Recognized Obstructive Sleep Apnea is Associated With Improved In‐Hospital Outcomes After ST Elevation Myocardial Infarction

Abstract

BackgroundObstructive sleep apnea (OSA) is an independent risk factor for many cardiovascular conditions such as coronary artery disease, myocardial infarction, systemic hypertension, pulmonary hypertension, and stroke. However, the association of OSA with outcomes in patients hospitalized for ST‐elevation myocardial infarction remains controversial.Methods and ResultsWe used the nation‐wide inpatient sample between 2003 and 2011 to identify patients with a primary discharge diagnosis of ST‐elevation myocardial infarction and then used the International Classification of Diseases, Clinical Modification code 327.23 to identify a group of patients with OSA. The primary outcome of interest was in‐hospital mortality, and secondary outcomes were in‐hospital cardiac arrest, length of stay and hospital charges. Our cohort included 1 850 625 patients with ST‐elevation myocardial infarction, of which 1.3% (24 623) had documented OSA. OSA patients were younger and more likely to be male, smokers, and have chronic pulmonary disease, depression, hypertension, known history of coronary artery disease, dyslipidemia, obesity, and renal failure (P<0.001 for all). Patients with OSA had significantly decreased in‐hospital mortality (adjusted odds ratio, 0.78 [95% CI, 0.73–0.84]), longer hospital stay (5.00±4.68 versus 4.85±5.96 days), and incurred greater hospital charges ($79 460.12±70 621.91 versus $62 889.91±69 124.15). There was no difference in incidence of in‐hospital cardiac arrest (adjusted odds ratio, 0.93 [95% CI, 0.84–1.03]) between these 2 groups.Conclusion ST‐elevation myocardial infarction patients with recognized OSA had significantly decreased mortality compared with patients without OSA. Although patients with OSA had longer hospital stays and incurred greater hospital charges, there was no difference in incidence of in‐hospital cardiac arrest.

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

“…One study used the Berlin Questionnaire, which has a sensitivity and specificity of approximately 0.76 and 0.59 for mild and 0.77 and 0.44 for moderate OSA, respectively [50]. We observed a large discrepancy between the OSA prevalence reported using ICD-9-CM administrative coding (1.3%) compared to PSG [39]. The accuracy of ICD coding to identify patients with OSA has been criticized as suboptimal as it demonstrated poor sensitivity (58%) and specificity (38%) [51].…”

“…Three other studies reported the prevalence of OSA based on clinical parameters. Mohananey et al reported a much lower OSA prevalence of 1.3% using administrative data (International Classification of Diseases, Ninth Revision, Clinical Modification ICD-9-CM) [39]. Marin et al defined OSA as having met 3 criteria: heavy snoring, excessive daytime sleepiness, and having an ODI ≥ 10.…”

“…One study reported a statistically significant increase in 30-day mortality in patients with a high suspicion of OSA (7.4 vs. 1%, p = 0.03) [25]. While in contrast, OSA was associated with a significant decrease in in-hospital mortality compared to patients without OSA (3.7 vs. 7.4%, respectively, aOR 0.78 p < 0.05) [39]. The use of ICD-9-CM coding in the latter study to identify patients with OSA may have led to the inclusion of undiagnosed or untreated OSA in the "non-OSA group".…”

“…One retrospective cohort study reported on resource utilization [39]. Greater hospital charges were incurred in OSA vs. non-OSA patients presenting with ST-elevation myocardial infarction ($79,460.12 ± 70,621.91 vs. $62,889.91± 69,124.15, respectively, p < 0.001) ( Table 2) [39].…”

Obstructive sleep apnoea in acute coronary syndrome

“…Bearing these controversial data in mind, several studies have been performed to further elucidate the clinical relevance of OSA on the outcome of ACS patients. The findings of MOHANANEY et al [47] seem to support the theory of preconditioning of vessels in intermittent hypoxia. They identified a group of OSA patients with primary discharge diagnosis of STEMI from a nationwide sample.…”