Prevalence of obstructive sleep apnea in patients weaned from prolonged mechanical ventilation

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Background: Few data are available on the prevalence of Obstructive Sleep Apnoea (OSA) in patients admitted to ICU and needing prolonged mechanical ventilation (MV). Aim: to evaluate the prevalence of OSA in difficult to wean patients (from either invasive or non-invasive ventilation) for Acute (ARF) or Post-Surgery Respiratory Failure (PSRF). Methods: Polysomnography (PSG) was performed in a stable phase after weaning from MV and, in the case, after closure of tracheostomy in patients underwent prolonged MV. Patients not weaned from MV or tracheostomy or with diagnosis of neuromuscular disease, end-stage chronic diseases and poor collaboration were excluded. Results: From January 2017 to January 2020, out of 212 admitted patients, 110 were eligible for screening. Among them, 23 died, 24 did not undergo PSG for different reasons. Forty-three out of 63 (68.2%) patients undergone PSG had OSA with a median apnoea-hypopnoea index of 35 events per hour of sleep. Out of patients with known lung function, OSA was present in 19/26 (73%) patients with obstructive, 5/6 (83%) with restrictive disorders (83%), 13/22 (59%) patients with normal lung function. OSA showed the same prevalence in ARF and PSRF (68% vs 69%, p=0.9), as well as in patients submitted to NIV or invasive ventilation (73% vs 67%, p=0.7). Only 7/43 (16%) OSA patients had persistent hypercapnia in stable state. Conclusion: prevalence of OSA is high in patients undergoing prolonged mechanical ventilation. A sleep study should be suggested in a stable phase.

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