Association of obstructive sleep apnea with severity of patients hospitalized for acute asthma

Background Studies suggest that obstructive sleep apnea (OSA) is associated with suboptimal disease control and worse chronic severity of asthma. However, little is known about the relations of OSA with acute asthma severity in hospitalized patients. Objective To investigate the association of OSA with acute asthma severity. Methods: This is a retrospective cohort study using State Inpatient Databases from eight geographically-diverse US states, 2010-2013. The outcomes were markers of acute severity—mechanical ventilation use, hospital length-of-stay (LOS), and inhospital mortality. To determine the association of interest, we fit multivariable logistic regression models adjusting for age, sex, race/ethnicity, primary insurance, household income, patient residence, comorbidities, hospital state, and hospitalization year. We repeated the analysis for children aged 6-17 years. Results Among 73,408 adult patients hospitalized for acute asthma, 10.3% had OSA. Coexistent OSA was associated with a significantly higher risk of non-invasive positive pressure ventilation (NIPPV) use (14.9% vs. 3.1%; unadjusted OR 6.48 [95%CI 5.88- 7.13]; adjusted OR 5.20 [95%CI 4.65-5.80]), while coexistent OSA was not significantly associated with the risk of invasive mechanical ventilation use. Patients with OSA had 37% longer hospital LOS (unadjusted incidence rate ratio [IRR] 1.37 [95%CI 1.33- 1.40]); this significant association persisted in the multivariable model (IRR 1.13 [95%CI 1.10-1.17]). The in-hospital mortality did not significantly differ between groups. These findings were consistent in both obesity and non-obesity groups, and in 27,935 children. Conclusion Among patients hospitalized for acute asthma, OSA was associated with a higher risk of NIPPV use and longer LOS compared to those without OSA.