Obstructive Sleep Apnea and Risk of Cardiovascular Events and All-Cause Mortality: A Decade-Long Historical Cohort Study
TLDR
The association between physiological measures of obstructive sleep apnea other than the apnea-hypopnea index and the risk of cardiovascular events is explored.Abstract:
Background: Obstructive sleep apnea (OSA) has been reported to be a risk factor for cardiovascular (CV) disease. Although the apnea-hypopnea index (AHI) is the most commonly used measure of OSA, other less well studied OSA-related variables may be more pathophysiologically relevant and offer better prediction. The objective of this study was to evaluate the relationship between OSA-related variables and risk of CV events. Methods and Findings: A historical cohort study was conducted using clinical database and health administrative data. Adults referred for suspected OSA who underwent diagnostic polysomnography at the sleep laboratory at St Michael’s Hospital (Toronto, Canada) between 1994 and 2010 were followed through provincial health administrative data (Ontario, Canada) until May 2011 to examine the occurrence of a composite outcome (myocardial infarction, stroke, congestive heart failure, revascularization procedures, or death from any cause). Cox regression models were used to investigate the association between baseline OSA-related variables and composite outcome controlling for traditional risk factors. The results were expressed as hazard ratios (HRs) and 95% CIs; for continuous variables, HRs compare the 75th and 25th percentiles. Over a median follow-up of 68 months, 1,172 (11.5%) of 10,149 participants experienced our composite outcome. In a fully adjusted model, other than AHI OSA-related variables were significant independent predictors: time spent with oxygen saturation ,90% (9 minutes versus 0; HR=1.50, 95% CI 1.25–1.79), sleep time (4.9 versus 6.4 hours; HR=1.20, 95% CI 1.12–1.27), awakenings (35 versus 18; HR=1.06, 95% CI 1.02–1.10), periodic leg movements (13 versus 0/ hour; HR=1.05, 95% CI 1.03–1.07), heart rate (70 versus 56 beats per minute [bpm]; HR=1.28, 95% CI 1.19–1.37), and daytime sleepiness (HR=1.13, 95% CI 1.01–1.28).The main study limitation was lack of information about continuous positive airway pressure (CPAP) adherence. Conclusion: OSA-related factors other than AHI were shown as important predictors of composite CV outcome and should be considered in future studies and clinical practice. Please see later in the article for the Editors’ Summary.read more
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Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association
Marie-Pierre St-Onge,Michael A. Grandner,Devin L. Brown,Molly B. Conroy,Girardin Jean-Louis,Michael J. Coons,Deepak L. Bhatt +6 more
TL;DR: The evidence relating sleep duration and sleep disorders to cardiometabolic risk is reviewed and it is called for health organizations to include evidence-based sleep recommendations in their guidelines for optimal health.
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The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study.
Ali Azarbarzin,Scott A. Sands,Katie L. Stone,Katie L. Stone,Luigi Taranto-Montemurro,Ludovico Messineo,Philip I. Terrill,Sonia Ancoli-Israel,Kristine E. Ensrud,Shaun Purcell,Shaun Purcell,David P. White,Susan Redline,Andrew Wellman +13 more
TL;DR: The 'hypoxic burden', an easily derived signal from overnight sleep study, predicts CVD mortality across populations and suggests that not only the frequency but the depth and duration of sleep related upper airway obstructions, are important disease characterizing features.
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Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients.
Olaf Oldenburg,Birgit Wellmann,Anika Buchholz,Thomas Bitter,Henrik Fox,Ulrich Thiem,Dieter Horstkotte,Karl Wegscheider +7 more
TL;DR: Hypoxaemic burden was a robust and independent predictor of all-cause mortality in chronic stable HF-REF patients, and whether or not targeting nocturnal hypoxaemia is associated with beneficial effects on mortality in HF-ref patients remains to be determined.
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Obstructive Sleep Apnea and Incident Diabetes. A Historical Cohort Study
TL;DR: Among people with OSA, and controlling for multiple confounders, initial OSA severity and its physiologic consequences predicted subsequent risk for incident diabetes.
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Obstructive sleep apnoea syndrome and its management
TL;DR: After more than three decades from its first use, continuous positive airway pressure (CPAP) is still recognized as the gold standard treatment and is highly effective in controlling symptoms, improving quality of life and reducing the clinical sequelae of sleep apnoea.
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