Abstract
Background
Obstructive sleep apnea (OSA) has been associated with multiple cardiovascular comorbidities. Despite increased awareness of OSA and its treatments, the management of OSA in the hospital setting remains below expectations.
Methods
We retrospectively reviewed the demographics, clinical characteristics, and hospital course on 413 consecutive patients with a history of OSA on domiciliary CPAP therapy admitted to the general medical ward and analyzed the prevalence of CPAP use and its effect on length of stay (LOS), 30-day readmission rate, and time-to-readmission in our tertiary care teaching hospital.
Results
Of the 413 study participants, 264 (64.0 %) patients were receiving CPAP during their hospital admission. Patients who were receiving CPAP therapy during their hospitalization had a significantly higher body mass index (BMI) (41.4 vs. 36.8 kg/m2, p < 0.001) and were more likely to be African-American (p = 0.01) and have congestive heart failure (CHF) (42.0 vs. 31.0 %, p = 0.038) peripheral vascular disease (PVD) (26.0 vs. 15.0 %, p = 0.013), and uncomplicated diabetes mellitus (p = 0.001) than those who were not. CPAP therapy in the hospital setting did not affect LOS (4.7 vs. 4.0 days, p = 0.291), readmission rate (11.0 % for both groups), or time-to-readmission (20.8 vs. 22.3 days, p = 0.762).
Conclusion
The majority of patients who are on domiciliary CPAP therapy were receiving CPAP therapy while admitted to the general medical ward of a tertiary care academic hospital. Presence of comorbid conditions such as obesity and certain cardiovascular diseases may have increased the likelihood of prescribing CPAP therapy while in the hospital. In-hospital CPAP therapy did not appear to significantly influence short-term outcomes such as hospital LOS, readmission rate, or time-to-readmission.
Similar content being viewed by others
References
Lee W, Nagubadi S, Kryger MH, Mokhlesi B (2008) Epidemiology of obstructive sleep apnea: a population-based perspective. Expert Review of Respiratory Medicine 2(3):349–364. doi:10.1586/17476348.2.3.349
Ye L, Pien GW, Ratcliffe SJ, Bjornsdottir E, Arnardottir ES, Pack AI, Benediktsdottir B, Gislason T (2014) The different clinical faces of obstructive sleep apnoea: a cluster analysis. The European Respiratory Journal 44(6):1600–1607. doi:10.1183/09031936.00032314
Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328(17):1230–1235
Peppard PE, Young, T., Barnet, J. H., Palta, M., Hagen, E. W., Hla, K. M. (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177(9):1006–1014. doi:10.1093/aje/kws342
Bue AL, Salvaggio A, Isidoro SI, Romano S, Marrone O, Insalaco G (2014) Usefulness of reinforcing interventions on continuous positive airway pressure compliance. BMC Pulmonary Medicine 14:78. doi:10.1186/1471-2466-14-78
Ou Q, Chen Y, Zhuo S, Tian X, He C, Lu X, Gao X (2015) Continuous positive airway pressure treatment reduces mortality in elderly patients with moderate to severe obstructive severe sleep apnea: a cohort study. PLoS one 10(6)
Kanimozhi S, Balaji C, Saravanan A, K KR (2015) Effect of short term CPAP therapy in obstructive sleep apnea patients with metabolic syndrome. J Clin Diagn Res 9(4):cc7-cc10
Fleetham J, Ayas N, Bradley D, Ferguson K, Fitzpatrick M, George C, Hanly P, Hill F, Kimoff J, Kryger M, Morrison D, Series F, Tsai W (2006) Canadian Thoracic Society guidelines: diagnosis and treatment of sleep disordered breathing in adults. Can Respir J 13(7):387–392
Durán-Cantolla J, Aizpuru F, Montserrat J, Ballester E, Terán-Santos J, Aguirregomoscorta J, Gonzalez M, Lloberes P, Masa J, Peña MDL, Carrizo S, Mayos M, Barbé F (2010) Continuous positive airway pressure as treatment for systemic hypertension in people with obstructive sleep apnoea: randomised controlled trial. BMJ 341:c5991
Hussain SF, Irfan M, Waheed Z, Alam N, Mansoor S, Islam M (2014) Compliance with continuous positive airway pressure (CPAP) therapy for obstructive sleep apnea among privately paying patients- a cross sectional study. BMC Pulmonary Medicine 14:188. doi:10.1186/1471-2466-14-188
Spurr KF, Graven MA, Gilbert RW (2008) Prevalence of unspecified sleep apnea and the use of continuous positive airway pressure in hospitalized patients, 2004 National Hospital Discharge Survey. Sleep & Breathing = Schlaf & Atmung 12(3):229–234. doi:10.1007/s11325-007-0166-2
