Does testing for sleep-disordered breathing predischarge vs postdischarge result in different treatment outcomes?

Cinthya Pena Orbea, Hussam Jenad, Lena Lea Kassab, Erik K. St Louis, Eric J. Olson, Gaja F. Shaughnessy, Lillian T. Peng, Timothy I. Morgenthaler

Research output: Contribution to journalArticlepeer-review

Abstract

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. CITATION: Orbea CP, Jenad H, Kassab LL, et al. Does testing for sleep-disordered breathing predischarge vs postdischarge result in different treatment outcomes? J Clin Sleep Med. 2021;17(12):2451-2460.

Original languageEnglish (US)
Pages (from-to)2451-2460
Number of pages10
JournalJournal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine
Volume17
Issue number12
DOIs
StatePublished - Dec 1 2021

Keywords

  • follow-up studies
  • inpatient
  • patient discharge
  • patient readmission
  • sleep-disordered breathing

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

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