老年合并阻塞性睡眠呼吸暂停和心血管疾病患者坚持使用持续气道正压通气可降低 30 天内再住院风险。

Adherence to continuous positive airway pressure reduces the risk of 30-day hospital readmission among older adults with comorbid obstructive sleep apnea and cardiovascular disease.

机构信息

Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.

Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland.

出版信息

J Clin Sleep Med. 2022 Dec 1;18(12):2739-2744. doi: 10.5664/jcsm.10196.

DOI:10.5664/jcsm.10196

PMID:35934923

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9713924/

Abstract

STUDY OBJECTIVES

Obstructive sleep apnea (OSA) is underdiagnosed and undertreated among patients hospitalized with comorbid cardiovascular disease (CVD). Treatment of OSA may reduce health care utilization, but benefits of continuous positive airway pressure (CPAP) therapy are related to adherence. Benefits of CPAP among hospitalized individuals with OSA and CVD have not been well studied. We evaluated the effect of CPAP adherence on 30-day hospital readmission among Medicare beneficiaries hospitalized with OSA and CVD.

METHODS

We conducted a retrospective cohort study of Medicare beneficiaries aged ≥ 65 years with pre-existing CVD who were newly diagnosed with OSA between 2009 and 2013, initiated CPAP, and were hospitalized. CPAP adherence was defined as nonadherent, partially adherent, or highly adherent based on the number of machine charges (< 4, 4-12, and > 12, respectively) over 25 months of follow-up. The primary outcome was 30-day hospital readmission.

RESULTS

Among 1,301 beneficiaries meeting study criteria, the 30-day readmission rate was 10.2%. In adjusted models and compared to patients with low CPAP adherence, those with high adherence had lower odds of 30-day readmission (odds ratio 0.41; 95% confidence interval 0.24-0.70). The protective effect of high CPAP adherence on 30-day readmission was significant among beneficiaries with heart failure (odds ratio 0.50; 95% confidence interval 0.16, 0.79), but not among those with other CVD.

CONCLUSIONS

In this nationally representative sample of older adults with CVD and comorbid OSA, high CPAP adherence was associated with lower odds of 30-day readmission. These results highlight the importance of screening for and treating OSA among individuals with CVD.

CITATION

Bailey MD, Wickwire EM, Somers VK, Albrecht JS. Adherence to continuous positive airway pressure reduces the risk of 30-day hospital readmission among older adults with comorbid obstructive sleep apnea and cardiovascular disease. . 2022;18(12):2739-2744.

摘要

研究目的

合并心血管疾病（CVD）住院的患者中阻塞性睡眠呼吸暂停（OSA）的诊断和治疗不足。OSA 的治疗可能会减少医疗保健的利用，但持续气道正压通气（CPAP）治疗的益处与依从性相关。在合并 OSA 和 CVD 的住院患者中，CPAP 的益处尚未得到很好的研究。我们评估了 CPAP 依从性对患有 OSA 和 CVD 的 Medicare 受益人的 30 天住院再入院的影响。

方法

我们对 2009 年至 2013 年间患有 CVD 的年龄≥65 岁的 Medicare 受益人群进行了回顾性队列研究，这些人群患有新诊断的 OSA，并接受了 CPAP 治疗并住院治疗。CPAP 依从性根据 25 个月随访期间的机器收费次数（<4、4-12 和>12）定义为不依从、部分依从或高度依从。主要结局是 30 天的医院再入院。

结果

在符合研究标准的 1301 名受益人中，30 天再入院率为 10.2%。在调整后的模型中，与低 CPAP 依从性的患者相比，高 CPAP 依从性的患者 30 天再入院的可能性较低（比值比 0.41；95%置信区间 0.24-0.70）。在心力衰竭患者中（比值比 0.50；95%置信区间 0.16,0.79），高 CPAP 依从性对 30 天再入院的保护作用显著，但在其他 CVD 患者中则不然。