{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T08:17:11Z","timestamp":1787905031989,"version":"build-2784847793"},"reference-count":48,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T00:00:00Z","timestamp":1658361600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Lungenliga St. Gallen - Appenzell"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"\nBackground<\/jats:title>\nSleep apnea (SA) is a prevalent disorder characterized by recurrent events of nocturnal apnea originating from obstructive and\/or central mechanisms. SA disrupts normal sleep and can lead to a series of complications when left untreated. SA results in intermittent hypoxia which has an impact on the cardio- and cerebrovascular system. Hospitalized patients with SA typically have a greater burden of comorbidity, a longer length of hospital stay, but may show an improvement of in-hospital mortality compared to patients without diagnosed SA. The reason for this survival benefit is controversial and we aimed to clarify this protective effect in the light of predictive factors including SA-associated comorbidities using a nation-wide hospitalization database.<\/jats:p>\n<\/jats:sec>\n\nMethods and findings<\/jats:title>\nData were extracted from a nation-wide hospitalization database provided by the Swiss Federal Office for Statistics. Hospitalized patients with a SA co-diagnosis were extracted from the database together with a 1:1-matched control population without SA. Overall, 212\u2019581 patients with SA were hospitalized in Switzerland between 2002 and 2018. Compared to the controls, SA cases had a longer median length of hospital stay (7 days; 95% CI: 3 to 15 vs. 4 days; 95% CI: 2 to 10) (p<\/jats:italic> < 0.001) and a higher median number of comorbidities (8 comorbidities; IQR: 5 to 11 vs. 3 comorbidities; IQR: 1 to 6) (p<\/jats:italic> < 0.001). The risk of in-hospital mortality was lower in the SA cases compared to the controls (OR: 0.73; 95% CI: 0.7 to 0.76; p<\/jats:italic> < 0.001). SA was associated with a survival benefit in hospitalizations related to 28 of 47 conditions with the highest rate of in-hospital death. Sixty-three comorbidities were significantly over-represented in SA cases among which obesity, hypertension and anatomic nasal deviations were associated with a significant decrease of in-hospital mortality.<\/jats:p>\n<\/jats:sec>\n\nConclusions<\/jats:title>\nCompared to matched controls, SA was associated with significant and relevant inpatient survival benefit in a number of most deadly conditions. Within SA-patients, associated comorbidities mostly correlated with a poorer prognosis, whereas obesity and hypertension were associated with an improved in-hospital mortality.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0271004","type":"journal-article","created":{"date-parts":[[2022,7,21]],"date-time":"2022-07-21T17:51:50Z","timestamp":1658425910000},"page":"e0271004","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["In-hospital survival paradox in patients with sleep apnea\u2014A nation-wide nested case-control study"],"prefix":"10.1371","volume":"17","author":[{"given":"Maurice","family":"Moser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1425-0428","authenticated-orcid":true,"given":"Florent","family":"Baty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin H.","family":"Brutsche","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0492-7172","authenticated-orcid":true,"given":"Otto D.","family":"Schoch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,7,21]]},"reference":[{"issue":"9 Suppl 1","key":"pone.0271004.ref001","doi-asserted-by":"crossref","first-page":"2","DOI":"10.3949\/ccjm.86.s1.02","article-title":"Obstructive sleep apnea basics","volume":"86","author":"JV Rundo","year":"2019","journal-title":"Cleve Clin J Med"},{"issue":"7","key":"pone.0271004.ref002","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1136\/thx.50.7.797","article-title":"Sleep-related breathing disorder.2. 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Reutrakul","year":"2017","journal-title":"Chest"},{"issue":"2","key":"pone.0271004.ref016","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1055\/s-0036-1579546","article-title":"Comorbidities Associated with Obstructive Sleep Apnea: a Retrospective Study","volume":"20","author":"JA Pinto","year":"2016","journal-title":"Int Arch Otorhinolaryngol"},{"issue":"2","key":"pone.0271004.ref017","doi-asserted-by":"crossref","first-page":"165","DOI":"10.5664\/jcsm.4466","article-title":"Obstructive sleep apnea and psychiatric disorders: a systematic review","volume":"11","author":"MA Gupta","year":"2015","journal-title":"J Clin Sleep Med"},{"issue":"5","key":"pone.0271004.ref018","doi-asserted-by":"crossref","first-page":"e63285","DOI":"10.1371\/journal.pone.0063285","article-title":"Comorbidities and burden of COPD: a population based case-control study","volume":"8","author":"F Baty","year":"2013","journal-title":"PLoS 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Strausz","year":"2021","journal-title":"BMJ Open Respir Res"},{"issue":"9","key":"pone.0271004.ref023","article-title":"Diagnosis of Obstructive Sleep Apnea in Patients with Allergic and Non-Allergic Rhinitis","volume":"56","author":"A Pace","year":"2020","journal-title":"Medicina (Kaunas)"},{"issue":"9","key":"pone.0271004.ref024","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1002\/jhm.2404","article-title":"Obstructive sleep apnea and adverse outcomes in surgical and nonsurgical patients on the wards","volume":"10","author":"PG Lyons","year":"2015","journal-title":"J Hosp Med"},{"issue":"7","key":"pone.0271004.ref025","doi-asserted-by":"crossref","first-page":"e006133","DOI":"10.1161\/JAHA.117.006133","article-title":"Recognized Obstructive Sleep Apnea is Associated With Improved In-Hospital Outcomes After ST Elevation Myocardial Infarction","volume":"6","author":"D Mohananey","year":"2017","journal-title":"J Am Heart Assoc"},{"issue":"suppl 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