Association between Obstructive Sleep Apnea and Community-Acquired Pneumonia

Eusebi Chiner, Mónica Llombart, Joan Valls, Esther Pastor, José N Sancho-Chust, Ada Luz Andreu, Manuel Sánchez-de-la-Torre, Ferran Barbé, Eusebi Chiner, Mónica Llombart, Joan Valls, Esther Pastor, José N Sancho-Chust, Ada Luz Andreu, Manuel Sánchez-de-la-Torre, Ferran Barbé

Abstract

Background: We hypothesized that obstructive sleep apnea (OSA) can predispose individuals to lower airway infections and community-acquired pneumonia (CAP) due to upper airway microaspiration. This study evaluated the association between OSA and CAP.

Methods: We performed a case-control study that included 82 patients with CAP and 41 patients with other infections (control group). The controls were matched according to age, sex and body mass index (BMI). A respiratory polygraph (RP) was performed upon admission for patients in both groups. The severity of pneumonia was assessed according to the Pneumonia Severity Index (PSI). The associations between CAP and the Epworth Sleepiness Scale (ESS), OSA, OSA severity and other sleep-related variables were evaluated using logistic regression models. The associations between OSA, OSA severity with CAP severity were evaluated with linear regression models and non-parametric tests.

Findings: No significant differences were found between CAP and control patients regarding anthropometric variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals with an Apnea-Hypopnea Index (AHI) ≥10, showed an increased risk of CAP (OR = 2·86, 95%CI 1·29-6·44, p = 0·01). Patients with severe OSA (AHI≥30) also had a higher risk of CAP (OR = 3·18, 95%CI 1·11-11·56, p = 0·047). In addition, OSA severity, defined according to the AHI quartile, was also significantly associated with CAP (p = 0·007). Furthermore, OSA was significantly associated with CAP severity (p = 0·0002), and OSA severity was also associated with CAP severity (p = 0·0006).

Conclusions: OSA and OSA severity are associated with CAP when compared to patients admitted to the hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of CAP and could have clinical implications. This link between OSA and infection risk should be explored to investigate the relationships among gastroesophageal reflux, silent aspiration, laryngeal sensory dysfunction and CAP.

Trial registration: ClinicalTrials.gov NCT01071421.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Study flowchart depicting recruitment.
Fig 1. Study flowchart depicting recruitment.
Fig 2
Fig 2
Association of OSA (A) and OSA severity (B) with CAP. ORs and corresponding 95% CIs (segments) comparing the risk of CAP in (A) patients with OSA (AHI≥10 vs. AHI<10) and (B) patients according to OSA severity (AHI quartiles) are shown. P-values from a logistic regression model and from a trend test are also shown.
Fig 3
Fig 3
Differences in CAP severity (PSI) according to an (A) AHI cutoff of 10 and (B) quartiles classification. Bar height represents the mean PSI value, and the segments represent one standard deviation for each category considered.

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