Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial pneumonia that has been shown to have an association with gastroesophageal reflux disease (GERD) possibly due to chronic micro-aspiration leading to remodeling of the lung parenchyma. While a causal relationship between these two pathologies has not been clearly demonstrated to date, prior studies suggest they are closely related with GERD being more common in IPF than the general population. This study sought to further investigate the potential link between GERD and IPF as well as characterize sources of inpatient mortality in patients with concurrent disease.METHODS: Data from the National Inpatient Sample (NIS) database for 2015-2016 was used to assess the prevalence of IPF and the major causes of inpatient mortality in patients with both GERD and IPF. All hospitalizations with GERD (ICD-10-CM K21.0 and K21.9) were analyzed. Univariate and multivariate logistic regression analyses were performed and was adjusted for age, sex, race. SPSS was used for data analysis.

Obstructive sleep apnea (OSA) is an independent risk factor for many diseases. While there is a known association between OSA and cardiovascular disease, the association with intravascular or thrombotic events such as deep vein thrombosis (DVT), pulmonary embolism (PE), and cerebrovascular accidents (CVA) is less understood. This study looks at the distribution of significant comorbidities, vascular events, and outcomes among patients with and without OSA.METHODS: Data from the National Inpatient Sample (NIS) database for 2015-2016 was used to assess the prevalence of hypercoagulable events in patients with and without OSA. Using propensity score matching, patients with OSA were matched to a cohort of those without OSA using a 1:5 ratio and was adjusted for age and gender. Adjusted chi square analysis and multivariate logistic regression, was also performed.RESULTS: There were 24,980 patients with OSA matched with 149,880 patients without OSA (mean age 60.09 years; 44.9% female) with 83.5% of between 40 and 60 years of age. Those with OSA were found to have 18.2% more DVTs, 14.3% more PEs, and 25.0% more CVAs than the non-OSA group. Of those with OSA, incidence of the following events were more common in males: PE (25.8%), DVT (61.3%), cerebral hemorrhage (71.1%), cerebral ischemic event (73.0%). However, females with OSA were approximately 3.7 more likely than males with OSA to have in-hospital mortality (OR 3.71; 95% CI 2.68-5.14). For both males and females, there was an increased risk of coagulable events in those with underlying pulmonary artery hypertension (PAH) (OR 4.11; 95% CI 3.36-5.02), emphysema (OR 3.04; 95% CI 2.02-4.57,) asthma (OR 1.17; 95% CI 1.02-1.35), and hypertension (OR 1.23; 95% CI 1.10-1.38) but not heart failure (OR 0.82; 95% CI 0.68-0.98), alcohol use disorder (OR 0.46; 95% CI 0.29-0.72), or cirrhosis (OR 0.35; 95% CI 0.19-0.65). The average length of stay for those with OSA was 4.57 days, 4.1% longer than those without OSA, and when comparing total hospital charges, the average cost for those with OSA was 19% more. The average length of hospital say for males and females with OSA were 4.60 and 4.47 days, respectively. CONCLUSIONS: Even when adjusted for age, sex, and various comorbidities, the presence of vascular events was significant in the OSA group and was associated with higher length of stays and hospital charges. Males had a higher frequency of coagulable events however, females were more likely to have in-hospital mortality, especially those with concomitant pulmonary disease.CLINICAL IMPLICATIONS: Although OSA is widely recognized as a risk factor for cardiovascular and cerebrovascular diseases, there is limited data on the thrombotic events associated with this disease, the distribution of significant comorbidities as well as clinical outcomes. Our findings add to the growing evidence that OSA represents a major risk factor for vascular events in hospitalized patients.