Pre-diagnosed sleep apnoea is linked to severe courses in community-acquired pneumonia

Sleep-disordered breathing (SDB) is associated with adverse outcomes in cardiopulmonary diseases, but its prognostic relevance in community-acquired pneumonia (CAP) is not well established. This study investigates whether pre-diagnosed SDB increases the risk for severe CAP.

In the prospective CAPNETZ cohort, 4686 adult patients with radiologically confirmed CAP were assessed for pre-existing SDB and continuous positive airway pressure (CPAP) therapy. Outcomes included intensive care unit (ICU) admission, mechanical ventilation (MV) and 28-day mortality. Univariable and multivariable logistic regression analyses were performed.

SDB was present in 120 patients (2.6%), and 74 (1.6%) had established CPAP therapy. SDB was significantly associated with ICU admission and MV, but not with 28-day mortality in univariate analyses. In multivariable models, SDB (OR 1.46, 95% CI 2.35-3.80), male sex, confusion and older age were independently associated with ICU admission. Similarly, SDB (OR 5.16, 95% CI 2.99-8.89), male sex, confusion, older age, tachypnoea and elevated heart rate were linked to MV. CPAP therapy did not emerge as an independent predictor in multivariable analysis. Mortality within 28 days was independently associated only with confusion, older age and malignancy.

Our results highlight SDB as a potential novel risk factor for severe courses of CAP, including the need for ICU and MV. It suggests that SDB should be considered a critical component in the risk stratification and management of CAP and that established CPAP treatment may have a protective effect. Additional study data are needed to further substantiate these findings.