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Am J Respir Crit Care Med. 2019 Feb 15. doi: 10.1164/rccm.201808-1509OC. [Epub ahead of print]

Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes.

Author information

1
University of Pennsylvania Perelman School of Medicine, 14640, Division of Sleep Medicine, Department of Medicine, Philadelphia, Pennsylvania, United States.
2
University of Pennsylvania Perelman School of Medicine, 14640, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania, United States ; diegomaz@upenn.edu.
3
University of Pennsylvania Perelman School of Medicine, 14640, Center for Sleep and Circadian Neurobiology, Philadelphia, Pennsylvania, United States.
4
VA Boston Healthcare System, 384350, Boston, Massachusetts, United States.
5
Brigham and Women's Hospital Department of Medicine, 370908, Boston, Massachusetts, United States.
6
Harvard Medical School, Division of Sleep Medicine, Boston, Massachusetts, United States.
7
University of Pennsylvania School of Nursing, 16142, Philadelphia, Pennsylvania, United States.

Abstract

RATIONALE:

Symptom subtypes have been described in clinical and population samples of obstructive sleep apnea (OSA) patients. It is unclear whether these subtypes have different cardiovascular consequences.

OBJECTIVES:

This study aimed to characterize OSA symptom subtypes and assess their association with prevalent and incident cardiovascular disease in the Sleep Heart Health Study.

METHODS:

Data from 1,207 OSA patients (apnea-hypopnea index [AHI]≥15 events/hour) were used to evaluate the existence of symptom subtypes using latent class analysis. Associations between subtypes and prevalence of overall cardiovascular disease (CVD), as well as its components (coronary heart disease [CHD]), heart failure [HF] and stroke) were assessed using logistic regression. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether subtypes were associated with incident events, including cardiovascular mortality.

MEASUREMENTS AND MAIN RESULTS:

Four symptom subtypes were identified (Disturbed Sleep [12.2%], Minimally Symptomatic [32.6%], Excessively Sleepy [16.7%], and Moderately Sleepy [38.5%]), similar to prior studies. In adjusted models, while no significant associations with prevalent CVD were found, the Excessively Sleepy subtype was associated with over 3-fold increased risk of prevalent HF compared to each of the other subtypes. Symptom subtype was also associated with incident CVD (p<0.001), CHD (p=0.015) and HF (p=0.018), with the Excessively Sleepy again demonstrating increased risk (hazard ratios of 1.7-2.4) compared to other subtypes. When compared to individuals without OSA (AHI<5), significantly increased risk for prevalent and incident cardiovascular events were observed mostly for patients in the Excessively Sleepy subtype.

CONCLUSIONS:

OSA symptom subtypes are reproducible and associated with cardiovascular risk, providing important evidence of their clinical relevance.

KEYWORDS:

cardiovascular disease; cluster analysis; sleep apnea; sleepiness; symptom subtypes

PMID:
30764637
DOI:
10.1164/rccm.201808-1509OC

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