Does testing for sleep-disordered breathing predischarge vs postdischarge result in different treatment outcomes?
J Clin Sleep Med
; 17(12): 2451-2460, 2021 12 01.
Article
en En
| MEDLINE
| ID: mdl-34216199
ABSTRACT
STUDY OBJECTIVES:
Treatment of sleep-disordered breathing may improve health-related outcomes postdischarge. However timely definitive sleep testing and provision of ongoing therapy has been a challenge. Little is known about how the time of testing-during hospitalization vs after discharge-affects important outcomes such as treatment adherence.METHODS:
We conducted a 10-year retrospective study of hospitalized adults who received an inpatient sleep medicine consultation for sleep-disordered breathing and subsequent sleep testing. We divided them into inpatient and outpatient sleep testing cohorts and studied their clinical characteristics, follow-up, positive airway pressure adherence, pressure adherence, hospital readmission and mortality.RESULTS:
Of 485 patients, 226 (47%) underwent inpatient sleep testing and 259 (53%) had outpatient sleep testing. The median age was 68 years old (interquartile range = 57-78), and 29.6% were females. The inpatient cohort had a higher Charlson Comorbidity Index (4 [3-6] vs 3[2-5], P ≤ .0004). A higher Charlson Comorbidity Index (hazard ratio = 1.14, 95% confidence interval1.03-1.25, P = .001), body mass index (hazard ratio = 1.03, 95% confidence interval1.0-1.05, P = .008), and stroke (hazard ratio = 2.22, 95% confidence interval1.0-4.9, P = .049) were associated with inpatient sleep testing. The inpatient cohort kept fewer follow-up appointments (39.90% vs 50.62%, P = .03); however positive airway pressure adherence was high among those keeping follow-up appointments (88.9% [inpatient] vs 85.71% [outpatient], P = .55). The inpatient group had an increased risk for death (hazard ratio 1.82 95% confidence interval 1.28-2.59, P ≤ .001) but readmission rates did not differ.CONCLUSIONS:
Medically complex patients were more likely to receive inpatient sleep testing but less likely to keep follow-up, which could impact adherence and effectiveness of therapy. Novel therapeutic interventions are needed to increase sleep medicine follow-up postdischarge, which may result in improvement in health outcomes in hospitalized patients with sleep-disordered breathing. CITATION Orbea CP, Jenad H, Kassab LL, et al. Does testing for sleep-disordered breathing predischarge vs postdischarge result in different treatment outcomes? J Clin Sleep Med. 2021;17(12)2451-2460.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Alta del Paciente
/
Síndromes de la Apnea del Sueño
Tipo de estudio:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Female
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Humans
Idioma:
En
Revista:
J Clin Sleep Med
Año:
2021
Tipo del documento:
Article