CPAP treatment improves outcomes in patients undergoing cardiac surgery: CHEST

USA: Routine CPAP in obstructive sleep apnea (OSA) patients undergoing surgical aortic valve replacement (AVR) helps in shorter hospital stays and less requirement of mechanical ventilation, according to a recent study. However, the risk for in-hospital mortality was almost the same in both groups (those who received in-hospital CPAP and those who did not). The study findings were presented at the CHEST Annual Meeting 2020 held from Oct. 18-22, 2020 (virtual meeting), and published in the journal CHEST.OSA is a common comorbidity in severe aortic stenosis patients. Despite this, there is limited data on the patient outcomes in these patients undergoing surgical AVR. Victor E. Prado, MD, clinical instructor of internal medicine at the University of Cincinnati School of Medicine, and colleagues, therefore, aimed to evaluate the effect of routine continuous positive airway pressure (CPAP) on possible outcomes.The study included 70,010 patients who underwent surgical AVR. The outcomes were compared among patients with OSA (15%) who did not and did receive in-hospital CPAP.Primary outcomes included in-hospital mortality, length of stay and health care utilization. Secondary outcomes included all postprocedural complications. 

Key findings of the study include:

• Those with OSA were found to be older (66.90 years vs 66.31 years), predominantly male (76.69% vs 65.23), and white (81.83% vs 77.13%).
• Patients with OSA were also more likely to have a Charlson comorbidity index score ≥3 (37.96% vs 30.06%), Medicare insurance (62.84% vs 60.29%), an income of $43,000-53,999 per year (27.7% vs 25%), and higher BMI.
• The use of CPAP in patients with OSA was associated with lower risk for endotracheal intubation and need for mechanical ventilation longer than 96 hours.
• Use of CPAP was also associated with shorter LOS (-1.78 day), and lower hospitalization charges (-$30,534%) and hospitalization costs (-$5,567).
• The use of CPAP during admission was not associated with changes in inpatient mortality.

Our findings reveal that the routine CPAP use in patients with OSA undergoing SAVR is associated with decreased need for endotracheal intubation, duration of mechanical ventilation, hospital LOS and total hospitalization charges and costs. There was no difference in mortality during the index admission," concluded the authors.

The study, "The Effect of CPAP on In-Hospital Outcomes in Patients with OSA Undergoing SAVR," is published in the Chest journal.

DOI: https://journal.chestnet.org/article/S0012-3692(20)34163-5/fulltext