0495 Sleep Medicine and the Hospitalized Patient: Evaluation and Predictors for Sleep Disordered Breathing Testing and Associated Outcomes

• Published in: Sleep (New York, N.Y.) N.Y.), 2019-04, Vol.42 (Supplement_1), p.A198-A198
• Main Authors: Orbea, Cinthya Pena, St Louis, Erik K, Dupuy-McCauley, Kara, Shaughnessy, Gaja F, Morgenthaler, Timothy I
• Format: Article
• Language: English
• Subjects: Hospitals; Medicine; Patients; Respiratory failure; Sleep; Sleep disorders
• ISSN: 0161-8105; 1550-9109
• DOI: 10.1093/sleep/zsz067.493

Introduction Untreated sleep disordered breathing (SDB) in patients admitted with pneumonia, COPD, stroke or heart failure increases the risk of hospital complications, and readmission rates. Treating SDB promptly may improve outcomes. At our institution, a sleep medicine inpatient consult service evaluates patients with clinically suspected SDB, and triages selected patients for inpatient sleep studies, while recommending expeditious outpatient evaluation for others. We aimed to investigate the frequency of sleep studies performed in different medical and surgical units, predictors of in- vs. out-patient sleep study, and subsequent adherence to sleep medicine recommendations. Methods We identified all patients over an 8-year period who had inpatient sleep medicine consultation and polysomnography or home sleep apnea testing within 60 days of the inpatient consult. Of 601 patients, we preliminarily analyzed 82 randomly selected patients. We recorded consult indications, co-morbidities, inpatient or outpatient sleep study results, treatment recommendations, and treatment compliance. Factors associated with inpatient versus outpatient sleep studies and treatment outcomes were determined using uni- and bi-variate analysis. Results These 82 inpatients had a mean age of 62±18 years, and were mostly Caucasian (92%) men (66%). The majority (57%) had private insurance. The most common admitting diagnosis was hypoxic hypercapnic respiratory failure (27%). Half of the consultations were requested by an Internal Medicine service. Inpatient sleep studies were performed on 46 (56%) patients. Patients having an inpatient (vs outpatient) sleep study had a higher Charlson Comorbidity Index (median=3 vs 2, p= 0.024) and more frequent pre-discharge BPAP qualification (84.6% vs 50.7%, p=0.024), but were less likely to follow up (32.6% vs 61.1%, p=0.01) and tended to be less PAP compliant (35.7% vs 55.6%, p = 0.292). Among patients with inpatient sleep studies, the 3-month hospital readmission rate was 19.5%, and the 6-month mortality rate was 10.8%. Conclusion Inpatient sleep testing is more commonly performed in complex patients with multiple co-morbidities, and those requiring BPAP qualification before discharge. However, patients tested in the hospital are less likely to adhere to sleep medicine treatment recommendations. Support (If Any)