0498 TITLE: Simmons Chin Press and Tongue Curl (SCPTC) Maneuver is a Reproducible Objective Physical Exam Finding to Screen for Obstructive Sleep Apnea (OSA) Associated with Cardiovascular Morbidities and All-Cause Mortality

Study Objectives: Some prior studies have demonstrated an increase in mortality associated with obstructive sleep apnea (OSA) utilizing a definition of OSA that requires a minimum 4% oxygen desaturation to identify a hypopnea. No large community-based studies have determined the risk of long-term mortality with OSA with hypopneas defined by a ≥3% O2 desaturation or arousal (AHI3%A). Methods: Data from 5591 Sleep Heart Health Study participants without prevalent cardiovascular disease at baseline who underwent polysomnography were analyzed regarding OSA diagnosed using the AHI3%A criteria and all-cause mortality over a mean follow up period of 10.9±3.2 years. Results: There were 1050 deaths in this group during the follow-up period. A Kaplan-Meir plot of survival revealed a reduction in survival with increasing AHI severity. Cox proportional hazards regression models revealed significantly increased all-cause mortality risk with increasing AHI, hazard ratio (HR, 95% CI) 1.13 (1.04-1.23), after adjusting for age, sex, race, BMI, cholesterol, HDL, self-reported hypertension and/or diabetes and smoking status. In categorical models, the mortality risk was significantly higher with severe OSA [adjusted HR 1.38 (1.09-1.76)]. When stratified by gender or age, severe OSA was associated with increased risk of death in men [adjusted HR 1.14 (1.01-1.28)] and in those <70 years of age [adjusted HR 1.51 (1.02-2.26)]. In contrast, AHI severity was not associated with increased mortality in women or those ≥70 years of age in fully adjusted models. Conclusion: Severe AHI3%A OSA is associated with significantly increased mortality risk, especially in men and those <70 years of age.

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All-Cause Mortality and Obstructive Sleep Apnea Severity Revisited

Otolaryngology ◽

10.1177/0194599812450256 ◽

2012 ◽

Vol 147 (3) ◽

pp. 583-587 ◽

Cited By ~ 21

Author(s):

Jeremy Rich ◽

Ayelette Raviv ◽

Nataly Raviv ◽

Scott E. Brietzke

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Obstructive Sleep Apnea Severity ◽

Obstructive Sleep ◽

All Cause Mortality

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Obstructive Sleep Apnea Increases Sudden Cardiac Death in Incident Hemodialysis Patients

American Journal of Nephrology ◽

10.1159/000489963 ◽

2018 ◽

Vol 48 (2) ◽

pp. 147-156 ◽

Cited By ~ 4

Author(s):

Eric S. Kerns ◽

Esther D. Kim ◽

Lucy A. Meoni ◽

Stephen M. Sozio ◽

Bernard G. Jaar ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Sudden Cardiac Death ◽

Cardiovascular Mortality ◽

Cardiac Death ◽

Hemodialysis Patients ◽

Obstructive Sleep ◽

All Cause Mortality

Background: Mortality in end-stage renal disease (ESRD) occurs predominantly from cardiovascular disease (CVD) and sudden cardiac death (SCD). Obstructive sleep apnea (OSA) is characterized by periodic airflow limitation associated with sleep arousal and oxygen desaturation and is prevalent in patients with ESRD. Whether OSA increases the risk for SCD, cardiovascular and all-cause mortality among hemodialysis patients remains unknown. Methods: In a prospective cohort of 558 incident hemodialysis patients, we examined the association of OSA with all-cause mortality, cardiovascular mortality, and SCD using Cox proportional hazards models controlling for traditional CVD risk factors. Results: Sixty-six incident hemodialysis patients (12%) had OSA. Mean age (56 years) and percentage of males (56%) were identical in OSA and no-OSA groups. Fewer African Americans had OSA than non-African Americans (9 vs. 18%, respectively). Participants with OSA had higher body-mass index, Charlson comorbidity score, and left ventricular mass index and greater prevalence of diabetes and coronary artery disease. During 1,080 person-years of follow-up, 104 deaths occurred, 29% of which were cardiovascular. OSA was associated with a higher risk of all-cause mortality (HR 1.90 [95% CI 1.04–3.46]) and cardiovascular mortality (HR 3.62 [95% CI 1.36–9.66]) after adjusting for demographics and body-mass index. OSA was associated with a higher risk of SCD after adjusting for demographics (HR 3.28 [95% CI 1.12–9.57]) and multiple cardiovascular risk factors. Conclusions: Incident hemodialysis patients with OSA are at increased risk of all-cause and cardiovascular mortality and SCD. Future studies should assess the impact of screening for OSA and OSA-targeted interventions on mortality in ESRD.

