Assessment of mortality risk in elderly persons with obstructive sleep apnea diagnosed with pneumonia

Objective: Aging is associated with increased risk of obstructive sleep apnea (OSA) and treatment of OSA in elderly is of great interest but controversial. Pneumonia requiring invasive mechanical ventilation (IMV) is a leading cause of death in the elderly. The purpose of the study was to assess pneumonia-related mortality in elderly persons with OSA. Methods: The Nationwide Inpatient Sample (NIS) was investigated for discharges with a primary or secondary diagnosis of pneumonia between 2009 and 2011. Persons with OSA, aged 65 years and older, were compared to a cohort of patients without OSA. Primary outcomes were in-hospital mortality and non-routine discharge (discharge to nursing home or skilled facility). Logistic regression models were used to assess the risk of OSA on in-hospital mortality and discharge status. Results: In 1,768,185 hospital discharges, approximately 5% had OSA, and its prevalence was inversely proportional to age (65-74: 8.3%, 75-84: 4.8%, 85+: 1.8%). Pneumonia requiring IMV was more common in the OSA cohort (OSA: 4.3% vs. Non-OSA: 3.3% <0.0001). In-hospital mortality (OSA: 3.3% vs. Non-OSA 5.1% <0.0001) and non-routine discharges (OSA: 46.9% vs. Non-OSA: 55.4% <0.0001) were significantly lower in the OSA group. Conclusion: OSA was associated with reduced inpatient mortality risk in pneumonia related respiratory failure in elderly subjects. Sleep apnea may confer a survival benefit in older individuals; but further research is warranted.