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Effect of Obstructive Sleep Apnea on Outcomes After Traumatic Brain Injury: A Retrospective Cohort Analysis

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Abstract

Background

Traumatic brain injury (TBI) and obstructive sleep apnea (OSA) are common in the general population and are associated with significant morbidity and mortality. The objective of this study was to assess hospital outcomes of patients with TBI with and without a pre-existing OSA diagnosis.

Methods

We retrospectively analyzed data from the National Inpatient Sample (NIS) database of adult patients aged ≥ 18 years with a primary diagnosis of TBI. In-hospital outcomes were assessed among patients with TBI with and without pre-existing OSA hospitalized between 2005 to 2015 in the United States. Propensity score matching and conditional logistic regression models were used to analyze in-hospital mortality, length of hospitalization, and in-hospital complications among patients with TBI with and without a pretrauma OSA diagnosis.

Results

In our TBI cohort, the overall prevalence of diagnosed OSA was 0.90%. Patients with OSA were mostly obese or morbidly obese older men with high comorbidity burden and sustained more severe head injuries yet were less likely to undergo craniotomy or craniectomy. Following propensity score matching, the odds risk (OR) of in-hospital mortality was significantly lower in the OSA group with TBI (OR 0.58; p < 0.001). Compared with the non-OSA group, patients with OSA had significantly higher risk of respiratory complications (OR 1.23) and acute heart failure (OR 1.25) and lower risk of acute myocardial infarction (OR 0.73), cardiogenic shock (OR 0.34), and packed red blood cell transfusions (OR 0.79). Patients with OSA spent on average 0.3 days less (7.4 vs. 7.7 days) hospitalized compared with the non-OSA group.

Conclusions

Patients with TBI with underlying OSA diagnosis were older and had higher comorbidity burden; however, hospital mortality was lower. Pre-existing OSA may result in protective physiologic changes such as hypoxic-ischemic preconditioning especially to cardiac and neural tissues, which can provide protection following neurological trauma, which may lead to a reduction in mortality.

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Funding

This study was not funded.

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Authors and Affiliations

  1. Department of Anesthesiology, Division of Critical Care Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA

    Talha Mubashir, Hunza S. Ahmad, Biai Dominique, Ray Hwong & George W. Williams

  2. Department of Biostatistics, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA

    Hongyin Lai, Vahed Maroufy & Biai Dominique

  3. Department of Anesthesiology and Pain Medicine, University of Toronto and University Health Network, Toronto, Canada

    Rabail Chaudhry & Frances Chung

  4. Department of Anesthesiology and Critical Care, University of Arkansas Medical Center, Little Rock, AR, USA

    Julius Balogh

Authors
  1. Talha Mubashir
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  2. Hunza S. Ahmad
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  4. Rabail Chaudhry
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  5. Vahed Maroufy
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  6. Julius Balogh
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  7. Biai Dominique
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  8. Ray Hwong
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  9. Frances Chung
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  10. George W. Williams
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Contributions

TM, HSA, HL, RC, VM, JB, BD, RH, FC and GWW designed the study and wrote the manuscript; HL and VM conducted the data analysis and collected the data. All authors approved the final manuscript.

Corresponding author

Correspondence to George W. Williams.

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Conflicts of Interest

All authors have disclosed that they do not have any conflict of interest. Dr. Williams has nothing to disclose. Dr. Maroufy has nothing to disclose. Dr. Mubashir has nothing to disclose. Dr. Chaudhry has nothing to disclose. Hongyin Lai has nothing to disclose. Dr. Ahmad has nothing to disclose. Biai Dominique has nothing to disclose. Dr. Balogh has nothing to disclose. Dr. Hwang has nothing to disclose. Dr. Chung has nothing to disclose.

Ethical approval/informed consent

This study adhered to appropriate ethical guidelines. We did not require informed consent for this study.

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Mubashir, T., Ahmad, H.S., Lai, H. et al. Effect of Obstructive Sleep Apnea on Outcomes After Traumatic Brain Injury: A Retrospective Cohort Analysis. Neurocrit Care 37, 228–235 (2022). https://doi.org/10.1007/s12028-022-01479-2

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  • DOI: https://doi.org/10.1007/s12028-022-01479-2

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