Impact of obstructive sleep apnea on outcomes of acute respiratory distress syndrome: propensity matched analysis of a national cohort

BACKGROUND: The effects of co-existing OSA on the outcomes of ARDS are unclear. OBJECTIVES: This retrospective study aimed to compare the outcomes and resource utilization rates of OSA patients who develop ARDS with a matched control group. MATERIALS AND METHODS: Adult patients hospitalized between 2016 and 2019 with a diagnostic code for ARDS were identified within the Nationwide Inpatient Sample. Patients with acute cardiogenic pulmonary edema were excluded. By utilizing propensity score calculations, patients with OSA were individually matched with and compared to patients without OSA. Primary outcomes were mortality, length of stay and total hospitalization charges. RESULTS: 9405 OSA patients were matched with 9206 controls. OSA was independently associated with 34% lower odds of in-hospital mortality (21.1%vs 24.9%; aOR 0.66, 95% CI 0.61-0.72; p < 0.001), shorter length of stay (B - 2.0 days; p < 0.001), and lower total hospitalization charges (B -$74,601; P < 0.001). OSA patients had lower rates of invasive mechanical ventilation (aOR 0.79; p < 0.001) and tracheostomy (aOR 0.66; p < 0.001) but higher noninvasive ventilation use (aOR 1.40; p < 0.001). In a subgroup analysis of OSA patients, NIV was associated with fewer tracheostomies (aOR 0.61; p < 0.001) and lower charges (B -$26,625; p < 0.001) but was not associated with mortality or length of stay. CONCLUSIONS: In this nationally representative cohort, preexisting OSA was paradoxically associated with lower mortality, shorter hospitalization, and reduced resource utilization in ARDS. These findings suggest possible protective mechanisms warranting further prospective investigation.