Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.

<h4>Background</h4>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 relevan...

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Autores principales:	Tetyana Kendzerska, Andrea S Gershon, Gillian Hawker, Richard S Leung, George Tomlinson
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/1f005e56fde84ab697afc042fa7465d1
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spelling	oai:doaj.org-article:1f005e56fde84ab697afc042fa7465d12021-11-18T05:42:58ZObstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.1549-12771549-167610.1371/journal.pmed.1001599https://doaj.org/article/1f005e56fde84ab697afc042fa7465d12014-02-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24503600/pdf/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusion</h4>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.Tetyana KendzerskaAndrea S GershonGillian HawkerRichard S LeungGeorge TomlinsonPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 11, Iss 2, p e1001599 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Tetyana Kendzerska Andrea S Gershon Gillian Hawker Richard S Leung George Tomlinson Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.
description	<h4>Background</h4>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.<h4>Methods and findings</h4>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.<h4>Conclusion</h4>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.
format	article
author	Tetyana Kendzerska Andrea S Gershon Gillian Hawker Richard S Leung George Tomlinson
author_facet	Tetyana Kendzerska Andrea S Gershon Gillian Hawker Richard S Leung George Tomlinson
author_sort	Tetyana Kendzerska
title	Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.
title_short	Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.
title_full	Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.
title_fullStr	Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.
title_full_unstemmed	Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.
title_sort	obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/1f005e56fde84ab697afc042fa7465d1
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Obstructive sleep apnea and risk of cardiovascular events and all-cause mortality: a decade-long historical cohort study.

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