Comorbid obstructive sleep apnea may increase readmission risk in patients with COPD

Many patients with COPD have comorbid obstructive sleep apnea and obesity, which may increase risk for hospital readmissions, researchers reported in Annals of the American Thoracic Society.

Researchers evaluated 1,662,983 discharge records of patients hospitalized for COPD exacerbations from 2010 to 2016 from the Nationwide Readmissions Database using Medicare’s Hospital Readmissions Reduction Program criteria.

Nineteen percent of patients with COPD had obesity, 12.9% had OSA, and 7.8% had both obesity and OSA.

Patients with comorbid obesity (OR = 1.04; 95% CI, 1.03-1.05) and those with comorbid OSA (OR = 1.11; 95% CI, 1.1-1.13) had increased odds of 30-day readmission for COPD exacerbations in unadjusted analyses (P < .001 for both).

Nearly three-quarters (71%) of the increased risk for readmission from obesity was attributable to OSA in models adjusted for patient and hospital characteristics, the researchers wrote.

When the researchers adjusted for Charlson Comorbidity Index, OSA remained a significant risk factor for readmission (OR = 1.05; 95% CI, 1.03-1.06; P < .001). However, after accounting for OSA, obesity remained a protective risk factor in this model (OR = 0.96; 95% CI, 0.94-0.97; P < .001), according to the researchers.

“Our study highlights an important comorbid factor that may be influencing health-related outcomes among patients with COPD,” Jessica E. Channick, MD, internal medicine resident in the department of medicine in the division of pulmonary, critical care and sleep medicine at the David Geffen School of Medicine at the University of California, Los Angeles, and colleagues wrote. “This also offers not only a better understanding of risk factors for readmission, but a potential intervention point for the diagnosis and treatment of OSA-COPD overlap with the goal of averting preventable readmissions. Further investigation with prospective analyses of how treatment of OSA affects other COPD parameters such as exacerbation frequency and quality of life will be useful to better understand the degree to which this risk factor is modifiable.”