Routine CPAP in patients with OSA undergoing heart surgery may improve outcomes
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Patients with obstructive sleep apnea treated with CPAP while in-hospital for surgical aortic valve replacement required less mechanical ventilation and had shorter hospital stays compared with those who did not receive in-hospital CPAP.
Risk for in-hospital mortality among patients with OSA who underwent surgical aortic valve replacement (AVR) for severe aortic stenosis did not significantly differ between those who did and did not receive in-hospital CPAP, according to results presented at the virtual CHEST Annual Meeting.
“Obstructive sleep apnea is a common comorbidity in patients with severe aortic stenosis. There is limited data regarding outcomes in patients undergoing surgical aortic valve replacement,” Victor E. Prado, MD, clinical instructor of internal medicine at the University of Cincinnati School of Medicine, said during his presentation. “We aimed to evaluate the effect of routine continuous positive airway pressure on possible outcomes.”
The retrospective analysis included 70,010 patients who underwent surgical AVR. Researchers compared outcomes among patients with OSA (15%) who did and did not receive in-hospital CPAP. Primary outcomes included in-hospital mortality, length of stay and health care utilization. Secondary outcomes included all postprocedural complications.
Among those who underwent surgical AVR, patients with OSA tended to be older (66.9 vs. 66.31 years; P = .016) and were mostly men (76.69% vs. 65.23%; P < .01) and predominantly white (81.83% vs. 77.13%; P < .01) compared with those without OSA.
In an adjusted analysis, routine use of CPAP in hospitalized patients with OSA was associated with reduced need for endotracheal intubation (adjusted OR = 0.37; P = .04) and use of mechanical ventilation for more than 96 hours (aOR = 0.13; P = .041) compared with no CPAP use, according to the results.
In addition, CPAP use during hospitalization for surgical AVR was associated with shorter hospital stay (–1.78 days; P < .01), lower hospitalization charges (–$30,534; P < .01) and lower hospitalization costs (–$5,567; P = .027), according to the results.
Moreover, CPAP use in this population did not appear to affect in-hospital mortality (aOR = 0.75; P = .62).
“We now know that there’s a positive effect from CPAP on this group of patients, but I would like to explore more based on the severity,” Prado said during the presentation. “Will all of these patients benefit from CPAP use or, as we have seen in previous data, is the main impact in those with moderate and severe OSA? In exploring the facts in each group based on severity, we can have a better idea of whether routine use of CPAP should be used views in these groups of patients.”