Undiagnosed OSA may worsen COPD outcomes

Sunil Sharma

Patients hospitalized for COPD exacerbations who were also found to have undiagnosed obstructive sleep apnea had an increased likelihood for subsequent death or hospital readmission, researchers reported in Chest.

“COPD is a very common lung condition and one of the top reasons for hospitalizations in the U.S. More than 10% to 20% of these hospitalized patients get readmitted within 30 days. This is at an enormous cost to the system. We wanted to find if sleep apnea (another common disorder) increases the risk of readmission for COPD patients. This was an important question as early recognition and treatment of OSA may reduce readmission rates in this population,” Sunil Sharma, MD, N. Leroy Lapp Professor and chief of the section of pulmonary, critical care and sleep medicine and director of MICU and pulmonary and sleep medicine program development at West Virginia University, wrote in an email to Healio Pulmonology.

From 2017 to 2018, Sharma and colleagues evaluated 380 patients who were admitted to Albert Einstein Medical Center in Philadelphia for COPD exacerbations and were screened for unrecognized or untreated OSA using the STOP questionnaire, followed by high-resolution pulse-oximetry or portable sleep monitoring study if the questionnaire was positive.

Of 238 patients who were admitted for COPD exacerbation and ultimately underwent sleep evaluation after a positive questionnaire, 111 had OSA. Of those who did, 28.6% had mild OSA, 97% had moderate OSA and 8.4% had severe OSA. Patients with OSA were more often men, had a higher BMI and a higher prevalence of comorbid heart failure. Otherwise, baseline characteristics were generally comparable between the two groups, the researchers noted.

Patients hospitalized for COPD exacerbations who were also found to have undiagnosed obstructive sleep apnea had an increased likelihood for subsequent death or hospital readmission, researchers reported in Chest.

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Results showed that overall, patients with COPD and OSA were approximately three times more likely than those without OSA to be readmitted to the hospital at 30 days (OR = 3.5; 95% CI, 1.97-6.29). When analyzed according to OSA severity, the odds for 30-day readmission were twofold higher for patients with mild OSA (OR = 2.05; 95% CI, 1.05-4.03), nearly sevenfold higher for patients with moderate OSA (OR = 6.68; 95% CI, 2.59-17.23) and 10-fold higher for patients with severe OSA (OR = 10.01; 95% CI, 3.49-28.75) when compared with patients without OSA.

Similar trends in readmission rates were noted at 90 and 180 days for patients with vs. without OSA.

Notably, all-cause mortality was lower for patients without OSA (P < .01) and the time to hospital readmission or death was shorter with worsening OSA severity (P < .01).

“While we did suspect some influence of OSA on COPD, there are several noteworthy observations in our study. The fact that nearly half the patients admitted for COPD exacerbation would have OSA (46%) was quite revealing. Furthermore, our study showed the severity of OSA determines the odds of readmission. Lastly, the presence and severity of OSA in patients admitted for COPD exacerbation also have an impact on mortality,” Sharma said.

This study, he added, has several implications for clinical practice.

“The very fact that an important comorbidity like OSA is being missed in half of the patients admitted for COPD exacerbation is important information for treating clinicians. A screening protocol with early recognition of the disorder and timely intervention can be easily implemented by hospitals,” Sharma told Healio Pulmonology. “In fact, we have previously published our novel and cost-effective two-step screening protocol for OSA in hospitalized patients. Hopefully, this may result in better outcomes in these patients and improve health care utilization.”

Looking ahead, Sharma said the next logical step would be a study evaluating whether early recognition and treatment of OSA in hospitalized patients with COPD affects readmissions and subsequent mortality. – by Melissa Foster

For more information:

Sunil Sharma, MD, N. Leroy Lapp Professor and chief of the section of pulmonary, critical care and sleep medicine and director of MICU and pulmonary and sleep medicine program development at West Virginia University, can be reached at Sunil.Sharma@hsc.wvu.edu; Twitter: @Suny_MBBS.

Disclosures: Sharma reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.