Department of Anesthesiology, Division of Critical Care Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
Neurocrit Care. 2022 Aug;37(1):228-235. doi: 10.1007/s12028-022-01479-2. Epub 2022 Mar 31.
Traumatic brain injury (TBI) and obstructive sleep apnea (OSA) are common in the general population and are associated with significant morbidity and mortality. The objective of this study was to assess hospital outcomes of patients with TBI with and without a pre-existing OSA diagnosis.
We retrospectively analyzed data from the National Inpatient Sample (NIS) database of adult patients aged ≥ 18 years with a primary diagnosis of TBI. In-hospital outcomes were assessed among patients with TBI with and without pre-existing OSA hospitalized between 2005 to 2015 in the United States. Propensity score matching and conditional logistic regression models were used to analyze in-hospital mortality, length of hospitalization, and in-hospital complications among patients with TBI with and without a pretrauma OSA diagnosis.
In our TBI cohort, the overall prevalence of diagnosed OSA was 0.90%. Patients with OSA were mostly obese or morbidly obese older men with high comorbidity burden and sustained more severe head injuries yet were less likely to undergo craniotomy or craniectomy. Following propensity score matching, the odds risk (OR) of in-hospital mortality was significantly lower in the OSA group with TBI (OR 0.58; p < 0.001). Compared with the non-OSA group, patients with OSA had significantly higher risk of respiratory complications (OR 1.23) and acute heart failure (OR 1.25) and lower risk of acute myocardial infarction (OR 0.73), cardiogenic shock (OR 0.34), and packed red blood cell transfusions (OR 0.79). Patients with OSA spent on average 0.3 days less (7.4 vs. 7.7 days) hospitalized compared with the non-OSA group.
Patients with TBI with underlying OSA diagnosis were older and had higher comorbidity burden; however, hospital mortality was lower. Pre-existing OSA may result in protective physiologic changes such as hypoxic-ischemic preconditioning especially to cardiac and neural tissues, which can provide protection following neurological trauma, which may lead to a reduction in mortality.
创伤性脑损伤 (TBI) 和阻塞性睡眠呼吸暂停 (OSA) 在普通人群中很常见，与显著的发病率和死亡率相关。本研究的目的是评估有和无预先存在的 OSA 诊断的 TBI 患者的住院结局。
我们回顾性分析了国家住院患者样本 (NIS) 数据库中年龄≥18 岁的原发性 TBI 成年患者的数据。在美国，2005 年至 2015 年间，我们评估了有和无预先存在的 OSA 的 TBI 患者的住院期间结局。采用倾向评分匹配和条件逻辑回归模型，分析了有和无创伤前 OSA 诊断的 TBI 患者的住院死亡率、住院时间和住院并发症。
在我们的 TBI 队列中，诊断为 OSA 的总体患病率为 0.90%。患有 OSA 的患者大多是肥胖或病态肥胖的老年男性，合并症负担高，头部受伤更严重，但接受开颅术或颅骨切除术的可能性较小。经过倾向评分匹配后，TBI 合并 OSA 患者的院内死亡率明显较低（OR 0.58；p<0.001）。与非 OSA 组相比，患有 OSA 的患者发生呼吸系统并发症（OR 1.23）和急性心力衰竭（OR 1.25）的风险显著更高，而发生急性心肌梗死（OR 0.73）、心源性休克（OR 0.34）和浓缩红细胞输注（OR 0.79）的风险显著更低。患有 OSA 的患者平均住院时间缩短了 0.3 天（7.4 天与 7.7 天）。
患有 TBI 合并潜在 OSA 诊断的患者年龄较大，合并症负担较重；然而，住院死亡率较低。预先存在的 OSA 可能导致缺氧-缺血预处理等保护性生理变化，特别是对心脏和神经组织，这可以为神经创伤后提供保护，从而降低死亡率。