Sorscher AJ, Caruso EM (2012) Frequency of provision of CPAP in the inpatient setting: an observational study: "CPAP provision in the inpatient setting". Sleep & Breathing = Schlaf & Atmung 16(4):1147–1150. doi:10.1007/s11325-011-0621-y
Spurr K, Morrison D, Graven M, Webber A, Gilbert R (2010) Analysis of hospital discharge data to characterize obstructive sleep apnea and its management in adult patients hospitalized in Canada: 2006 to 2007. Can Respir J 17(5):213–218
Proczko MA, Stepaniak PS, de Quelerij M, van der Lely FH, Smulders JF, Kaska L, Soliman Hamad MA (2014) STOP-bang and the effect on patient outcome and length of hospital stay when patients are not using continuous positive airway pressure. J Anesth 28(6):891–897. doi:10.1007/s00540-014-1848-0
Mutter TC, Chateau, D., Moffatt, M., Ramsey, C., Roos, L. L., Kryger, M. (2014) A matched cohort study of postoperative outcomes in obstructive sleep apnea: could preoperative diagnosis and treatment prevent complications? Anesthesiology 121(4):707–718. doi:10.1097/aln.0000000000000407
Abdelsattar ZM, Hendren, S., Wong, S. L., Campbell, D. A., Jr., Ramachandran, S. K. (2015) The impact of untreated obstructive sleep apnea on cardiopulmonary complications in general and vascular surgery: a cohort study. Sleep 38(8):1205–1210. doi:10.5665/sleep.4892
Nagappa M, Mokhlesi, B., Wong, J., Wong, D. T., Kaw, R., Chung, F. (2015) The effects of continuous positive airway pressure on postoperative outcomes in obstructive sleep apnea patients undergoing surgery: a systematic review and meta-analysis. Anesth Analg 120(5):1013–1023. doi:10.1213/ane.0000000000000634
Miguel-Díez Jd, Carrasco-Garrido P, Jiménez-García R, Puente-Maestu L, Hernández-Barrera V, Andrés ALd (2015) Obstructive sleep apnea among hospitalized patients in Spain, analysis of hospital discharge datas 2008–2012. Sleep & breathing = Schlaf & Atmung. doi:10.1007/s11325–014-1104-8
Charlson M, Pompei P, Ales K, MacKenzie C (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383
Charlson M, Szatrowski T, Peterson J, Gold J (1994) Validation of a combined comorbidity index. J Clin Epidemiol 47(11):1245–1251
Smith DF, Spiceland CP, Pringle LC, Mattare KL, Benke JR, Ishman SL (2014) Financial incentive of home continuous positive airway pressure machine use in the inpatient hospital setting. Laryngoscope 124(9):2200–2204. doi:10.1002/lary.24604
Holmqvist F, Guan N, Zhu Z, Kowey PR, Allen LA, Fonarow GC, Hylek EM, Mahaffey KW, Freeman JV, Chang P, Holmes DN, Peterson ED, Piccini JP, Gersh BJ (2015) Impact of obstructive sleep apnea and continuous positive airway pressure therapy on outcomes in patients with atrial fibrillation—results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). American heart journal 169(5):647–654.e642. doi:10.1016/j.ahj.2014.12.024
Nishihata Y, Takata Y, Usui Y, Kato K, Yamaguchi T, Shiina K, Yamashina A (2015) Continuous positive airway pressure treatment improves cardiovascular outcomes in elderly patients with cardiovascular disease and obstructive sleep apnea. Heart Vessel 30(1):61–69. doi:10.1007/s00380-013-0451-x
Kasai T, DYumino, Redolfi S, Su MC, Ruttanaumpawan P, Mak S, Newton GE, Floras JS, Bradley TD (2015) Overnight effects of obstructive sleep apnea and its treatment on stroke volume in patients with heart failure. The Canadian Journal of Cardiology 31(7):832–838. doi:10.1016/j.cjca.2015.01.001
Khayat R, Jarjoura D, Porter K, Sow A, Wannemacher J, Dohar R, Pleister A, Abraham WT (2015) Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. Eur Heart J 36(23):1463–1469. doi:10.1093/eurheartj/ehu522
Kauta SR, Keenan BT, Goldberg L, Schwab RJ (2014) Diagnosis and treatment of sleep disordered breathing in hospitalized cardiac patients: a reduction in 30-day hospital readmission rates. Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy Of Sleep Medicine 10(10):1051–1059. doi:10.5664/jcsm.4096
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
No ethical approval was required for this study.
Funding
No funding was received for this research.
Informed consent
No informed consent was required for this study.
Rights and permissions
About this article
Cite this article
Kamel, G., Munzer, K. & Espiritu, J. Use of CPAP in patients with obstructive sleep apnea admitted to the general ward: effect on length of stay and readmission rate. Sleep Breath 20, 1103–1110 (2016). https://doi.org/10.1007/s11325-016-1328-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11325-016-1328-x