Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome
AffiliationUniv Arizona, Coll Med, Asthma & Airways Res Ctr
MetadataShow full item record
PublisherNATL MED ASSOC
CitationQuintos, A., Naranjo, M., Kelly, C., Quan, S. F., & Sharma, S. (2019). Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome. Journal of the National Medical Association, 111(2), 176-184.
RightsCopyright © 2018 National Medical Association
Collection InformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at firstname.lastname@example.org.
AbstractPurpose: The HoSMed Database recently demonstrated a high prevalence of obstructive sleep apnea (OSA) in hospitalized obese patients. Based on a long-term follow-up, this study showed an improved survival among patients who were adherent with the therapy. In this post-hoc analysis we explore the characteristics, associations, and mortality outcome of OSA in the African American (AA) population. Methods: These subset analyses included obese AA patients screened in the hospital as high-risk for OSA. Stepwise logistic regression analysis was used to identify predictors of OSA. Patients who had polysomnography (PSG) and were initiated on positive airway pressure (PAP) therapy were followed and dichotomized to adherent versus non-adherent groups based on compliance data. Mortality rates in both groups were compared. Results: Of the total of 2022 AA patients screened, 1370 (60.7% females) were identified as high risk for OSA. Of these, 279 had PSG diagnosed OSA (mean AHI = 36/hour) and were initiated on PAP therapy. Adherence in AAs was significantly lower than for Caucasians (21% versus 45%, Chi-square p < 0.0001). The following statistically significant predictors of OSA were found: heart failure, chronic kidney disease, hypertension and asthma/COPD, BMI and age. A Log-rank survival analysis of AAs on CPAP showed non-significant benefit of adherence (HR: 0.22; 95% CI 0.03-1.7, p = 0.11); a propensity analysis of AAs and Caucasians that adjusted for race and potential confounding variables found a statistically significant benefit of adherence (HR: 0.29; 0.13-0.64; p = 0.002). Conclusion: This large database of hospitalized patients confirms a high prevalence and lower adherence to PAP therapy in African Americans. Adherent patients, however, showed mortality benefit similar to Caucasians.
Note12 month embargo; published online: 9 October 2018
VersionFinal accepted manuscript
- Polysomnography in patients with obstructive sleep apnea: an evidence-based analysis.
- Authors: Medical Advisory Secretariat.
- Issue date: 2006
- Racial disparity in adherence to positive airway pressure among US veterans.
- Authors: Schwartz SW, Sebastião Y, Rosas J, Iannacone MR, Foulis PR, Anderson WM
- Issue date: 2016 Sep
- Adherence to Continuous Positive Airway Pressure therapy in Singaporean patients with Obstructive Sleep Apnea.
- Authors: Tan B, Tan A, Chan YH, Mok Y, Wong HS, Hsu PP
- Issue date: 2018 Sep - Oct
- Commercial Motor Vehicle Driver Positive Airway Pressure Therapy Adherence in a Sleep Center.
- Authors: Colvin LJ, Dace GA, Colvin RM, Ojile J, Collop N
- Issue date: 2016 Apr 15
- Recognition and Treatment of Sleep-Disordered Breathing in Obese Hospitalized Patients May Improve Survival. The HoSMed Database.
- Authors: Sharma S, Mukhtar U, Kelly C, Mather P, Quan SF
- Issue date: 2017 Oct