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    Recognition and Treatment of Sleep-disordered Breathing in Obese African American Hospitalized Patients may Improve Outcome

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    SDBinAApatients_JNMA_SQ.pdf
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    Description:
    Final Accepted Manuscript
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    Author
    Quintos, Abigail
    Naranjo, Mario
    Kelly, Colleen
    Quan, Stuart F
    Sharma, Sunil
    Affiliation
    Univ Arizona, Coll Med, Asthma & Airways Res Ctr
    Issue Date
    2019-04-01
    Keywords
    African Americans
    Hospitalized patients
    Sleep disordered breathing
    
    Metadata
    Show full item record
    Publisher
    NATL MED ASSOC
    Citation
    Quintos, 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.
    Journal
    JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
    Rights
    Copyright © 2018 National Medical Association
    Collection Information
    This 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 repository@u.library.arizona.edu.
    Abstract
    Purpose: 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.
    Note
    12 month embargo; published online: 9 October 2018
    ISSN
    1943-4693
    PubMed ID
    30314827
    DOI
    10.1016/j.jnma.2018.09.003
    Version
    Final accepted manuscript
    Sponsors
    ResMed Inc.
    Additional Links
    https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0027968418302414?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0027968418302414%3Fshowall%3Dtrue&referrer=https:%2F%2Fwww.ncbi.nlm.nih.gov%2F
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.jnma.2018.09.003
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