CPAP/BiPAP Administration and Cardiac Arrest Events in Hospitalized OSA/OHS Patients

Abstract Introduction: Obstructive Sleep Apnea (OSA) and Obesity Hypoventilation Syndrome (OHS) are associated with increased cardiovascular risks and potential cardiac events. Despite these risks, only 4.8%-26% of hospitalized patients with sleep apnea receive CPAP therapy, leaving up to potentially 95% untreated. Prior studies on in-hospital outcomes for OSA/OHS patients have shown mixed results, with some linking OSA/OHS to increased coronary events and ICU transfers, while others suggest a paradoxical reduction in mortality. This study aims to evaluate CPAP/BiPAP prescription rates for OSA/OHS patients and assess their association with cardiac arrest events. We hypothesized that patients with OSA who are untreated would be more likely to have a cardiopulmonary arrest than those who were not treated or had a delay in receiving their therapy. Methods:This retrospective study was performed at a 3-hospital academic health system. A total of 215 patients with OSA/OHS were enrolled from August 2023-August 2024. Demographic and clinical data were collected, including age, race, sex, length of stay, SOFA score, and CPAP/BiPAP therapy details, specifically if therapy was initiated, and if initiation occurred on admission or was delayed. Data were cross-referenced with the institutional resuscitation database. To investigate the relationship between CPAP/BiPAP treatment, treatment timing (on admission vs. delayed) and cardiac arrest events, we conducted a contingency table analysis and applied Fisher's exact test. Results:Among patients with a diagnosis of OSA/OHS who received CPAP/BIPAP on admission (n=60), none experienced a cardiopulmonary arrest. Among those who had a delay in receiving CPAP/BIPAP (n=89), only one patient suffered a cardiopulmonary arrest. The difference between cardiopulmonary arrest events between patients with timely and delayed administration of CPAP/BIPAP was not statistically significant (p-value > 0.9999). When comparing rates of cardiopulmonary arrest for patients treated with CPAP/BIPAP at any point during hospitalization (including delayed treatment) (1/150) to those who did not receive CPAP/BIPAP (1/65) there was no significant difference (p-value = 0.5142). Finally, there was no significant difference between cardiac arrest incidence in patients who received timely CPAP/BIPAP (0/60) versus those who remained untreated (1/65) (p>0.999). Conclusions:Our findings suggest that neither the presence or timing of CPAP/BiPAP prescription was associated with a difference in the likelihood of cardiopulmonary arrest in hospitalized OSA/OHS patients. Future research could examine whether OSA/OHS patients are at higher risk of cardiopulmonary arrest compared to non-OSA patients and investigate the impact on hospital length of stay, level of care adjustments, and resource utilization.