title: Early recognition of obstructive sleep apnea in patients hospitalized with COPD exacerbation is associated with reduced readmission.
abstract: OBJECTIVE
  The combination of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease is known as the "overlap syndrome", and results in frequent hospitalizations and worse prognosis. We hypothesized that early detection and treatment of this condition in hospitalized patients may reduce clinical events (hospital admissions and emergency room visits) Methods: Between April 2013 and January 2014 all patients consulted for COPD exacerbation and having a BMI of > 30 kg/m(2) were screened for OSA. If high risk, patients underwent a polysomnography on discharge. Readmission rate in patients compliant with positive airway pressure was compared to patients who were deemed non-compliant based on objective data from the device.
  
  
  RESULTS
  Full polysomnogram data and compliance was available on 24 patients. The baseline characteristics were comparable between the compliant and non-compliant groups. The mean change in the total clinical events 6 months prior to intervention compared to 6 months following intervention was -2.1 ± 0.3 in the compliant group, compared to -0.8 ± 0.5 in the non-compliant group (p = 0.01). The mean change in the total clinical events 12 months prior to intervention compared to 12 months following intervention was -2.7 ± 0.5 in the compliant group, compared to -0.8 ± 0.6 in the non-compliant group (p = 0.03) CONCLUSION: In conclusion, our data suggest that early recognition and treatment of OSA in patients admitted with COPD exacerbation and compliant with PAP therapy is associated with reduced 6-month hospital readmission rates and emergency room visits. Screening for OSA in patients admitted with COPD exacerbation is a simple and early intervention that should be encouraged to help reduce hospital readmissions in this patient population.
authors.affiliation: a Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: John
authors.initials: J
authors.lastname: Konikkara
authors.affiliation: a Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Tavella
authors.affiliation: b Willes Consulting Group, Inc , CA , USA.
authors.forename: Leslee
authors.initials: L
authors.lastname: Willes
authors.affiliation: a Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Kavuru
authors.affiliation: a Jefferson Sleep Disorders Center, Thomas Jefferson University Hospital , Philadelphia , PA , USA.
authors.forename: Sunil
authors.initials: S
authors.lastname: Sharma
mesh_terms: D000368:Aged; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure; D042241:Early Diagnosis; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D015143:Philadelphia / Q000453:epidemiology; D017286:Polysomnography; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology / Q000628:therapy*; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*
keywords: Chronic obstructive pulmonary disease; Hospital readmissions; Obstructive sleep apnea; positive airway pressure therapy