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Impact of Obstructive Sleep Apnea Complicated With Type 2 Diabetes on Long‐term Cardiovascular Risks and All-cause Mortality in Elderly Patients

10.21203/rs.3.rs-639989/v1 ◽

2021 ◽

Author(s):

Xiaofeng Su ◽

JianHua Li ◽

Yinghui Gao ◽

Kaibing Kaibing Chen ◽

Yan Gao ◽

...

Keyword(s):

Type 2 Diabetes ◽

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Elderly Patients ◽

Unstable Angina ◽

Kaplan Meier ◽

Obstructive Sleep ◽

All Cause Mortality

Abstract BackgroundThe prognostic significance of obstructive sleep apnea (OSA) in elderly patients with type 2 diabetes is unclear. The aim of this study was to determine the risk of cardiovascular disease (CVD) and mortality in elderly patients with OSA complicated with type 2 diabetes compared to patients with OSA without type 2 diabetes.MethodsFrom January 2015 to October 2017, 1113 eligible elderly patients with OSA were enrolled in this consecutive multicentre prospective cohort study. An apnoea-hypopnoea index of ≥5 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSA. We collected baseline demographics, clinical characteristics, sleep parameters and follow-up outcomes. The primary aim of this study was to determine the risk of incident major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, components of MACE and a composite of all events. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether type 2 diabetes was associated with incident events.ResultsA total of 266 (23.9%) patients had OSA complicated with type 2 diabetes. MACE occurred in 97 patients during the median 42-month follow-up. Kaplan-Meier survival curves indicated a significant relationship between OSA and MACE (log-rank P=0.003). Multivariable Cox regression analysis showed that type 2 diabetes increased the risk of MACE (HR=1.68, 95% CI:1.10-2.58, P=0.018), hospitalisation for unstable angina (HR=1.87, 95% CI:1.03-3.39, P=0.038) and a composite of all events in elderly patients with OSA (HR=1.72, 95% CI:1.12-2.64, P=0.012). However, there were no significant differences in the incidence of cardiovascular death, all-cause mortality, MI and hospitalisation for heart failure between patients with and without diabetes (P>0.05). The subgroup analysis demonstrated that females (AHR=2.50, 95% CI:1.15-5.43, P=0.021), ≥ 70 years (AHR=1.99, 95% CI:1.08-3.65, P=0.027), overweight and obese (AHR=1.75, 95% CI:1.10-2.80, P=0.019) with mild OSA (AHR=2.30, 95% CI: 1.01-5.26, P=0.49) were at a higher risk for MACE by diabetes.ConclusionOSA and type 2 diabetes are interrelated and synergistic with MACE, hospitalisation for unstable angina and a composite of all events development. Overweight and obese females, ≥ 70 years with mild OSA combined with type 2 diabetes presented a significantly high MACE risk.

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Association between obstructive sleep apnea and venous thromboembolism recurrence: results from a French cohort

Thrombosis Journal ◽

10.1186/s12959-021-00358-8 ◽

2022 ◽

Vol 20 (1) ◽

Author(s):

Olivier Nepveu ◽

Charles Orione ◽

Cécile Tromeur ◽

Alexandre Fauché ◽

Cecile L’heveder ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Venous Thromboembolism ◽

Sleep Apnea ◽

Multivariable Analysis ◽

Recurrence Risk ◽

Vein Thrombosis ◽

Risk Of Death ◽

Obstructive Sleep ◽

All Cause Mortality ◽

Recurrent Vte

Abstract Background Growing evidence suggests the relationship between obstructive sleep apnea (OSA) and venous thromboembolism (VTE). Few studies focused on VTE recurrence risk associated with OSA after anticoagulation cessation. Methods In a prospective cohort study, patients with documented VTE, were followed for an indefinite length of time and VTE recurrence were documented and adjudicated. The primary outcome was recurrent VTE after anticoagulation discontinuation. Secondary outcomes included all-cause mortality and the clinical presentation of VTE. Univariable and multivariable analyses were performed to identify risk factors for recurrence and mortality. Results Among the 2109 patients with documented VTE included, 74 patients had moderate to severe OSA diagnosis confirmed by home sleep test or polysomnography. During a median follow-up of 4.8 (interquartile range 2.5–8.0) years recurrent VTE occurred in 252 patients (9 with OSA and 243 without OSA). The recurrence risk in the univariable and multivariable analysis was not increased in patients with OSA, regardless of the time of diagnosis (before or after index VTE or pooled). VTE phenotype was significantly more often PE with or without associated deep vein thrombosis in the first event and recurrence for OSA patients compared to non-OSA patients. The risk of death was not increased in the OSA population compared to non-OSA patients in multivariable analysis. Conclusions In patients with OSA and VTE, the risk of all-cause mortality and VTE recurrence after anticoagulation discontinuation was not increased compared to non-OSA patients.

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