PAP therapy and readmission rates after in-hospital laboratory titration polysomnography in patients with hypoventilation
Author Department
Neurology; Healthcare Quality; Medicine
Document Type
Article, Peer-reviewed
Publication Date
3-2022
Abstract
Study objectives: Hypoventilation associated with sleep disordered breathing in inpatients is associated with higher risk of morbidity, hospitalizations and death. In-hospital titration polysomnography qualifies patients for positive airway pressure (PAP) therapy and optimizes settings, but impact is unknown. This study describes a process for in-hospital sleep testing and evaluates subsequent PAP adherence and readmission.
Methods: A retrospective cohort of patients with hypoventilation and in-hospital titration polysomnography with available PAP data were analyzed to determine whether PAP adherence was associated with 90-day readmission. Absolute differences were obtained using logistic regression models. Models were adjusted for body mass index, age and Elixhauser Index. PAP adherence and nonadherence were defined as ≥ 4 and < 4 hours daily average use prior to readmission or first 90-days post-discharge.
Results: 81 patients, 50.6% male, age (mean ± SD) 61.1 ± 13.5 years were included. Comorbid sleep disorders included 91.4% with OSA and 23.5% with central sleep apnea. 28/52 (53.8%) nonadherent and 6/29 (20.7%) adherent patients had 90-day readmissions. 11 (13.6%) patients (all nonadherent) were readmitted within 2 weeks of discharge. Adjusted model showed a 35.6% (95% CI 15.9%-55.2%) reduction in 90-day readmission in adherent group compared to nonadherent (p=0.004). Similar reductions in readmission were found with adherence ≥ 50% and ≥ 70% days ≥ 4 hours. Male sex, treatment with iVAPS, and highest CO2 ≥ 60 mmHg on polysomnography were associated with largest differences in readmission rates between adherent and nonadherent patients.
Conclusions: Adherence to optimized PAP therapy after in-hospital titration polysomnography in patients with hypoventilation may decrease readmissions.
Keywords: hypoventilation; inpatient; noninvasive ventilation; positive airway pressure; readmission.
Recommended Citation
Johnson KG, Rastegar V, Scuderi N, Johnson DC, Visintainer P. PAP therapy and readmission rates after in-hospital laboratory titration polysomnography in patients with hypoventilation. J Clin Sleep Med. 2022 Mar 28. doi: 10.5664/jcsm.9962. Epub ahead of print.
PMID
35332871