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. 2023 Apr;163(4):942-952.
doi: 10.1016/j.chest.2022.11.028. Epub 2022 Nov 26.

OSA and Subsequent Risk of Hospitalization With Pneumonia, Respiratory Infection, and Total Infection: The Atherosclerosis Risk in Communities Study

Pamela L Lutsey  1 , Islam Zineldin  2 , Jeffrey R Misialek  3 , Kelsie M Full  4 , Kamakshi Lakshminarayan  3 , Junichi Ishigami  5 , Logan T Cowan  6 , Kunihiro Matsushita  5 , Ryan T Demmer  3
Affiliations

OSA and Subsequent Risk of Hospitalization With Pneumonia, Respiratory Infection, and Total Infection: The Atherosclerosis Risk in Communities Study

Pamela L Lutsey et al. Chest. 2023 Apr.

Abstract

Background: OSA has been linked to microaspiration, systemic inflammation, and suboptimal immune function.

Research question: Is OSA prospectively associated with risk of hospitalization for pneumonia, respiratory, and total infections?

Study design and methods: Prospective cohort. Participants in the Atherosclerosis Risk in Communities (ARIC) study (N = 1,586) underwent polysomnography in 1996-1998 and were followed up through 2018 for infection-related hospitalizations. The apnea-hypopnea index (AHI; events/h) was used to categorize participants as having severe OSA (≥ 30), moderate OSA (15-29), mild OSA (5-14), or a normal breathing pattern (< 5). Cox regression was used to calculate hazard ratios (HRs) and 95% CIs.

Results: ARIC participants were on average 62.7 (SD = 5.5) years of age, and 52.8% were female. Severe OSA was present in 6.0%, moderate OSA in 12.7%, mild OSA in 30.0%, and normal breathing in 51.3%. A total of 253 hospitalizations with pneumonia occurred over a median 20.4 (max, 22.9) years' follow-up. Participants with severe OSA were at 1.87 times (95% CI, 1.19-2.95) higher risk of hospitalization with pneumonia compared with those with a normal breathing pattern after adjustment for demographics and lifestyle behaviors. Results were attenuated modestly after adjustment for BMI (1.62 [0.99-2.63]), and prevalent asthma and COPD (1.62 [0.99-2.63]). A similar pattern existed for hospitalization with respiratory infection and composite infection (demographic and behavior-adjusted HRs: 1.47 [0.96-2.25] and 1.48 [1.07-2.04], respectively).

Interpretation: Severe OSA was associated with increased risk of hospitalizations with pneumonia in this community-based cohort. OSA patients may benefit from more aggressive efforts to prevent pneumonia and other infectious conditions.

Keywords: Atherosclerosis Risk in Communities (ARIC) study; OSA; Sleep Heart Health Study (SHHS); infection; pneumonia.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Participants flow chart.
Figure 2
Figure 2
Kaplan-Meier plot - The crude association between OSA–hypopnea index categories and incident hospitalization with pneumonia: the ARIC study, 1996-1998 through 2018 (N = 1,586).
See this image and copyright information in PMC

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