清楚。本研究描述了一种住院睡眠测试的流程，并评估了随后的 PAP 依从性和再入院率。
对接受过低通气和住院滴定式多导睡眠图检查并可获得 PAP 数据的患者进行回顾性队列研究，以确定 PAP 依从性是否与 90 天再入院相关。使用逻辑回归模型获得绝对差异。模型调整了体重指数、年龄和 Elixhauser 指数。PAP 依从性和不依从性定义为再入院或出院后前 90 天内每天平均使用≥4 小时和<4 小时。
共纳入 81 例患者，50.6%为男性，年龄（均值±标准差）为 61.1±13.5 岁。合并的睡眠障碍包括 91.4%的阻塞性睡眠呼吸暂停和 23.5%的中枢性睡眠呼吸暂停。52 例不依从者中有 28 例（53.8%）和 29 例依从者中有 6 例（20.7%）在 90 天内再入院。11 例（13.6%）患者（均不依从）在出院后 2 周内再次入院。调整后的模型显示，与不依从组相比，依从组的 90 天再入院率降低了 35.6%（95%置信区间 15.9-55.2%）（ =.004）。在依从性≥50%和≥70%的天数≥4 小时时，也观察到再入院率的类似降低。男性、使用 iVAPS（智能容量保证压力支持）治疗和多导睡眠图上的最高 CO≥60mmHg 与依从组和不依从组之间再入院率的最大差异相关。
在接受过住院期间滴定式多导睡眠图检查的低通气患者中，依从性优化的 PAP 治疗可能会降低再入院率。
Johnson KG、Rastegar V、Scuderi N、Johnson DC、Visintainer P. 住院实验室滴定多导睡眠图后，低通气患者的 PAP 治疗和再入院率。睡眠医学杂志。2022；18（7）：1739-1748。
