부산대학교 도서관

Background: Obstructive Sleep Apnea (OSA) is associated with higher prevalence of cardiac arrhythmias, yet recurrent hypoxemia that induces cardioprotective responses may improve survival outcomes after cardiac arrest.Methods: Using the Nationwide Inpatient Sample database, adult patients undergoing resuscitation for in-hospital cardiac arrest (IHCA) from 2005 to 2008 were identified and patients with OSA were 1:1 propensity matched (age, sex and major comorbidities) with no OSA group. Differences in hospital mortality in patients with ventricular fibrillation (VF) and non-VF-related IHCA were determined. Logistic regression model was used to identify independent predictors of mortality.Results: Out of 75,099 patients who experienced IHCA, 1260 patients had OSA and were 1:1 matched with non-OSA patients. Of the 2520 patients in the matched group, 1687 (67%) patients died after IHCA; overall survival was significantly better in those who had VF cardiac arrest than in those with non-VF arrest (38.7% vs 32.3%, p=0.027). Patients with OSA had significantly better survival after IHCA than the matched non-OSA group (38% vs 28% p<0.001). The difference in hospital survival was only seen in patients with non-VF cardiac arrest (37.6% vs 27.0%, p<0.001). VF arrest patients had better survival than non-VF arrest but no significant difference was present between patients with or without OSA (41.9% vs 35.6%, p=0.263). The presence of OSA or VF was associated with higher survival, whereas cardiac and neurologic organ failure and severe sepsis were associated with higher mortality (Figure).Conclusion: The in-hospital survival after IHCA was significantly better in patients with OSA than non-OSA patients in those without VF IHCA. Whether hypoxia-induced cardioprotective responses are involved in improved survival outcomes of nonarrhythmic cardiac arrest patients need to be investigated.