Risk of sleep apnea in hospitalized older patients

Abstract

Background/objectives: To assess the prevalence of undiagnosed obstructive sleep apnea (OSA) among general medical inpatients and to investigate whether OSA risk is associated with in-hospital sleep quantity and quality.

Design: Prospective cohort study.

Setting: General medicine ward in academic medical center.

Participants: 424 hospitalized adult patients ≥ 50 years old without a sleep disorder diagnosis (mean age 65 years, 57% female, 72% African American).

Main measures: The Berlin questionnaire, a validated screen for determining risk of OSA, was administered to hospitalized medical patients. Sleep duration and efficiency were measured via wrist actigraphy. Self-reported sleep quality was evaluated using Karolinska Sleep Quality Index (KSQI).

Key results: Two of every 5 inpatients ≥ 50 years old (39.5%, n = 168) were found to be at high risk for OSA. Mean in-hospital sleep duration was ∼ 5 h and mean sleep efficiency was 70%. Using random effects linear regression models, we found that patients who screened at high risk for OSA obtained ∼ 40 min less sleep per night (-39.6 min [-66.5, -12.8], p = 0.004). These findings remained significant after controlling for African American race, sex, and age quartiles. In similar models, those patients who screened at high risk had ∼ 5.5% less sleep efficiency per night (-5.50 [-9.96, -1.05], p = 0.015). In multivariate analysis, patients at high risk for OSA also had lower self-reported sleep quality on KSQI (-0.101 [-0.164, -0.037], p = 0.002).

Conclusion: Two of every 5 inpatients older than 50 years screened at high risk for OSA. Those screening at high risk have worse in-hospital sleep quantity and quality.

Commentary: A commentary on this article appears in this issue on page 1067.

Keywords: hospitalized patients; obstructive sleep apnea; sleep.

Figures

Figure 1. Patient flow through the study.

Figure 2. Percentage of hospitalized patients screened at high risk for obstructive sleep apnea (total n = 424).

Percentage of hospitalized patients on the general medicine service at the University of Chicago screened as at high or low risk for obstructive sleep apnea (OSA) using the Berlin questionnaire. High risk for OSA is defined as a score on the Berlin questionnaire of ≥ 2.