Association of obstructive sleep apnea with all-cause readmissions after hospitalization for asthma exacerbation in adults aged 18–54 years: a population-based study, 2010–2013

Abstract

Objective

To investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for asthma exacerbation.

Methods

We conducted a retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 to 2013. We identified all adults (aged 18–54 years) hospitalized for asthma exacerbation. The outcome measure was all-cause readmissions within one year after hospitalization for asthma exacerbation. To determine associations between OSA and readmission risk, we constructed negative binomial regression models estimating the incidence rate ratio (IRR) for readmissions and Cox proportional hazards models estimating hazard rate (HR) for the time-to-first readmission.

Results

Among 65,731 patients hospitalized for asthma exacerbation, 6,549 (10.0%) had OSA. Overall, OSA was associated with significantly higher incident rate of all cause readmission (1.36 vs. 0.85 readmissions per person-year; unadjusted IRR 1.60; 95%CI 1.54–1.66). Additionally, OSA was associated with higher incident rates of readmissions for five major diseases—asthma (IRR 1.21; 95%CI 1.15–1.27), COPD (IRR 2.03; 95%CI 1.88–2.19), respiratory failure (IRR 3.04; 95%CI 2.76–3.34), pneumonia (IRR 1.67; 95%CI 1.49–1.88), and congestive heart failure (IRR 3.78; 95%CI 3.36–4.24), compared to non-OSA. The Cox model demonstrated that patients with OSA had significantly higher rates for all-cause readmission compared to those without OSA (HR 1.56; 95% CI 1.50–1.62). These associations remained significant after adjustment for confounders.

Conclusions

The observed association of OSA with a higher risk of readmissions after hospitalization for asthma exacerbation underscores the importance of identifying coexistent OSA in this population and optimizing both OSA and asthma management.

Keywords:

• Obstructive sleep apnea
• asthma
• COPD
• heart failure
• pneumonia
• readmission
• respiratory failure

Conflict of interest statements

Dr. Camargo has provided asthma-related consulting services to AstraZeneca, GlaxoSmithKline, Novartis, and Teva. Dr. Hasegawa has received a grant for asthma-related research from Novartis and Teva. The other authors have no relevant financial relationships to disclose.

Role of the authors

All authors have seen and approved the manuscript. Drs. Hirayama, Goto, and Hasegawa conceived the study. Drs. Hirayama and Goto, and Mr. Faridi analyzed the data. Dr. Hirayama drafted the manuscript. Drs. Camargo and Hasegawa supervised the conduct of the study. Finally, all authors contributed substantially to its revision and all authors had access to data.

Additional information

Funding

Dr. Hirayama was supported by a grant from the Fulbright Scholarship. This study was supported by the grant R01 HS023305 from the Agency for Healthcare Research and Quality (Rockville, MD, USA). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality.