ABSTRACT
Hospital use in the US is concentrated in the approximately 2% of the population that is repeatedly hospitalized. Using the research integration technique of information synthesis, empirical studies of readmission were assembled and analyzed to determine the demographic and clinical characteristics of the repeatedly hospitalized adult. The authors' synthesis of articles that met preset criteria of relevance and validity indicated that clinical variables show a more consistent association with readmission than demographic variables. Diagnosis, prior use, and disability appear to be strong predictors of an individual's level of hospital use. Demographic variables with consistent positive associations with readmission include being widowed, living with relatives other than a spouse, decreasing income, living in the South, and living in an urban area, but available work does not indicate whether these demographic variables are independent predictors of readmission or merely markers of an increased prevalence of chronic disease. Findings indicate that future investigations of the predictors of this costly pattern of hospital use will be most illuminating if illness-related factors such as diagnosis, disease severity, functional status, and usage history are carefully specified and examined.
Subject(s)
Hospitals/statistics & numerical data , Patient Readmission , Adolescent , Adult , Aged , Chronic Disease , Data Collection/methods , Demography , Diagnosis , Disabled Persons , Female , Humans , Male , Middle Aged , Socioeconomic Factors , United StatesABSTRACT
The prevalence of sleep apnea was studied in 46 middle- and older-aged men with "essential hypertension." Thirty-four age- and weight-similar normotensive men were also studied. Fourteen hypertensive men and three controls had sleep apnea syndrome, as defined as greater than ten apneas per hour of sleep. Hypertensive men with apnea tended to be more overweight and slightly older than the hypertensive men without apnea, but differences were not statistically significant. Individual men with apnea could not be distinguished by their answers on a questionnaire that elicited symptoms related to apnea. Seven hypertensive men with apnea were treated with protriptyline and one with uvulopalatopharyngoplasty, and apnea index (apneas per hour) decreased by 77% from pretreatment levels while mean blood pressure decreased from 149/95 mm Hg to 139/90 mm Hg. Undiagnosed sleep apnea syndrome may be associated with systemic hypertension in many middle- and older-aged men. In some, sleep apnea syndrome could be the cause of hypertension, and in others it may contribute to hypertension of another cause.
