F. S. Jehan1, J. Con1, M. Khan1, A. Azim1, R. Latifi1 1Westchester Medical Center,Surgery,Valhalla, NEW YORK, USA
Introduction: Sleep-disordered breathing (SDA) also known as obstructive sleep apnea is feared to be associated with respiratory complications especially in surgical patients. Trauma patients with SDA may have increased risk of these complications usually due to complex nature of injuries, increase use of opioids/ sedative medications and decreased consciousness levels. However, the association between SDA and outcomes in trauma patients has not been evaluated.
Methods: We performed a 2-year (2011-2012) analysis of the Nationwide Inpatient Sample (NIS) and included all adult (>18 year) trauma patients. Patients were stratified into those with history of SDA and those without history of SDA. Primary outcomes were complications; respiratory and cardiac; the need for non-invasive ventilation and tracheostomy. Secondary outcomes were hospital length of stay, and mortality. Multivariate regression analysis was performed.
Results: A total of 63,284 trauma patients were included in the study. Mean age was 43±17 years and 60% were males. 7.5%(4746) of patients had a SDB. Overall 16.7% patients developed a complication and overall mortality rate was 5.1%.The unadjusted rate of complications between SDA and non-SDA group was (26% vs. 16%, p=0.01) while the unadjusted mortality was (7.6% vs. 4.9%, p=0.02). After performing regression analysis and controlling for all the possible confounders, trauma patients with SDA had higher adjusted rates of developing any complication (OR: 1.5[1.2-2.5], p=0.03), cardiac complications (OR: 1.7[1.3-2.4], p=0.02), respiratory complication [OR: 3.1[2.1-3.9], p<0.01], the need for non-invasive ventilation (OR: 2.5[1.9-.3.2], p<0.01) and tracheostomy (OR: 1.8[1.3-.2.2], p=0.02). The adjusted hospital length of stay was higher (3 days vs. 2 days, p=0.02) in the SDA group compared to the non-SDA group. However, there was no difference in the adjusted mortality between the two groups.
Conclusion: Trauma patients with sleep-disordered breathing are associated with higher risk of cardiac and respiratory complications, the need for non-invasive ventilation, and tracheostomy rates. Patients with SDA spend longer time in the hospital; however, there was no difference between the mortality compared to patients without SDA. These effects of SDA might be attributed to Use of screening criteria including the STOP BANG, will lead to early identification of these patients, and allocation of resources to prevent these complications.