阻塞性睡眠呼吸暂停对急性呼吸窘迫综合征结局的影响：一项全国队列的倾向性匹配分析
Impact of obstructive sleep apnea on outcomes of acute respiratory distress syndrome: propensity matched analysis of a national cohort.
文献信息
| PMID | 42843107 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Berk Madendere |
| 作者单位 | Department of Medicine, Rutgers New Jersey Medical School, Newark, NJ, United States. Electronic address: bm1026@njms.rutgers.edu. |
| 期刊 | Heart & lung : the journal of critical care |
| SCI 分区 | Q2 |
| IF | 2.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 合并阻塞性睡眠呼吸暂停（OSA）对急性呼吸窘迫综合征（ARDS）结局的影响尚不明确。
目的： 本回顾性研究旨在比较发生ARDS的OSA患者与匹配对照组的结局和资源利用率。
材料与方法： 在全国住院患者样本中识别2016年至2019年间住院且带有ARDS诊断代码的成年患者。排除急性心源性肺水肿患者。通过倾向性评分计算，将OSA患者与无OSA患者进行个体匹配并比较。主要结局为死亡率、住院时间和总住院费用。
结果： 9405例OSA患者与9206例对照匹配。OSA与院内死亡几率降低34%独立相关（21.1% vs 24.9%；aOR 0.66，95% CI 0.61-0.72；p < 0.001）、住院时间缩短（B -2.0天；p < 0.001）以及总住院费用降低（B -$74,601；P < 0.001）。OSA患者的有创机械通气率（aOR 0.79；p < 0.001）和气管切开率（aOR 0.66；p < 0.001）较低，但无创通气使用率较高（aOR 1.40；p < 0.001）。在OSA患者的亚组分析中，无创通气与较少的气管切开（aOR 0.61；p < 0.001）和较低的费用（B -$26,625；p < 0.001）相关，但与死亡率或住院时间无关。
结论： 在这个具有全国代表性的队列中，既存OSA paradoxically与ARDS中较低的死亡率、较短的住院时间和减少的资源利用相关。这些发现提示可能存在保护机制，值得进一步前瞻性研究。
英文摘要
BACKGROUND: The effects of co-existing OSA on the outcomes of ARDS are unclear.
OBJECTIVES: This retrospective study aimed to compare the outcomes and resource utilization rates of OSA patients who develop ARDS with a matched control group.
MATERIALS AND METHODS: Adult patients hospitalized between 2016 and 2019 with a diagnostic code for ARDS were identified within the Nationwide Inpatient Sample. Patients with acute cardiogenic pulmonary edema were excluded. By utilizing propensity score calculations, patients with OSA were individually matched with and compared to patients without OSA. Primary outcomes were mortality, length of stay and total hospitalization charges.
RESULTS: 9405 OSA patients were matched with 9206 controls. OSA was independently associated with 34% lower odds of in-hospital mortality (21.1%vs 24.9%; aOR 0.66, 95% CI 0.61-0.72; p < 0.001), shorter length of stay (B - 2.0 days; p < 0.001), and lower total hospitalization charges (B -$74,601; P < 0.001). OSA patients had lower rates of invasive mechanical ventilation (aOR 0.79; p < 0.001) and tracheostomy (aOR 0.66; p < 0.001) but higher noninvasive ventilation use (aOR 1.40; p < 0.001). In a subgroup analysis of OSA patients, NIV was associated with fewer tracheostomies (aOR 0.61; p < 0.001) and lower charges (B -$26,625; p < 0.001) but was not associated with mortality or length of stay.
CONCLUSIONS: In this nationally representative cohort, preexisting OSA was paradoxically associated with lower mortality, shorter hospitalization, and reduced resource utilization in ARDS. These findings suggest possible protective mechanisms warranting further prospective investigation.