title: Use of CPAP in patients with obstructive sleep apnea admitted to the general ward: effect on length of stay and readmission rate.
abstract: BACKGROUND
  Obstructive sleep apnea (OSA) has been associated with multiple cardiovascular comorbidities. Despite increased awareness of OSA and its treatments, the management of OSA in the hospital setting remains below expectations.
  
  
  METHODS
  We retrospectively reviewed the demographics, clinical characteristics, and hospital course on 413 consecutive patients with a history of OSA on domiciliary CPAP therapy admitted to the general medical ward and analyzed the prevalence of CPAP use and its effect on length of stay (LOS), 30-day readmission rate, and time-to-readmission in our tertiary care teaching hospital.
  
  
  RESULTS
  Of the 413 study participants, 264 (64.0 %) patients were receiving CPAP during their hospital admission. Patients who were receiving CPAP therapy during their hospitalization had a significantly higher body mass index (BMI) (41.4 vs. 36.8 kg/m(2), p < 0.001) and were more likely to be African-American (p = 0.01) and have congestive heart failure (CHF) (42.0 vs. 31.0 %, p = 0.038) peripheral vascular disease (PVD) (26.0 vs. 15.0 %, p = 0.013), and uncomplicated diabetes mellitus (p = 0.001) than those who were not. CPAP therapy in the hospital setting did not affect LOS (4.7 vs. 4.0 days, p = 0.291), readmission rate (11.0 % for both groups), or time-to-readmission (20.8 vs. 22.3 days, p = 0.762).
  
  
  CONCLUSIONS
  The majority of patients who are on domiciliary CPAP therapy were receiving CPAP therapy while admitted to the general medical ward of a tertiary care academic hospital. Presence of comorbid conditions such as obesity and certain cardiovascular diseases may have increased the likelihood of prescribing CPAP therapy while in the hospital. In-hospital CPAP therapy did not appear to significantly influence short-term outcomes such as hospital LOS, readmission rate, or time-to-readmission.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd., MC / SLUH / 7 FDT, St. Louis, MO, USA. gkamel@slu.edu.
authors.forename: G
authors.initials: G
authors.lastname: Kamel
authors.affiliation: Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA.
authors.forename: K
authors.initials: K
authors.lastname: Munzer
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Saint Louis University School of Medicine, 1402 South Grand Blvd., MC / SLUH / 7 FDT, St. Louis, MO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Espiritu
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D045422:Continuous Positive Airway Pressure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology* / Q000628:therapy*; D013223:Statistics as Topic; D014600:Utilization Review / Q000706:statistics & numerical data
keywords: CPAP; In-hospital CPAP use; Length of stay; Obstructive sleep apnea; readmission