Recognition and Treatment of Sleep-Disordered Breathing in Obese Hospitalized Patients May Improve Survival. The HoSMed Database

Sunil Sharma, Umer Mukhtar, Colleen Kelly, Paul Mather, Stuart F Quan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose Sleep-disordered breathing is a common sleep disorder. Recent studies have shown that hospitalized obese patients have a high likelihood of unrecognized sleep-disordered breathing. However, no systematic large study has so far evaluated the outcomes of a screening program. This study provides demographic, clinical, and outcome data from a screening program at a tertiary care academic center. Methods Subjects were 5062 patients screened from March 2013 to July 2016. Of these, 1410 underwent in-hospital overnight high-resolution pulse oximetry and 680 underwent polysomnography post discharge. Patients placed on positive airway therapy were followed in an ambulatory setting. Results The mean age was 60.7 years (SD 15.2), and mean body mass index was 34.8 kg/m2 (SD 8.3), with 2477 (49.0%) males. Of the 1410 high-risk patients who underwent high-resolution plethysmography (HRPO), 1092 were sleep-disordered breathing positive (oxygen desaturation index [ODI] ≥5) and 680 high-risk patients underwent polysomnography. In this latter group, 585 (87%) were found to have sleep-disordered breathing (apnea-hypopnea index [AHI] >5). A receiver operating characteristic curve for ODI derived from HRPO plotted against AHI from polysomnography showed an area under the curve of 0.83 for an ODI of >5. Patients who were adherent to positive airway pressure therapy in the first 3 months had improved survival over a mean follow-up of 609 days compared with those who were nonadherent (P =.01). Conclusion This large database of hospitalized patients confirms a high prevalence of undetected sleep-disordered breathing. Long-term follow-up of those compliant with treatment reveals a survival benefit.

Original languageEnglish (US)
Pages (from-to)1184-1191
Number of pages8
JournalAmerican Journal of Medicine
Volume130
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

Fingerprint

Sleep Apnea Syndromes
Databases
Survival
Polysomnography
Plethysmography
Apnea
Oxygen
Therapeutics
Oximetry
Tertiary Care Centers
ROC Curve
Area Under Curve
Body Mass Index
Demography
Pressure

Keywords

  • Heart failure
  • Obesity
  • Polysomnography
  • Sleep apnea

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Recognition and Treatment of Sleep-Disordered Breathing in Obese Hospitalized Patients May Improve Survival. The HoSMed Database. / Sharma, Sunil; Mukhtar, Umer; Kelly, Colleen; Mather, Paul; Quan, Stuart F.

In: American Journal of Medicine, Vol. 130, No. 10, 01.10.2017, p. 1184-1191.

Research output: Contribution to journalArticle

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abstract = "Purpose Sleep-disordered breathing is a common sleep disorder. Recent studies have shown that hospitalized obese patients have a high likelihood of unrecognized sleep-disordered breathing. However, no systematic large study has so far evaluated the outcomes of a screening program. This study provides demographic, clinical, and outcome data from a screening program at a tertiary care academic center. Methods Subjects were 5062 patients screened from March 2013 to July 2016. Of these, 1410 underwent in-hospital overnight high-resolution pulse oximetry and 680 underwent polysomnography post discharge. Patients placed on positive airway therapy were followed in an ambulatory setting. Results The mean age was 60.7 years (SD 15.2), and mean body mass index was 34.8 kg/m2 (SD 8.3), with 2477 (49.0{\%}) males. Of the 1410 high-risk patients who underwent high-resolution plethysmography (HRPO), 1092 were sleep-disordered breathing positive (oxygen desaturation index [ODI] ≥5) and 680 high-risk patients underwent polysomnography. In this latter group, 585 (87{\%}) were found to have sleep-disordered breathing (apnea-hypopnea index [AHI] >5). A receiver operating characteristic curve for ODI derived from HRPO plotted against AHI from polysomnography showed an area under the curve of 0.83 for an ODI of >5. Patients who were adherent to positive airway pressure therapy in the first 3 months had improved survival over a mean follow-up of 609 days compared with those who were nonadherent (P =.01). Conclusion This large database of hospitalized patients confirms a high prevalence of undetected sleep-disordered breathing. Long-term follow-up of those compliant with treatment reveals a survival benefit.",
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