TY - JOUR
T1 - Sleep-disordered breathing is associated with increased mortality in hospitalized infants with congenital heart disease
AU - Combs, Daniel
AU - Skrepnek, Grant
AU - Seckeler, Michael D.
AU - Barber, Brent J.
AU - Morgan, Wayne J.
AU - Parthasarathy, Sairam
N1 - Funding Information:
The KID database is provided through the Healthcare Cost and Utilization Project, with partners (https://www.hcup-us.ahrq.gov/db/hcupdatapartners.jsp) contributing data. All authors have seen and approved this manuscript. This work was supported by the National Institutes of Health Grants (HL138377 to S.P.); Patient-Centered Outcomes Research Institute contract (IHS-1306-2505; EAIN 3394-UOA; and PPRND-1507-31666 to S.P); and the American Sleep Medicine Foundation (ASMF 150-JF-16 to D.C.). The statements in this manuscript are solely the responsibility of the author and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee. Conflicts of Interest: Dr. Parthasarathy reports grants from ASMF (169-SR-17), NIH/ NHLBI (HL13877), grants from Patient Centered Outcomes Research Institute (IHS-1306-2505, EAIN #3394-UoA, PPRND-1507-31666), grants from US Department of Defense, grants from NIH/NCI (1R21CA184920), grants from Johrei Institute, personal fees from American Academy of Sleep Medicine, personal fees from UpToDate Inc., grants from Younes Sleep Technologies, Ltd., grants from Niveus Medical Inc., personal fees from Vapotherm, Inc., personal fees from Merck, Inc., grants from Philips Respironics, Inc., personal fees from Philips Respironics, Inc., personal fees from Bayer, Inc. outside the submitted work; In addition, Dr. Parthasarathy has a patent UA 14-018 U.S.S.N. 61/884,654; PTAS 502570970 (Home breathing device) issued. Dr. Morgan has received consultant fees from Genentech and the Cystic Fibrosis Foundation. The above-mentioned conflicts including the patent are unrelated to the topic of this paper. Drs. Combs, Skrepnek, Barber, and Seckeler report no conflicts of interest.
Funding Information:
by the National Institutes of Health Grants (HL138377 to S.P.); Patient-Centered Outcomes Research Institute contract (IHS-1306-2505; EAIN 3394-UOA; and PPRND-1507-31666 to S.P); and the American Sleep Medicine Foundation (ASMF 150-JF-16 to D.C.). The statements in this manuscript are solely the responsibility of the author and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee. Conflicts of Interest: Dr. Parthasarathy reports grants from ASMF (169-SR-17), NIH/ NHLBI (HL13877), grants from Patient Centered Outcomes Research Institute (IHS-1306-2505, EAIN #3394-UoA , PPRND-1507-31666), grants from US Department of Defense, grants from NIH/NCI (1R21CA184920), grants from Johrei Institute, personal fees from American Academy of Sleep Medicine, personal fees from UpToDate Inc., grants from Younes Sleep Technologies, Ltd., grants from Niveus Medical Inc., personal fees from Vapotherm, Inc., personal fees from Merck, Inc., grants from Philips Respironics, Inc., personal fees from Philips Respironics, Inc., personal fees from Bayer, Inc. outside the submitted work; In addition, Dr. Parthasarathy has a patent UA 14-018 U.S.S.N. 61/884,654; PTAS 502570970 (Home breathing device) issued. Dr. Morgan has received consultant fees from Genentech and the Cystic Fibrosis Foundation. The above-mentioned conflicts including the patent are unrelated to the topic of this paper. Drs. Combs, Skrepnek, Barber, and Seckeler report no conflicts of interest.
Publisher Copyright:
© 2018 American Academy of Sleep Medicine. All rights reserved.
PY - 2018/9/15
Y1 - 2018/9/15
N2 - Study Objectives: Sleep-disordered breathing (SDB) has adverse cardiovascular effects in children and adults. In adults with cardiac disease, SDB is highly prevalent and confers increased mortality risk. It is unknown if SDB confers a similar risk in infants with congenital heart disease (CHD). We evaluated clinical and economic outcomes associated with SDB among inpatient infants with CHD in the United States from 1997–2012. Methods: This retrospective, cross-sectional study used discharge data from the Kids’ Inpatient Database. Inclusion criteria included diagnosed CHD and age younger than 1 year. Exclusion criteria included apnea of prematurity, cardiac surgery during admission, and invasive mechanical ventilation. Generalized linear models were used to assess outcomes of mortality, length of stay, and total charges after controlling for SDB, clinical characteristics, hospital characteristics, and economic factors. Results: Across 461,778 inpatient infant cases of CHD from 1997–2012, 4,839 involved SDB (14% obstructive, 4% central, 82% not specified). Multivariable analyses show that central sleep apnea was independently associated with increased risk of inpatient mortality (odds ratio 4.3), 92% longer inpatient stay, and 112% higher total charges when compared to infants with CHD without comorbid SDB (P < .05). Obstructive and unspecified SDB were associated with longer adjusted lengths of stay (56% and 18%, respectively) and higher charges (48% and 21%, respectively) relative to infants with CHD without comorbid SDB (P < .001). Conclusions: SDB, particularly central sleep apnea, was independently associated with worse outcomes in hospitalized infants with CHD. Further research on whether treatment of SDB in infants with CHD can abrogate adverse patient outcomes is needed.
AB - Study Objectives: Sleep-disordered breathing (SDB) has adverse cardiovascular effects in children and adults. In adults with cardiac disease, SDB is highly prevalent and confers increased mortality risk. It is unknown if SDB confers a similar risk in infants with congenital heart disease (CHD). We evaluated clinical and economic outcomes associated with SDB among inpatient infants with CHD in the United States from 1997–2012. Methods: This retrospective, cross-sectional study used discharge data from the Kids’ Inpatient Database. Inclusion criteria included diagnosed CHD and age younger than 1 year. Exclusion criteria included apnea of prematurity, cardiac surgery during admission, and invasive mechanical ventilation. Generalized linear models were used to assess outcomes of mortality, length of stay, and total charges after controlling for SDB, clinical characteristics, hospital characteristics, and economic factors. Results: Across 461,778 inpatient infant cases of CHD from 1997–2012, 4,839 involved SDB (14% obstructive, 4% central, 82% not specified). Multivariable analyses show that central sleep apnea was independently associated with increased risk of inpatient mortality (odds ratio 4.3), 92% longer inpatient stay, and 112% higher total charges when compared to infants with CHD without comorbid SDB (P < .05). Obstructive and unspecified SDB were associated with longer adjusted lengths of stay (56% and 18%, respectively) and higher charges (48% and 21%, respectively) relative to infants with CHD without comorbid SDB (P < .001). Conclusions: SDB, particularly central sleep apnea, was independently associated with worse outcomes in hospitalized infants with CHD. Further research on whether treatment of SDB in infants with CHD can abrogate adverse patient outcomes is needed.
KW - Children
KW - Congenital heart disease
KW - Sleep apnea
KW - Sleep-disordered breathing
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U2 - 10.5664/jcsm.7334
DO - 10.5664/jcsm.7334
M3 - Article
C2 - 30176962
AN - SCOPUS:85053191060
VL - 14
SP - 1551
EP - 1558
JO - Journal of Clinical Sleep Medicine
JF - Journal of Clinical Sleep Medicine
SN - 1550-9389
IS - 9
ER -