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

• Published in: Journal of clinical sleep medicine 2021-12, Vol.17 (12), p.2451-2460
• Main Authors: Orbea, Cinthya Pena, Jenad, Hussam, Kassab, Lena Lea, St Louis, Erik K, Olson, Eric J, Shaughnessy, Gaja F, Peng, Lillian T, Morgenthaler, Timothy I
• Format: Article
• Language: English
• Subjects: Adult; Aftercare; Aged; Female; Humans; Patient Discharge; Retrospective Studies; Scientific Investigations; Sleep Apnea Syndromes - diagnosis; Sleep Apnea Syndromes - therapy; Treatment Outcome
• ISSN: 1550-9389; 1550-9397
• DOI: 10.5664/jcsm.9450

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. 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. 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], ≤ .0004). A higher Charlson Comorbidity Index (hazard ratio = 1.14, 95% confidence interval:1.03-1.25, = .001), body mass index (hazard ratio = 1.03, 95% confidence interval:1.0-1.05, = .008), and stroke (hazard ratio = 2.22, 95% confidence interval:1.0-4.9, = .049) were associated with inpatient sleep testing. The inpatient cohort kept fewer follow-up appointments (39.90% vs 50.62%, = .03); however positive airway pressure adherence was high among those keeping follow-up appointments (88.9% [inpatient] vs 85.71% [outpatient], = .55). The inpatient group had an increased risk for death (hazard ratio: 1.82 95% confidence interval 1.28-2.59, ≤ .001) but readmission rates did not differ. 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. Orbea CP, Jenad H, Kassab LL, et al. Does testing for sleep-disordered breathing predischarge vs postdischarge result in different treatment outcomes? . 2021;17(12):2451-2460.