Sleep-disordered breathing and mortality in amyotrophic lateral sclerosis: A review of a national inpatient sample
Kristen L. McHenry, Amanda Leightner, Lanny InabnitBackground
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative motor neuron disease. Due to its progressiveness, respiratory muscle weakness can lead to hypoventilation and subsequent sleep-disordered breathing (SDB).
Methods
The 2021 Healthcare Cost and Utilization Project (H-CUP) National Inpatient Sample (NIS) data were analyzed for this retrospective observational cohort study. Multinomial logistic regression was used to calculate the adjusted odds ratio, and chi-square was used to determine the significance (
Results
2273 patient encounters in 2021 were coded as having ALS; 201 (8.8%) also had an ICD-10 code for some form of SDB. Significant findings for the whole sample include a decrease in odds of mortality with a longer hospital length of stay, 0.71 (0.52 to 0.96); a decrease in odds of mortality for the East South Central hospital region, 0.38 (0.16 to 0.91); and an increase in mortality in those ≥ 50 years old, 3.76 (1.17 to 12.11). There was a significant association between having ALS and SDB overlap and experiencing lower inpatient mortality, especially in those who were receiving palliative care, had respiratory failure, and were ventilator-dependent. Primary reasons for hospital admission outside of the ALS diagnosis could be categorized into infectious conditions and respiratory-related complications.
Conclusions
A notable subset of the inpatients with ALS also presented with concomitant SDB. Those with overlap tended to have lower mortality rates, possibly due to the use of noninvasive respiratory support. Increased age, male gender, and being White were the primary characteristics of those with ALS. Ventilator dependence can prolong life, hospital region can impact patient outcomes, and utilization of palliative care services is on the rise. Respiratory failure continues to be a primary driver of hospitalization in those with ALS.