“Obstructive sleep apnea (OSA) is increasingly being recognized as a risk factor for cardiovascular complications, including cardiac arrhythmias, congestive heart failure, stroke and even sudden death,” says Sunil Sharma, MD. “However, few studies have determined if hospitalized patients at high risk for OSA have a greater rate of RRS events.” Data are also lacking on whether or not intervening with positive airway pressure (PAP) devices can reduce the rate of these events.

A Closer Look

For a study published in PLOS One, Dr. Sharma and colleagues screened 2,590 obese patients (BMI of 30 kg/m2 or higher) in select medical services with a validated sleep disordered breathing questionnaire during a 15-month period. The OSA screening tool used was the STOP questionnaire, which stands for Snoring, Tiredness, Observed Apneas, and Blood Pressure. “The STOP questionnaire was used because of its simplicity, ability to self-administer, and the research team’s institutional experience using the questionnaire,” adds Dr. Sharma.

Based on the STOP questionnaire results, patients were characterized as high or low risk, and RRS rates were compared between groups. The authors then evaluated the impact of PAP therapy on RRS events. According to the results, there was an increased rate of RRS events in high-risk OSA patients when compared with those at lower risk for OSA. About 76% of the patients screened were deemed high risk. These individuals subsequently received a comprehensive sleep evaluation and started PAP treatment if tolerable. “Patients who were compliant with PAP treatment had fewer rapid response events than those who were non-compliant or didn’t accept PAP treatment,” Dr. Sharma says.

Significant Implications

A high burden of OSA in obese hospitalized patients appears to put patients at greater risk for unanticipated adverse outcomes while they are hospitalized. “We also found that patients at higher risk for OSA had longer lengths of stay in the hospital,” adds Dr. Sharma. Given that high risk for OSA is most likely a marker of illness severity, this finding was not surprising. However, the data showing that PAP therapy helped to reduce the frequency of RRS events in compliant patients adds to the current knowledge base.

Use of the STOP screening tool for OSA and PAP therapy for those at high risk are strategies that can be implemented by hospitals with minimal financial burden and expertise. “Our data suggests that it may be beneficial to identify and treat OSA in hospitalized patients in order to improve patient safety and quality of care in the hospital,” Dr. Sharma says. “Multi-centric prospective studies and randomized control trials are needed in the future to confirm our findings and determine the costs and benefits of such initiatives.”

Sunil Sharma, MD, has indicated to Physician’s Weekly that he worked as a paid speaker for Gilead and has previously received an unrestricted research grant from RESMED Corporation. However, the funder of the study discussed in this article had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

 

References

Sharma S, Chowdhury A, Tang L, Willes L, Glynn B, Quan SF. Hospitalized patients at high risk for obstructive sleep apnea have more rapid response system events and intervention is associated with reduced events. PLOS One. 2016:11;e0153790. Available at: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0153790.

Sharma S, Mather PJ, Efird JT, et al. Obstructive sleep apnea in obese hospitalized patients: a single center experience. J Clin Sleep Med. 2015;11:717-723

Winters BD, Weaver SJ, Pfoh ER, Yang T, Pham JC, Dy SM. Rapid-response systems as a patient safety strategy: a systematic review. Ann Intern Med. 2013; 158:417-425.

Gami AS, Olson EJ, Shen WK, et al. Obstructive sleep apnea and the risk of sudden cardiac death: a longitudinal study of 10,701 adults. J Am Coll Cardiol. 2013; 62:610-616.