BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) is the second most common cause of hospital admission in the United States. Obstructive sleep apnea (OSA) is a highly prevalent and underdiagnosed condition which may impact the outcome of COPD. We hypothesized that presence of unrecognized and untreated OSA will increase hospital readmissions in patients admitted for COPD exacerbation. METHODS We reviewed patients admitted for COPD exacerbation from May 2017- July 2018 who were also screened for previously unrecognized and untreated OSA with a sleep questionnaire, and who subsequently underwent a high-resolution pulse-oximetry (HRPO) or portable sleep monitoring (PM) study. We compared the rates of 30, 90 and 180-day readmission or death across OSA categories and compared overall survival in patients with and without OSA. RESULTS Of 380 patients admitted for COPD exacerbation, 256 were screened for OSA with a sleep questionnaire (STOP). Of these, 238 underwent an overnight HRPO/PM. Out of the total 238 patients, 111 (46.6%) were found to have OSA; 28.6% had mild, 9.7% moderate, and 8.4% severe OSA. Baseline characteristics and demographics were compared between the cohorts of participants with OSA and without OSA and were similar except that patients with OSA had a higher mean BMI (33.9 vs 30.3 kg/m2) and an increased prevalence of heart failure (19.8% vs 7.1%). For COPD patients with mild OSA, odds of 30-day readmission were 2.05 times higher than for patients without OSA (32.4% vs 18.9%). Additionally, odds of 30-day readmission were 6.68 times higher for moderate OSA patients versus patients without OSA (60.9% vs. 18.9%) and 10.01 times high for severe OSA patients versus patients without OSA (70 % vs. 18.9%). Readmission rates were also greater at 90 and 180 days. All-cause mortality was lower for patients without OSA than for patients with OSA (p<0.01). The time to hospital readmission or death was shorter with greater OSA severity (p<0.01). CONCLUSION Patients hospitalized for COPD exacerbation and who have unrecognized OSA, 30, 90 and 180 day readmission rates, and 6 month mortality rates are higher than in those without OSA.

中文翻译：

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未确诊的阻塞性睡眠呼吸暂停可能会显着影响内城医院因 COPD 入院的成年人的预后

背景慢性阻塞性肺病(COPD)是美国住院的第二大常见原因。阻塞性睡眠呼吸暂停 (OSA) 是一种非常普遍且未被充分诊断的疾病，可能会影响 COPD 的预后。我们假设存在未被识别和未经治疗的 OSA 会增加因 COPD 恶化入院的患者的再入院率。方法 我们回顾了 2017 年 5 月至 2018 年 7 月因 COPD 急性加重入院的患者，这些患者还通过睡眠问卷筛查了先前未被识别和未治疗的 OSA，随后接受了高分辨率脉搏血氧仪 (HRPO) 或便携式睡眠监测 (PM)学习。我们比较了 OSA 类别的 30、90 和 180 天再入院率或死亡率，并比较了 OSA 和非 OSA 患者的总生存率。结果 在因 COPD 急性加重入院的 380 名患者中，256 名接受了睡眠问卷 (STOP) 的 OSA 筛查。其中，238 人经历了过夜 HRPO/PM。在总共 238 名患者中，111 名 (46.6%) 被发现患有 OSA；28.6% 有轻度、9.7% 中度和 8.4% 重度 OSA。对 OSA 和非 OSA 参与者队列的基线特征和人口统计学进行了比较，除了 OSA 患者的平均 BMI 较高（33.9 对 30.3 kg/m2）和心力衰竭患病率增加（19.8% 对 7.1%） ）。对于患有轻度 OSA 的 COPD 患者，30 天再入院的几率比没有 OSA 的患者高 2.05 倍（32.4% 对 18.9%）。此外，中度 OSA 患者 30 天再入院的几率是非 OSA 患者的 6.68 倍（60.9% 对 18.9%）和 10。与没有 OSA 的患者相比，严重 OSA 患者高 01 倍（70% 对 18.9%）。90 天和 180 天的再入院率也更高。无 OSA 患者的全因死亡率低于 OSA 患者（p<0.01）。OSA 严重程度越高，再入院或死亡的时间越短（p<0.01）。结论 因 COPD 急性加重住院且未确诊 OSA 的患者，30、90 和 180 天的再入院率以及 6 个月的死亡率高于无 OSA 的患者。