Introduction: With nearly 1 billion people affected, Obstructive Sleep Apnea Syndrome (OSAS) is the most common sleep-related breathing disorder, characterized by intermittent apnea, hypoxemia, and sympathetic activation. OSAS has been linked to worse outcomes and pulmonary complications, including Acute Respiratory Distress Syndrome (ARDS), particularly in postoperative settings. However, its impact on ARDS outcomes remains underexplored. We conducted a nationwide analysis to assess the association between OSAS and outcomes in ARDS hospitalizations. Methods: We performed a retrospective cohort study using the 2016–2019 National Inpatient Sample (NIS), the largest all-payer inpatient database in the U. S. Adults (≥18 years) hospitalized with ARDS were identified using ICD-10-CM codes, excluding those with cardiogenic pulmonary edema. Patients were categorized by OSAS status. Discharge weights were applied for national estimates. Propensity score matching (1: 1) was conducted using demographic, hospital, and clinical variables. Multivariate regression was used to assess associations between OSAS and outcomes. Analyses were conducted using SPSS 29. 0. 2. 0. Results: After exclusions and weighting, 119, 040 ARDS hospitalizations were identified. Following matching, 9, 260 OSAS and 9, 405 non-OSAS patients were included. OSAS was associated with lower in-hospital mortality (aOR 0. 643; P < 0. 001), acute kidney injury (aOR 0. 760; P < 0. 001), ventilator-associated pneumonia (aOR 0. 556; P < 0. 001), delirium (aOR 0. 728; P = 0. 001), C. difficile infection (aOR 0. 770; P = 0. 019), and deep vein thrombosis (aOR 0. 867; P = 0. 031). OSAS patients had greater odds of non-invasive ventilation use (aOR 1. 404; P < 0. 001), but lower odds of invasive mechanical ventilation (aOR 0. 792; P < 0. 001), tracheostomy (aOR 0. 639; P < 0. 001), and ECMO use (aOR 0. 363; P < 0. 001). Total charges were 77, 663 lower and length of stay was 2. 12 days shorter (P < 0. 001 for both). Conclusions: OSAS in ARDS hospitalizations was associated with reduced mortality, fewer complications, lower use of invasive procedures, and significantly reduced resource utilization. These findings may reflect earlier initiation of non-invasive support or protective adaptations from chronic hypoxic preconditioning. Further studies are warranted to explore these mechanisms.
Madendere et al. (Sun,) studied this question.