title: Prevalence, treatment, and outcomes associated with OSA among patients hospitalized with pneumonia.
abstract: BACKGROUND
  OSA is associated with increased risks of respiratory complications following surgery. However, its relationship to the outcomes of hospitalized medical patients is unknown.
  
  
  METHODS
  We carried out a retrospective cohort study of patients with pneumonia at 347 US hospitals. We compared the characteristics, treatment, and risk of complications and mortality among patients with and without a diagnosis of OSA while adjusting for other patient and hospital factors.
  
  
  RESULTS
  Of the 250,907 patients studied, 15,569 (6.2%) had a diagnosis of OSA. Patients with OSA were younger (63 years vs 72 years), more likely to be men (53% vs 46%), more likely to be married (46% vs 38%), and had a higher prevalence of obesity (38% vs 6%), chronic pulmonary disease (68% vs 47%), and heart failure (28% vs 19%). Patients with OSA were more likely to receive invasive (18.1% vs 9.3%) and noninvasive (28.8% vs 6.8%) forms of ventilation upon hospital admission. After multivariable adjustment, OSA was associated with an increased risk of transfer to intensive care (OR, 1.54; 95% CI, 1.42-1.68) and intubation (OR, 1.68; 95% CI, 1.55-1.81) on or after the third hospital day, longer hospital stays (risk ratio [RR], 1.14; 95% CI, 1.13-1.15), and higher costs (RR, 1.22; 95% CI, 1.21-1.23) among survivors, but lower mortality (OR, 0.90; 95% CI, 0.84-0.98).
  
  
  CONCLUSIONS
  Among patients hospitalized for pneumonia, OSA is associated with higher initial rates of mechanical ventilation, increased risk of clinical deterioration, and higher resource use, yet a modestly lower risk of inpatient mortality.
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA. Electronic address: peter.lindenauer@baystatehealth.org.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA.
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
authors.affiliation: Division of Neurology, Baystate Medical Center, Springfield, MA; Tufts University School of Medicine, Boston, MA.
authors.forename: Karin G
authors.initials: KG
authors.lastname: Johnson
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, MA.
authors.forename: Aruna
authors.initials: A
authors.lastname: Priya
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; School of Public Health and Health Sciences, University of Massachusetts-Amherst, Amherst, MA.
authors.forename: Penelope S
authors.initials: PS
authors.lastname: Pekow
authors.affiliation: Department of Medicine, Medicine Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Rothberg
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D015995:Prevalence; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D014481:United States / Q000453:epidemiology