The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study.

Eur Heart J
Authors
Keywords
Abstract

AIMS: Apnoea-hypopnoea index (AHI), the universal clinical metric of sleep apnoea severity, poorly predicts the adverse outcomes of sleep apnoea, potentially because the AHI, a frequency measure, does not adequately capture disease burden. Therefore, we sought to evaluate whether quantifying the severity of sleep apnoea by the 'hypoxic burden' would predict mortality among adults aged 40 and older.

METHODS AND RESULTS: The samples were derived from two cohort studies: The Outcomes of Sleep Disorders in Older Men (MrOS), which included 2743 men, age 76.3 ± 5.5 years; and the Sleep Heart Health Study (SHHS), which included 5111 middle-aged and older adults (52.8% women), age: 63.7 ± 10.9 years. The outcomes were all-cause and Cardiovascular disease (CVD)-related mortality. The hypoxic burden was determined by measuring the respiratory event-associated area under the desaturation curve from pre-event baseline. Cox models were used to calculate the adjusted hazard ratios for hypoxic burden. Unlike the AHI, the hypoxic burden strongly predicted CVD mortality and all-cause mortality (only in MrOS). Individuals in the MrOS study with hypoxic burden in the highest two quintiles had hazard ratios of 1.81 [95% confidence interval (CI) 1.25-2.62] and 2.73 (95% CI 1.71-4.36), respectively. Similarly, the group in the SHHS with hypoxic burden in the highest quintile had a hazard ratio of 1.96 (95% CI 1.11-3.43).

CONCLUSION: The 'hypoxic burden', an easily derived signal from overnight sleep study, predicts CVD mortality across populations. The findings suggest that not only the frequency but the depth and duration of sleep related upper airway obstructions, are important disease characterizing features.

Year of Publication
2019
Journal
Eur Heart J
Volume
40
Issue
14
Pages
1149-1157
Date Published
2019 Apr 07
ISSN
1522-9645
DOI
10.1093/eurheartj/ehy624
PubMed ID
30376054
PubMed Central ID
PMC6451769
Links
Grant list
R01 HL070848 / HL / NHLBI NIH HHS / United States
R01 HL071194 / HL / NHLBI NIH HHS / United States
R01 HL070847 / HL / NHLBI NIH HHS / United States
U01 AG042145 / AG / NIA NIH HHS / United States
R35 HL135818 / HL / NHLBI NIH HHS / United States
U01 AG042168 / AG / NIA NIH HHS / United States
R01 HL070841 / HL / NHLBI NIH HHS / United States
R24 HL114473 / HL / NHLBI NIH HHS / United States
U01 AG027810 / AG / NIA NIH HHS / United States
R01 HL070837 / HL / NHLBI NIH HHS / United States
U01 AG042139 / AG / NIA NIH HHS / United States
U01 AR066160 / AR / NIAMS NIH HHS / United States
R01 HL070842 / HL / NHLBI NIH HHS / United States
U01 AG042124 / AG / NIA NIH HHS / United States
U01 AG042140 / AG / NIA NIH HHS / United States
R01 HL070838 / HL / NHLBI NIH HHS / United States
R01 HL070839 / HL / NHLBI NIH HHS / United States
UL1 TR001102 / TR / NCATS NIH HHS / United States