ABSTRACT
BACKGROUND: Obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are associated with unfavorable outcomes following coronary artery bypass grafting (CABG). The purpose of this study was to compare in-hospital outcomes of patients with COPD alone versus OSA-COPD overlap after CABG. METHODS: Data of adults ≥ 18 years old with COPD who received elective CABG between 2005 and 2018 were extracted from the US Nationwide Inpatient Sample (NIS). Patients were divided into two groups: with OSA-COPD overlap and COPD alone. Propensity score matching (PSM) was employed to balance the between-group characteristics. Logistic and linear regression analyses determined the associations between study variables and inpatient outcomes. RESULTS: After PSM, data of 2,439 patients with OSA-COPD overlap and 9,756 with COPD alone were analyzed. After adjustment, OSA-COPD overlap was associated with a significantly increased risk of overall postoperative complications (adjusted odd ratio [aOR] = 1.12, 95% confidence interval [CI]: 95% CI: 1.01-1.24), respiratory failure/prolonged mechanical ventilation (aOR = 1.27, 95%CI: 1.14-1.41), and non-routine discharge (aOR = 1.16, 95%CI: 1.03-1.29), and AKI (aOR = 1.14, 95% CI: 1.00-1.29). Patients with OSA-COPD overlap had a lower risk of in-hospital mortality (adjusted odd ratio [aOR] = 0.53, 95% CI: 0.35-0.81) than those with COPD only. Pneumonia or postoperative atrial fibrillation (AF) risks were not significantly different between the 2 groups. Stratified analyses revealed that, compared to COPD alone, OSA-COPD overlap was associated with increased respiratory failure/prolonged mechanical ventilation risks among patients ≥ 60 years, and both obese and non-obese subgroups. In addition, OSA-COPD overlap was associated with increased risk of AKI among the older and obese subgroups. CONCLUSION: In US adults who undergo CABG, compared to COPD alone, those with OSA-COPD are at higher risks of non-routine discharge, AKI, and respiratory failure/prolonged mechanical ventilation, but a lower in-hospital mortality. No increased risk of AF was noted.
Subject(s)
Acute Kidney Injury , Pulmonary Disease, Chronic Obstructive , Respiratory Insufficiency , Sleep Apnea, Obstructive , Adult , Humans , Adolescent , Inpatients , Coronary Artery Bypass/adverse effects , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/epidemiology , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/epidemiology , Obesity/complications , Respiratory Insufficiency/etiology , Acute Kidney Injury/etiology , Risk FactorsABSTRACT
Highly effective carbon supported-Pt75Au25 catalysts for oxygen reduction reaction (ORR) are prepared though titanium dioxide modification and post heat treatment. After accelerated durability test (ADT) of 1700 cycles, the ORR activity of PtAu/C catalysts modified by TiO2 and air heat treatment is 3 times higher than that of the commercial Pt/C. The enhancement of ORR activity is attributed to surface and structural alteration by air-induced Pt surface segregation and lower unfilled d states. On the contrary, for TiO2 modified and H2 treated PtAu/C catalysts, the deterioration of the ORR activity may be due to the loss of electrochemical surface area after ADT and the increase of d-band vacancy.
