EFFECTS OF OSA ON OUTCOMES IN ADULT HOSPITALIZED PATIENTS WITH ACUTE ISCHEMIC STROKE

Abstract

SESSION TITLE: New Insights Into the Relationship Between OSA and Cardiovascular Disease SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Obstructive sleep apnea (OSA) is prevalent and is associated with an increased risk of cardiovascular diseases. There is a paucity of national-level data showing the effect of OSA on patients hospitalized with acute ischemic stroke. We aim to assess the impact of OSA on clinical outcomes in patients hospitalized with acute ischemic stroke. METHODS: Adult patients admitted in 2014 with a primary discharge diagnosis of acute ischemic stroke were included using the Nationwide inpatient sample. These were divided into two groups, with or without a co-existing diagnosis of OSA. We used the International Classification of Diseases, Ninth Revision, Clinical Modification/Procedure Coding System (ICD-9-CM) to identify co-morbid conditions and acute ischemic stroke associated in-hospital complications. For each hospitalization, only the principal diagnosis code was used to identify acute ischemic stroke admissions, which reflects the condition that is chiefly responsible for the patient’s admission to the hospital. We also used ICD-9-CM procedure codes to estimate the percentage of acute ischemic stroke patients who underwent related procedures such as intubation, gastrostomy, jejunostomy. Multivariate regression analysis was performed using STATA 16.0. RESULTS: In 2014, 475,655 adults were admitted with a primary diagnosis of acute ischemic stroke. Among them, 23,650 (4.9%) had a concomitant diagnosis of OSA. In unadjusted analyses, when compared to the group without OSA, patients with OSA were younger (mean age 66.3 vs. 70.7), predominantly males (63.2% vs. 48.3%, p<0.05) and Caucasians (75.1% vs. 69.8%, p<0.05). After adjusting for patient and hospital-level confounders, patients admitted for acute ischemic stroke with OSA had significantly higher odds of having hypertension [adjusted odds ratio (aOR) 1.61, 95% CI 1.46- 1.78, p<0.05], coronary artery disease (aOR 1.44, 95% CI 1.34- 1.54, p<0.05), congestive heart failure (aOR 1.69, 95% CI 1.55- 1.84, p<0.05), diabetes (aOR 1.71, 95% CI 1.58- 1.84, p<0.05), hyperlipidemia (aOR 1.56, 95% CI 1.46- 1.67, p<0.05) and obesity (aOR 5.9, 95% CI 5.54- 6.39, p<0.05). In the OSA group, lower mortality rate (2.8% vs 4.5%, aOR 0.69, 95% CI 0.58- 0.83, p<0.05) was also noticed. No statistically significant difference was seen in rates of developing pneumonia, intubation, gastrostomy/jejunostomy, length or cost of stay between the two groups. CONCLUSIONS: While patients hospitalized for acute ischemic stroke with OSA had higher odds of having comorbidities including hypertension, coronary artery disease, congestive heart failure, diabetes, hyperlipidemia, they had lower in-hospital mortality than those without OSA. CLINICAL IMPLICATIONS: Randomized controlled trials with stratifications of apnea-hypopnea index (AHI) and compliance to continuous positive airway pressure (CPAP) are needed to investigate the paradoxically decreased mortality. DISCLOSURES: No relevant relationships by Nasha Elavia, source=Web Response No relevant relationships by Si Li, source=Web Response No relevant relationships by Bojana Milekic, source=Web Response No relevant relationships by Pius Ochieng, source=Web Response No relevant relationships by Palakkumar Patel, source=Web Response No relevant relationships by NISHANT SHARMA, source=Web Response No relevant relationships by Yichen Wang, source=Web Response