OSA Diagnoses Not Carried Forward to the Inpatient Setting

Andrew D. Bowser

October 27, 2020

Obstructive sleep apnea diagnoses may not be carried over to the inpatient setting, with potentially negative consequences for clinical outcomes, quality of life, and health care costs, an investigator said at the virtual meeting of the American College of Chest Physicians.

In a retrospective, single-center study, nearly 40% of patients with obstructive sleep apnea (OSA) diagnosed in the outpatient setting did not have a corresponding diagnosis during hospitalization, according to researcher Nitasa Sahu, MD.

The missed OSA diagnoses could have especially negative implications for patients who don't continue on positive airway pressure (PAP) therapy during the hospital stay, said Sahu, a fellow in pulmonary/critical care at St. Luke's University Health Network in Bethlehem, Pa.

The finding indicates a large-magnitude opportunity to improve health care through better communication and optimized care, according to the researcher.

"Obstructive sleep apnea is underrecognized, it's underdiagnosed, and it has a lot of implications for a patient's hospitalization," she said in interview

Clinical pathways should be set up to ensure that patients with OSA are properly identified and use their prescribed treatment, according to Sahu.

"I think that should, and would, reduce overall health care costs, with better outcomes as well," she said.

Pulmonologist Saadia A. Faiz, MD, FCCP, said she hoped this study, presented at a late-breaking abstract at the virtual meeting, would highlight the importance of OSA screening and call attention to barriers to screening that may be in place in the inpatient setting.

That's especially important because, after admission, the focus is often on the cause of admission rather than underlying comorbidities such as OSA, said Faiz, professor in the department of pulmonary medicine at the University of Texas MD Anderson Cancer Center in Houston.

"Working in a cancer hospital, the focus is always on the cancer, so sometimes even the patient will dismiss issues with their sleep," Faiz said of her own experience in an interview.

"Often with sleep apnea, for people in the general population, the reason they seek medical attention is because their spouse notices that they're snoring, so it is something that is not as emphasized," added Faiz, who was not involved in the study.

In their study, Sahu and coauthors reviewed electronic health record data for adults hospitalized on the general internal medicine service at Penn State Hershey Medical Center from January 2017 through 2018. They restricted their search to first admissions.

The researchers looked for ICD-9 codes indicating an OSA diagnosis during their inpatient admission. They looked for the same codes in the preceding 5 years to see if the patients had a prior outpatient OSA diagnosis.

The inpatient cohort included 13,067 patients, of whom 53% were male, 87% were White, and 77% were over 50 years of age. Comorbidities included hypertension in 42%, atrial fibrillation in 21%, type 2 diabetes mellitus in 14%, congestive heart failure in 15%, and prior stroke in 0.5%.

A total of 991 individuals in the inpatient cohort had a prior outpatient OSA diagnosis. Of that group, 376 patients (38%) did not have an inpatient OSA diagnosis on inpatient record, according to the reported study data.

That large proportion of discordant diagnoses suggests a lot of missed opportunities to provide OSA therapy in the inpatient setting and to reinforce chronic disease state management, according to Sahu and colleagues.

How those discordant OSA diagnoses impact length of stay, cost of care, and readmissions are unanswered questions that deserve further study, Sahu said.

Among patients who did not have outpatient OSA diagnoses, another 804 patients, or about 6%, ended up with an inpatient diagnosis during their hospitalization, the researchers also reported.

While a number of those inpatient OSA diagnoses could have been coded in error, it's also possible that they were indeed cases of OSA that went unrecognized until the individuals were hospitalized, Sahu said.

Sahu had no relevant relationships to report related to the study. One of four study coauthors reported relationships with Boehringer Ingelheim, Nitto Denko, and Galapagos.

SOURCE: Sahu N. CHEST 2020. Abstract.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.


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