Comparison of Percutaneous Coronary Intervention Outcomes Among Patients With Obstructive Sleep Apnea, Chronic Obstructive Pulmonary Disease Overlap, and Pickwickian Syndrome (Obesity Hypoventilation Syndrome).

• Type of Material: Article
• Authors: Rupak Desai, Atlanta Veterans Affairs Medical Center; Sonali Sachdeva, Boston University; Akhil Jain, Mercy Catholic Medical Center; Bisharah Rizvi, Saint Agnes Medical Center; Hee Kong Fong, University of California Davis; Jilmil Raina, Brookdale University; Vikram Itare, BronxCare Health System; Thomas Alukal, Virginia Commonwealth University; Anubhav Jain, Ascension Genesys Hospital; Ankita Aggarwal, Ascension Providence Hospital; Gautam Kumar, Emory University; Rajesh Sachdeva, Atlanta Veterans Affairs Medical Center
• Language: English
• Date: 2022-05
• Publisher: Cureus
• Publication Version: Final Published Version
• Copyright Statement: © 2022, Desai et al.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.7759/cureus.24816
• Title of Journal or Parent Work: Cureus
• Volume: 14
• Issue: 5
• Start Page: e24816
• End Page: e24816
• Keywords: pickwickian syndrome; chronic obstructive pulmonary disease overlap; obstructive sleep apnea; percutaneous coronary intervention; outcomes
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Public Health

Abstract

Background Obstructive sleep apnea (OSA) is often present in coronary artery disease patients and confers a high risk of complications following percutaneous coronary interventions (PCI). The impact of two commonly associated comorbid conditions, chronic obstructive pulmonary disease (COPD) and obesity hypoventilation syndrome (OHS, Pickwickian syndrome) in OSA patients undergoing PCI has never been studied. Methods The National Inpatient Sample (NIS; 2007-2014) was queried using the International Classification of Diseases, Clinical Modification 9 (ICD-9-CM) codes to compare baseline characteristics, comorbidities, and outcomes in adults undergoing PCI with OSA, COPD-overlap syndrome, and OSA+OHS. Results Of a total of 4,792,177 PCI-related inpatient encounters, OSA, OSA-COPD overlap syndrome, and OSA+OHS were found to be present in 153,706 (median age 62 years, 79.4% male), 65135 (median age 65 years, 66.0% male), and 2291 (median age 63 years, 58.2% males) patients, respectively. The OHS+OSA cohort, when compared to the COPD-OSA and OSA cohorts, was found to have the worst outcomes in terms of all-cause mortality (2.8% vs. 1.5% vs. 1.1%), hospital stay (median 6 vs. 3 vs. 2 days), hospital charges ($147, 209 vs. $101,416 vs. $87,983). Complications, including cardiogenic shock (7.3% vs. 3.4% vs. 2.6%), post-procedural myocardial infarction (11.2% vs. 7.1% vs. 6.0%), iatrogenic cardiac complications (6.1% vs. 3.5% vs. 3.7%), respiratory failure, acute kidney injury, infections, and pulmonary embolism, were also significantly higher in patients with OHS+OSA. Adjusted multivariable analysis revealed equivalent results with OHS+OSA having worse outcomes than OSA-COPD and OSA. Conclusion Concomitant OHS and COPD were linked to worse clinical outcomes in patients with OSA undergoing PCI. Future prospective studies are warranted to fully understand related pathophysiology, evaluate and validate long-term outcomes, and formulate effective preventive and management strategies.