Disentangling the role of obstructive sleep apnea in heart failure with preserved ejection fraction readmissions: a National Readmissions Database analysis.

Abstract

Background: Obstructive sleep apnea (OSA) is highly prevalent among patients with heart failure with preserved ejection fraction (HFpEF). The aim of this study was to analyze the poorly characterized independent impact of OSA on short-term readmission and in-hospital outcomes among hospitalizations with HFpEF.

Methods: We performed a retrospective cohort study using the 2019 Nationwide Readmission Database. Adult hospitalizations with acute decompensated HFpEF were identified using ICD-10 codes, and OSA was defined using secondary ICD-10 codes during the index hospitalization. The primary outcome was 30-day all-cause readmission following index hospitalization. Secondary outcomes included length of stay, total hospital charges, days to readmission, and in-hospital mortality. Survey-weighted multivariable logistic and linear regression models were utilized.

Results: Among 16,614 acute HFpEF admissions, approximately 17% had documented OSA. Hospitalizations with OSA were younger, more often male, and had higher rates of respiratory failure during index hospitalization. Unadjusted 30-day readmission rates were similar between OSA and non-OSA groups (17.0% vs 17.4%, P = 0.82). OSA was not independently associated with readmission after adjustment (adjusted odds ratio 0.92, 95% confidence interval 0.77-1.09). Among readmitted patients, those with OSA had higher renal and respiratory complications, while comorbidity burden, payer mix, income quartile, and hospital characteristics were otherwise comparable. The most common readmission diagnosis in the OSA group was hypertensive heart disease. OSA was also not associated with index length of stay, total charges, time to readmission, or in-hospital mortality. Adverse outcomes were noted to be primarily driven by illness severity and resource intensity.

Conclusion: The national prevalence of OSA is approximately 32% and noted to be higher in heart failure patients. Our study depicted a prevalence of 17%, which may be associated with underuse of the code. Readmission risk and resource utilization were driven by acute illness severity and need for organ support, highlighting the importance of targeting inpatient complications to reduce early HFpEF readmissions.