Low mortality, higher odds of comorbidities in hospitalized patients with stroke, OSA

Patients hospitalized with acute ischemic stroke and obstructive sleep apnea have lower in-hospital mortality compared with those without obstructive sleep apnea, but higher odds of comorbidities, researchers reported.

Researchers assessed the impact of OSA on clinical outcomes in 475,655 adults admitted to the hospital in 2014 with a primary discharge diagnosis of acute ischemic stroke. Patients were categorized based on coexisting diagnosis of OSA (n = 23,650) or no OSA (n = 452,005).

Patients with OSA were younger (mean age, 66.3 vs. 70.7 years), predominantly men (63.2% vs. 48.3%; P < .05) and white (75.1% vs. 69.8%; P < .05) compared with patients without OSA.

Patients admitted to the hospital for acute ischemic stroke with OSA had significantly higher odds of hypertension (adjusted OR = 1.61; 95% CI, 1.46-1.78), coronary artery disease (aOR = 1.44; 95% CI, 1.34-1.54), congestive heart failure (aOR = 1.69; 95% CI, 1.55-1.84), diabetes (aOR = 1.71; 95% CI, 1.58-1.84), hyperlipidemia (aOR = 1.56; 95% CI, 1.46-1.67) and obesity (aOR = 5.9; 95% CI, 5.54-6.39) after adjustment for patient and hospital-level confounders (P < .05 for all).

Researchers observed a lower mortality rate in patients with OSA compared with patients without OSA (2.8% vs. 4.5%; aOR = 0.69; 95% CI, 0.58-0.83; P < .05).

The researchers reported no significant difference in rates of pneumonia, intubation, gastrostomy, jejunostomy and length or cost of stay between patients with and without OSA.

“In the future, we suggest more randomized controlled trials with stratification of apnea-hypopnea index and compliance to CPAP to investigate the paradoxically decreased mortality,” Si Li, MD, with the Wright Center for Graduate Medical Education in Scranton, Pennsylvania, said during a presentation at the virtual CHEST Annual Meeting.

Reference:

Li S, et al. Chest. 2020;doi:10.1016/j.chest.2020.08.1972.