C75-10 Exploring Obstructive Sleep Apnea as a Risk Factor for Extubation Failure in the ICU: Elevated Prevalence, Diagnostic Challenges, and Treatment Limitations

Obstructive sleep apnea (OSA) is a highly prevalent yet frequently underdiagnosed condition that is associated with significant cardiopulmonary, metabolic, and neurocognitive outcomes. Risk factors for OSA, such as obesity, advanced age, and comorbid cardiopulmonary diseases, overlap with illnesses commonly observed in intensive care unit (ICU) patients, resulting in disproportionately elevated burden in healthcare. This study strives to evaluate the prevalence, diagnostic challenges, and management limitations of OSA in the ICU specifically relating to extubation failure, with the goal of identifying strategies to improve awareness and outcomes in critically ill populations. A critical analysis of published literature was conducted using PubMed, EMBASE, and Scopus. Key search terms included “obstructive sleep apnea,” “ICU,” “extubation failure,” and “sleep-disordered breathing.” A total of six studies encompassing diverse ICU and hospitalized populations (aggregate N ≈ 1.9 million) reported data relevant to extubation outcomes or mechanical ventilation requirements among patients with OSA or high OSA risk. Populations included mixed medical-surgical ICUs, neurocritical care units, perioperative surgical cohorts, and disease-specific hospitalizations (pneumonia, COPD, asthma, and COVID-19). Diagnostic definitions varied across studies, including polysomnography (PSG), portable polygraphy, clinical coding (ICD-based OSA), and validated screening instruments (STOP-BANG). OSA is present in up to 60-70% of ICU patients, yet only ∼5% are formally diagnosed during hospitalization. Underdiagnosis is linked to prolonged mechanical ventilation, extubation failure as high as 30%, 2-fold higher perioperative complication rates, cardiovascular instability, 1.8-fold greater 30-day ICU readmission, and 2.2-fold mortality. OSA or high-risk OSA status consistently predicted worse extubation and ventilation outcomes. The overall extubation failure rate was approximately 19%, and OSA patients demonstrated about threefold higher odds of requiring mechanical ventilation or reintubation. Mortality following failed extubation exceeded 8%, tripled relative to successful extubation cases. Male predominance (≈60%), elevated BMI (>30 kg/m²), and cardiopulmonary comorbidities such as heart failure, COPD, and obesity were common risk modifiers. Our analyses reveal various issues in the clinical care of OSA in ICU. Current diagnostic and treatment strategies are poorly adapted to critically ill patients, highlighting the pressing need for ICU-specific diagnostic tools and management protocols. Implementation of structured OSA screening, particularly among obese and COPD patients, may improve ventilator weaning, reduce ICU length of stay, and prevent avoidable reintubation events. This abstract is funded by: None