TY - JOUR
T1 - Does testing for sleep-disordered breathing predischarge vs postdischarge result in different treatment outcomes?
AU - Orbea, Cinthya Pena
AU - Jenad, Hussam
AU - Kassab, Lena Lea
AU - St Louis, Erik K.
AU - Olson, Eric J.
AU - Shaughnessy, Gaja F.
AU - Peng, Lillian T.
AU - Morgenthaler, Timothy I.
N1 - Publisher Copyright:
Copyright 2022 American Academy of Sleep Medicine. All rights reserved.
PY - 2021/12
Y1 - 2021/12
N2 - Study Objectives: Treatment of sleep-disordered breathing may improve health-related outcomes postdischarge. However timely definitive sleep testing and provision of ongoing therapy has been a challenge. Little is known about how the time of testing—during hospitalization vs after discharge—affects important outcomes such as treatment adherence. Methods: We conducted a 10-year retrospective study of hospitalized adults who received an inpatient sleep medicine consultation for sleep-disordered breathing and subsequent sleep testing. We divided them into inpatient and outpatient sleep testing cohorts and studied their clinical characteristics, follow-up, positive airway pressure adherence, pressure adherence, hospital readmission and mortality. Results: Of 485 patients, 226 (47%) underwent inpatient sleep testing and 259 (53%) had outpatient sleep testing. The median age was 68 years old (interquartile range = 57–78), and 29.6% were females. The inpatient cohort had a higher Charlson Comorbidity Index (4 [3–6] vs 3[2–5], P ≤ .0004). A higher Charlson Comorbidity Index (hazard ratio = 1.14, 95% confidence interval:1.03–1.25, P = .001), body mass index (hazard ratio = 1.03, 95% confidence interval:1.0–1.05, P = .008), and stroke (hazard ratio = 2.22, 95% confidence interval:1.0–4.9, P = .049) were associated with inpatient sleep testing. The inpatient cohort kept fewer follow-up appointments (39.90% vs 50.62%, P = .03); however positive airway pressure adherence was high among those keeping follow-up appointments (88.9% [inpatient] vs 85.71% [outpatient], P = .55). The inpatient group had an increased risk for death (hazard ratio: 1.82 95% confidence interval 1.28–2.59, P ≤ .001) but readmission rates did not differ. Conclusions: Medically complex patients were more likely to receive inpatient sleep testing but less likely to keep follow-up, which could impact adherence and effectiveness of therapy. Novel therapeutic interventions are needed to increase sleep medicine follow-up postdischarge, which may result in improvement in health outcomes in hospitalized patients with sleep-disordered breathing.
AB - Study Objectives: Treatment of sleep-disordered breathing may improve health-related outcomes postdischarge. However timely definitive sleep testing and provision of ongoing therapy has been a challenge. Little is known about how the time of testing—during hospitalization vs after discharge—affects important outcomes such as treatment adherence. Methods: We conducted a 10-year retrospective study of hospitalized adults who received an inpatient sleep medicine consultation for sleep-disordered breathing and subsequent sleep testing. We divided them into inpatient and outpatient sleep testing cohorts and studied their clinical characteristics, follow-up, positive airway pressure adherence, pressure adherence, hospital readmission and mortality. Results: Of 485 patients, 226 (47%) underwent inpatient sleep testing and 259 (53%) had outpatient sleep testing. The median age was 68 years old (interquartile range = 57–78), and 29.6% were females. The inpatient cohort had a higher Charlson Comorbidity Index (4 [3–6] vs 3[2–5], P ≤ .0004). A higher Charlson Comorbidity Index (hazard ratio = 1.14, 95% confidence interval:1.03–1.25, P = .001), body mass index (hazard ratio = 1.03, 95% confidence interval:1.0–1.05, P = .008), and stroke (hazard ratio = 2.22, 95% confidence interval:1.0–4.9, P = .049) were associated with inpatient sleep testing. The inpatient cohort kept fewer follow-up appointments (39.90% vs 50.62%, P = .03); however positive airway pressure adherence was high among those keeping follow-up appointments (88.9% [inpatient] vs 85.71% [outpatient], P = .55). The inpatient group had an increased risk for death (hazard ratio: 1.82 95% confidence interval 1.28–2.59, P ≤ .001) but readmission rates did not differ. Conclusions: Medically complex patients were more likely to receive inpatient sleep testing but less likely to keep follow-up, which could impact adherence and effectiveness of therapy. Novel therapeutic interventions are needed to increase sleep medicine follow-up postdischarge, which may result in improvement in health outcomes in hospitalized patients with sleep-disordered breathing.
KW - follow-up studies
KW - inpatient
KW - patient discharge
KW - patient readmission
KW - sleep-disordered breathing
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U2 - 10.5664/jcsm.9450
DO - 10.5664/jcsm.9450
M3 - Article
C2 - 34216199
AN - SCOPUS:85122489291
SN - 1550-9389
VL - 17
SP - 2451
EP - 2460
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
IS - 12
ER -