(1229) Assessing the Influence of OSA on Pneumonia Outcomes: Evidence From a National Database

Introduction: Obstructive Sleep Apnea (OSA) is associated with an increased risk of pneumonia. However, there is a paucity of data on the impact of OSA on in-hospital outcomes in patients admitted for pneumonia. We sought to assess this using a national database.

Methods: A retrospective study was conducted with the National Inpatient Sample Database (2018 to 2020), utilizing ICD-10 codes. We searched for hospitalized adults with a primary diagnosis of pneumonia, categorizing patients with co-existing OSA as the exposure group. The primary outcome assessed was in-hospital mortality, while secondary outcomes were also queried by ICD-10 codes. Multivariate logistic regression was used to compare outcomes, adjusting for patient comorbidities.

Results: A total of 4,467,748 patients were admitted for pneumonia, with 450,580 (10.09%) having associated OSA. After adjusting for various demographic and comorbidity factors, patients with associated OSA exhibited a statistically significant lower mortality rate (aOR 0.74, p <.0001, CI 0.71-0.77), reduced risks of sepsis (aOR 0.89, p <.0001, CI 0.87-0.89) and septic shock (aOR 0.8, p <.0001, CI 0.76-0.84). However, they faced increased risks of acute kidney injury (AKI) (aOR 1.13, p <.0001, CI 1.11-1.15), acute respiratory failure (aOR 1.56, p <.0001, CI 1.54-1.59), ARDS (aOR 1.32, p <.0001, CI 1.23-1.42), need for noninvasive ventilation (aOR 3.26, p <.0001, CI 3.17-3.34), and invasive ventilation (aOR 1.11, p <.0001, CI 1.08-1.15). Notably, the length of stay was marginally longer in patients with associated OSA (+0.11 day, p <.0001, CI 0.07-0.16), but there was no statistically significant difference in total hospital charges.

Conclusions: In our study, pneumonia patients with obstructive sleep apnea (OSA) exhibited lower in-hospital mortality and reduced risks of sepsis and septic shock. This could be attributed to early detection and more active interventions, or potentially an inherent benefit of OSA that is not yet fully understood. However, the study also found increased risks of acute respiratory failure, ARDS, and higher needs for ventilation in these patients. These results highlight the importance of tailored management strategies in OSA patients hospitalized with pneumonia.