Increased incidence of heart failure in patients with severe obstructive sleep apnoea: a long-term prospective cohort study

Abstract Background Obstructive sleep apnoea (OSA) is highly prevalent among patients with heart failure. Accumulating research data suggest that this association is bidirectional. Less is known regarding the long-term impact of OSA and continuous positive airway pressure (CPAP) treatment on incident heart failure. Purpose We addressed the association of severe OSA with development of heart failure, and consequently addressed the impact of efficient CPAP treatment in a sleep clinic cohort. Methods The “Sleep Apnea Patients in Skaraborg (SAPIS)” project was a single center (two sites), open-label, prospective cohort study, conducted in Sweden between 2005 and 2018. All consecutive adults admitted to the Skaraborg Hospital between 2005 and 2011 were registered in a local database, and the follow-up ended in May 2018. Anthropomorphic and clinical characteristics as well as results of the diagnostic cardiorespiratory recordings were documented. Treatment of OSA was based on the clinical routines. OSA was defined as an apnoea-hypopnoea index (AHI) of at least 5 events/hr, and severe OSA consisted of patients with an AHI ≥30 events/hr. Median follow-up for the entire cohort was 8.8 years (interquartile range 7.5–10.1 years). Data regarding incident heart failure were obtained from the medical records and the Swedish Hospital Discharge Register. CPAP use (downloaded reports from the devices) of at least 4 hrs/night was defined as efficient treatment. Results Among 4239 patients with diagnostic sleep recordings, 3185 were free of a known cardiac disease at baseline. Severe OSA was observed among 953 (29.9%). Severe OSA significantly predicted incident heart failure (hazard ratio [HR] 2.42; 95% confidence interval [CI] 1.44–4.06) compared to adults with AHI <30 events/hr, adjusted for age, gender, obesity, hypertension and diabetes mellitus. The adjusted HR for severe OSA was 2.82 (95% CI 1.33–5.99) among inefficiently treated/untreated patients whereas the risk was lower but still meaningful among the individuals who were adherent to CPAP (HR 2.25; 95% CI 0.99–5.15) Conclusion Our results suggest that severe OSA is associated with increased risk for development of heart failure. More than 4 hours of CPAP use per night may be necessary for OSA patients in the primary prevention models. CHF-free survival Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): ALF

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Mortality and morbidity in obstructive sleep apnoea–hypopnoea syndrome: results from a 30-year prospective cohort study

ERJ Open Research ◽

10.1183/23120541.00057-2020 ◽

2020 ◽

Vol 6 (3) ◽

pp. 00057-2020 ◽

Cited By ~ 1

Author(s):

Sophie Dodds ◽

Linda J. Williams ◽

Amber Roguski ◽

Marjorie Vennelle ◽

Neil J. Douglas ◽

...

Keyword(s):

Cohort Study ◽

General Population ◽

Prospective Cohort Study ◽

Obstructive Sleep Apnoea ◽

Prospective Cohort ◽

Sleep Apnoea ◽

Mortality And Morbidity ◽

Obstructive Sleep

BackgroundObstructive sleep apnoea–hypopnoea syndrome (OSAHS) carries substantial negative health consequences. This study examines factors affecting mortality and morbidity according to continuous positive airway pressure (CPAP) use and predictors affecting CPAP adherence in a longitudinal cohort of OSAHS patients.Materials and methodsThis prospective, cohort study comprised 4502 patients who were diagnosed with OSAHS at a tertiary sleep disorders centre between 1982 and 2003. Of these, 1174 patients completed follow-up in 2012. Data collected included anthropometric, sleep and demographic characteristics, including comorbidities, ongoing medications and CPAP adherence. Patients were followed up for an average of 14.8±3.7 years.ResultsImputation analysis showed that long-term CPAP users (>5 years) were 5.63 times more likely to be alive at study end than non-CPAP users (95% CI: 4.83–6.58, p<0.001) and 1.74-times more likely than short-term CPAP users (≤5 years) (95% CI: 1.49–2.02, p<0.001). Females had a significantly higher mortality rate during the follow-up period (26.8% versus 19.6%, p<0.001). Respiratory mortality was more common in patients with OSAHS, in particular those who did not use CPAP, compared to the general population (17.2% versus 12.2%, p=0.002 respectively), whereas deaths from cancer were less common compared to the general population (16.2% versus 25.6%, p<0.001). Compared to CPAP users, non-CPAP-users had a significantly increased incidence of type II diabetes mellitus (DMII) (27.9% versus 18.7%, p=0.003), ischaemic heart disease (IHD) (25.5% versus 12.7%, p<0.001) and myocardial infarction (MI) (14.7% versus 4.2%, p<0.001) at long-term follow-up.ConclusionsLong-term CPAP use in men and women with OSAHS reduces mortality and decreases the incidence of DMII and cardiovascular disease.

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Faculty Opinions recommendation of Gender differences in all-cause, cardiovascular and cancer mortality during long-term follow-up after acute myocardial infarction; a prospective cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727409677.793552943 ◽

2018 ◽

Author(s):

Nanette Wenger ◽

Tina Varghese

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Gender Differences ◽

Cohort Study ◽

Prospective Cohort Study ◽

Cancer Mortality ◽

Prospective Cohort ◽

Long Term Follow Up

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Long-term predictors of remission in patients treated for medication-overuse headache at a specialized headache center: A prospective cohort study

Cephalalgia ◽

10.1177/0333102416683918 ◽

2016 ◽

Vol 38 (2) ◽

pp. 265-273 ◽

Cited By ~ 9

Author(s):

Jasna J Zidverc-Trajkovic ◽

Tatjana Pekmezovic ◽

Zagorka Jovanovic ◽

Aleksandra Pavlovic ◽

Milija Mijajlovic ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Medication Overuse ◽

Medication Overuse Headache ◽

Predictive Values ◽

One Year ◽

The One

Objective To evaluate long-term predictors of remission in patients with medication-overuse headache (MOH) by prospective cohort study. Background Knowledge regarding long-term predictors of MOH outcome is limited. Methods Two hundred and forty MOH patients recruited from 2000 to 2005 were included in a one-year follow-up study and then subsequently followed until 31 December 2013. The median follow-up was three years (interquartile range, three years). Predictive values of selected variables were assessed by the Cox proportional hazard regression model. Results At the end of follow-up, 102 (42.5%) patients were in remission. The most important predictors of remission were lower number of headache days per month before the one-year follow-up (HR-hazard ratio = 0.936, 95% confidence interval (CI) 0.884–0.990, p = 0.021) and efficient initial drug withdrawal (HR = 0.136, 95% CI 0.042–0.444, p = 0.001). Refractory MOH was observed in seven (2.9%) and MOH relapse in 131 patients (54.6%). Conclusions Outcome at the one-year follow-up is a reliable predictor of MOH long-term remission.

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