# Predictors of Secondary Pulmonary Hypertension-Related Hospitalizations and Subsequent Mortality in Adults with Obstructive Sleep Apnea

## TL;DR

This study finds that secondary pulmonary hypertension is more common in women and Black patients with sleep apnea, but men and White patients face higher inpatient mortality.

## Contribution

The study identifies sex and racial disparities in SPH prevalence and mortality among OSA patients using a large national database.

## Key findings

- 9.4% of OSA hospitalizations were associated with secondary pulmonary hypertension.
- Females and Black patients had higher SPH prevalence, while males and White patients had higher inpatient mortality.
- Comorbidities like hypertension and COPD were more common in SPH patients.

## Abstract

Background: Secondary pulmonary hypertension (SPH) predicts poor outcomes in obstructive sleep apnea (OSA) patients. This study examines sex/racial disparities, predictors, and inpatient mortality in SPH-related OSA hospitalizations. Methods: We used the National Inpatient Sample (2019) and ICD-10 codes to identify OSA-related hospitalizations with SPH. The burden of SPH and disparities by sex/race were assessed. We also compared the odds and predictors of in-hospital mortality in OSA patients with vs. without SPH. Results: Of total adult OSA hospitalizations (n = 2,317,136, median age of 66 [56–74] years, and males: 57.2%), 9.4% (218,795/2,317,136) had SPH. Females vs. males (11.3% vs. 8.1%) and Blacks vs. other race groups (13.5%) with OSA had a higher prevalence of SPH. The SPH cohort often consisted of females (51 vs. 41.9%), Blacks (20.9 vs. 14.0%), Medicare-insured (73.4 vs. 60.6%), and non-elective admissions (89.2 vs. 74.4%) vs. the non-SPH cohort. The SPH cohort also had a higher burden of complicated HTN (52.9 vs. 36.3%), DM with complications (42.7 vs. 32.4%), COPD (52.5 vs. 36.9%), history of prior MI (11.4 vs. 9.6%), and venous thromboembolism (10.4 vs. 8.4%). However, in-hospital mortality was more likely to be in males (OR 1.12; 95%CI 1.00–1.25, p = 0.048) vs. females, and OSA patients with metastatic cancer (OR 2.73; 95%CI 2.04–3.65) and solid non-metastatic tumors (OR 1.65; 95%CI 1.26–2.15) (p < 0.001). Conclusions: The prevalence of SPH with OSA was greater in females and Blacks, whereas males and Whites had higher subsequent inpatient mortality. More prospective studies are needed to understand the role of comorbidities on survival outcomes.