Sleep Apnea-Specific Hypoxic Burden, Symptom Subtypes, and Risk of Cardiovascular Events and All-Cause Mortality

• Published in: American journal of respiratory and critical care medicine 2022-01, Vol.205 (1), p.108-117
• Main Authors: Trzepizur, Wojciech, Blanchard, Margaux, Ganem, Timothée, Balusson, Frédéric, Feuilloy, Mathieu, Girault, Jean-Marc, Meslier, Nicole, Oger, Emmanuel, Paris, Audrey, Pigeanne, Thierry, Racineux, Jean-Louis, Sabil, AbdelKebir, Gervès-Pinquié, Chloé, Gagnadoux, Frédéric
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biomarkers; Cardiovascular disease; Cardiovascular Diseases - etiology; Cardiovascular Diseases - mortality; Cluster Analysis; Databases, Factual; Female; Follow-Up Studies; France - epidemiology; Health risks; Heart Disease Risk Factors; Humans; Hypoxemia; Hypoxia; Hypoxia - complications; Hypoxia - diagnosis; Hypoxia - mortality; Hypoxia - physiopathology; Kaplan-Meier Estimate; Life Sciences; Male; Middle Aged; Mortality; Patient Acuity; Proportional Hazards Models; Risk factors; Sleep apnea; Sleep Apnea, Obstructive - complications; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - mortality; Sleep Apnea, Obstructive - physiopathology
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.202105-1274OC

Data from population-based cohorts suggest that symptom subtypes and obstructive sleep apnea (OSA)-specific hypoxic burden (HB) could help to better identify patients with OSA at high cardiovascular (CV) risk. We aimed to evaluate whether those new markers are associated with the risk of major adverse CV events (MACE) in clinical setting. Data from the Pays de la Loire cohort were linked to health administrative data to identify the occurrence of MACE (a composite outcome including all-cause mortality, acute myocardial infarction, stroke, and unplanned coronary revascularization) in patients with newly diagnosed OSA and no overt CV disease. Latent class analysis was used to identify subtypes based on eight clinically relevant variables. HB was defined as the total area under the respiratory event-related desaturation curve. Cox proportional hazards models were used to evaluate the association of symptom subtypes and HB with MACE. Four symptom subtypes were identified (minimally symptomatic [22.0%], disturbed sleep [17.5%], excessively sleepy [49.8%], and moderately sleepy [10.6%]). After a median follow-up of 78 months (interquartile range, 52-109), 592 (11.05%) of 5,358 patients experienced MACE. In a fully adjusted model, HB and overall nocturnal hypoxemia assessed by sleep time with oxygen saturation