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Author:
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Chiner, Eusebi; Llombart, Mónica; Valls Marsal, Joan; Pastor, Esther; Sancho-Chust, José; Luz Andreu, Ada; Sánchez de la Torre, Manuel; Barbé Illa, Ferran
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Notes:
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Background:
We hypothesized that obstructive sleep apnea (OSA) can predispose individuals to lower
airway infections and community-acquired pneumonia (CAP) due to upper airway microaspiration.
This study evaluated the association between OSA and CAP.
Methods:
We performed a case-control study that included 82 patients with CAP and 41 patients with
other infections (control group). The controls were matched according to age, sex and body
mass index (BMI). A respiratory polygraph (RP) was performed upon admission for patients
in both groups. The severity of pneumonia was assessed according to the Pneumonia
Severity Index (PSI). The associations between CAP and the Epworth Sleepiness Scale
(ESS), OSA, OSA severity and other sleep-related variables were evaluated using logistic
regression models. The associations between OSA, OSA severity with CAP severity were
evaluated with linear regression models and non-parametric tests.
Findings:
No significant differences were found between CAP and control patients regarding anthropometric
variables, toxic habits and risk factors for CAP. Patients with OSA, defined as individuals
with an Apnea-Hypopnea Index (AHI) 10, showed an increased risk of CAP (OR =
2 86, 95%CI 1 29–6 44, p = 0 01). Patients with severe OSA (AHI 30) also had a higher
risk of CAP (OR = 3 18, 95%CI 1 11–11 56, p = 0 047). In addition, OSA severity, defined
according to the AHI quartile, was also significantly associated with CAP (p = 0 007). Furthermore,
OSA was significantly associated with CAP severity (p = 0 0002), and OSA severity
was also associated with CAP severity (p = 0 0006).
Conclusions:
OSA and OSA severity are associated with CAP when compared to patients admitted to the
hospital for non-respiratory infections. In addition, OSA and OSA severity are associated with CAP severity. These results support the potential role of OSA in the pathogenesis of
CAP and could have clinical implications. This link between OSA and infection risk should
be explored to investigate the relationships among gastroesophageal reflux, silent aspiration,
laryngeal sensory dysfunction and CAP. |
