Objective: Aging is associated with increased risk of obstructive sleep apnea (OSA) and
treatment of OSA in elderly is of great interest but controversial. Pneumonia requiring invasive
mechanical ventilation (IMV) is a leading cause of death in the elderly. The purpose of the study was to
assess pneumonia-related mortality in elderly persons with OSA.
Methods: The Nationwide Inpatient Sample (NIS) was investigated for discharges with a primary or
secondary diagnosis of pneumonia between 2009 and 2011. Persons with OSA, aged 65 years and older,
were compared to a cohort of patients without OSA. Primary outcomes were in-hospital mortality and
non-routine discharge (discharge to nursing home or skilled facility). Logistic regression models were
used to assess the risk of OSA on in-hospital mortality and discharge status.
Results: In 1,768,185 hospital discharges, approximately 5% had OSA, and its prevalence was inversely
proportional to age (65-74: 8.3%, 75-84: 4.8%, 85+: 1.8%). Pneumonia requiring IMV was more
common in the OSA cohort (OSA: 4.3% vs. Non-OSA: 3.3% <0.0001). In-hospital mortality (OSA:
3.3% vs. Non-OSA 5.1% <0.0001) and non-routine discharges (OSA: 46.9% vs. Non-OSA: 55.4%
<0.0001) were significantly lower in the OSA group.
Conclusion: OSA was associated with reduced inpatient mortality risk in pneumonia related respiratory
failure in elderly subjects. Sleep apnea may confer a survival benefit in older individuals; but further
research is warranted.