1109 Impact of Obstructive Sleep Apnea and Pulmonary Hypertension on Hospital Re-admission and Overall Survival in Rural Appalachia Population

Abstract Introduction Obstructive sleep apnea (OSA) is a highly prevalent comorbid condition and is present in 12-13% of patients with pulmonary hypertension (PH). However direct causality for pulmonary hypertension and its impact on long-term outcome in PH patients is not clearly established. This study aims to understand the prognostic impact of OHS and PH on hospital re-admission and survival in rural Appalachia. Methods We conducted a retrospective study including hospitalized patients undergoing evaluation for OSA from Nov 2019 to January 2024. The sample size was divided into two cohorts depending on presence of absence of OSA and each cohort was subclassified based on presence of absence of PH based on echocardiography. Baseline characteristics were summarized as mean (± standard deviation) for continuous variables and frequency/percentages for categorical variables. Hospital re-admission rates and survival were assessed using Kaplan-Meier (KM) survival curves and Cox proportional hazard ratios. Results We included a total of 573 patients (228 patients without OSA and 345 patients with OSA). In the OSA cohort, 195 patients had echocardiographic evidence of PH. In the non-OSA cohort, 103 patients had evidence of PH. Patients with PH in no OSA cohort had the highest risk of mortality (HR=1.95, 95%CI=1.19-3.20, p=0.008), whereas patients with OSA and PH did not significantly alter survival (HR=1.11, p=0.67). On KM curves, OSA and PH cohort had better survival (HR=0.58, p=0.01). Interestingly, body mass index (BMI) was associated with lower odds of hospital re-admission in rural Appalachia (HR-0.98,CI=0.98-0.99, p=0.002), adjusted for age, gender and BMI. Conclusion Our study identifies a paradox of better survival in patients with OSA and echocardiographic evidence of PH compared to patients with PH and no OSA in rural Appalachia. Furthermore, BMI had an inverse association with hospital re-admission rate. The reason for these findings remain unclear, however, we hypothesize, that an inpatient sleep medicine service, closer follow-up on discharge and monitoring of patients with OSA and PH may play a role and need to be studied in future studies. Support (if any)