title: Obstructive sleep apnea and adverse outcomes in surgical and nonsurgical patients on the wards.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) has been associated with clinical deterioration in postoperative patients and patients hospitalized with pneumonia. Paradoxically, OSA has also been associated with decreased risk of inpatient mortality in these same populations.
  
  
  OBJECTIVE
  To investigate the association between OSA and in-hospital mortality in a large cohort of surgical and nonsurgical ward patients.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  A 500-bed academic tertiary care hospital in the United States.
  
  
  METHODS
  A total of 93,676 ward admissions from 53,150 unique adult patients between November 1, 2008 and October 1, 2013.
  
  
  METHODS
  None.
  
  
  METHODS
  OSA diagnoses and comorbidities were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Logistic regression was used to control for patient characteristics, location prior to ward admission, and admission severity of illness. The primary outcome was in-hospital death. Secondary outcomes included rapid response team (RRT) activation, intensive care unit (ICU) transfer, intubation, and cardiac arrest on the wards.
  
  
  RESULTS
  OSA was identified in 5,625 (10.6%) patients. Patients with OSA were more likely to be older, male, and obese, and had higher rates of comorbidities. OSA patients had more frequent RRT activations (1.5% vs 1.1%) and ICU transfers (8% vs 7%) than controls (P < 0.001 for both comparisons), but a lower inpatient mortality rate (1.1% vs 1.4%, P < 0.05). OSA was associated with decreased adjusted odds for ICU transfer (odds ratio [OR]: 0.91 [0.84-0.99]), cardiac arrest (OR: 0.72 [0.55-0.95]), and in-hospital mortality (OR: 0.70 [0.58-0.85]).
  
  
  CONCLUSIONS
  After adjustment for important confounders, OSA was not associated with clinical deterioration on the wards and was associated with significantly decreased in-hospital mortality.
authors.affiliation: University of Chicago Internal Medicine Residency, Chicago, Illinois.
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Lyons
authors.affiliation: Department of Medicine, Section of Hospital Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Zadravecz
authors.affiliation: Department of Medicine, Section of Hospital Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Dana P
authors.initials: DP
authors.lastname: Edelson
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Babak
authors.initials: B
authors.lastname: Mokhlesi
authors.affiliation: Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago Medicine, Chicago, Illinois.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Churpek
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D017052:Hospital Mortality; D057209:Hospital Rapid Response Team; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D020181:Sleep Apnea, Obstructive / Q000150:complications* / Q000401:mortality; D014481:United States