Hospitalized Patients at High Risk for Obstructive Sleep Apnea Have More Rapid Response System Events and Intervention Is Associated with Reduced Events

Abstract

BackgroundRapid response system (RRS) is a safety tool designed for early detection and intervention of a deteriorating patient on the general floor in the hospital. Obstructive sleep apnea (OSA) has been associated with significant cardiovascular complications. We hypothesized that patients with high-risk of OSA have higher rate of RRS events and intervention with positive airway pressure therapy in these patients can mitigate the RRS events.MethodsAs part of a clinical pathway, during a 15 month period, patients with BMI ≥ 30 kg/m2 in select medical services were screened with a validated sleep questionnaire. Patients were characterized as high or low risk based on the screening questionnaire. RRS rates were compared between the groups. Subsequently the impact of PAP therapy on RRS events was evaluated.ResultsOut of the 2,590 patients screened, 1,973 (76%) were identified as high-risk. RRS rates calculated per 1,000 admissions, were 43.60 in the High-Risk OSA group versus 25.91 in the Low-Risk OSA Group. The PAP therapy compliant group had significantly reduced RRS event rates compared to non-compliant group and group with no PAP therapy (16.99 vs. 53.40 vs. 56.21) (p < 0.01).ConclusionIn a large cohort of patients at a tertiary care hospital, we show an association of increased rate of RRS events in high-risk OSA patients and reduction of the risk with PAP intervention in the compliant group.

Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

“…Consequently, evidence to guide the management of cardiac inpatients with OSA is limited. Previous studies have highlighted that cardiac inpatients with a high risk of OSA are more likely to experience critical events requiring activation of rapid response systems [12,13]. Treatments such as positive airway pressure (PAP) therapy can potentially reduce critical events, which have several implications for clinical practice [12].…”

Oximetry use in obstructive sleep apnea

“…Early diagnosis and treatment is essential to decrease the impact of OSAS in the quality of life of patients [2].…”

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

“…Early recognition of highrisk patients for obstructive sleep apnea in hospitalized patients also predicted more frequent rapid response events, which were reduced in patients who were successfully intervened with PAP therapy. 9 The major finding in this study was that patients treated and compliant with PAP therapy showed a significant survival advantage compared with those who were noncompliant. We do not believe that differences in various comorbidities explains the observed survival advantage of PAP therapy-adherent patients in that there were few differences in the prevalence of important comorbid conditions between the 2 groups, and this observation was supported using an inverse propensity score analysis that accounted for differences between the 2 groups.…”

“…Of 5062 patients included in the final database, 1161 patients have been included in prior publications. 9,11,12,16,17 The Thomas Jefferson University Institutional Review Board approved the study.…”

“…8 Thus, efforts to more quickly diagnose and treat patients with sleepdisordered breathing have the potential to reduce negative outcomes. 9 Recent efforts to perform sleep-disordered breathing screening and treatment in hospitalized patients have been encouraging. Studies by ourselves and others have shown that early diagnosis of sleep-disordered breathing and intervention in hospitalized patients resulted in a reduction in 30-day and 6-month readmissions in patients admitted for acute heart failure and chronic obstructive pulmonary disease exacerbation.…”