Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death

• Published in: Journal of the American College of Cardiology 2013-08, Vol.62 (7), p.610-616
• Main Authors: Gami, Apoor S., MD, MSc, Olson, Eric J., MD, Shen, Win K., MD, Wright, R. Scott, MD, Ballman, Karla V., PhD, Hodge, Dave O., MS, Herges, Regina M., BS, Howard, Daniel E., MD, MPH, Somers, Virend K., MD, PhD
• Format: Article
• Language: English
• Subjects: arrhythmia; Cardiac arrhythmia; Cardiology; Cardiovascular; Cardiovascular disease; Heart attacks; heart disease; Internal Medicine; Medical records; risk factor; sleep apnea; Sleep disorders; sudden cardiac death
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2013.04.080

Objectives This study sought to identify the risk of sudden cardiac death (SCD) associated with obstructive sleep apnea (OSA). Background Risk stratification for SCD, a major cause of mortality, is difficult. OSA is linked to cardiovascular disease and arrhythmias and has been shown to increase the risk of nocturnal SCD. It is unknown if OSA independently increases the risk of SCD. Methods We included 10,701 consecutive adults undergoing their first diagnostic polysomnogram between July 1987 and July 2003. During follow-up up to 15 years, we assessed incident resuscitated or fatal SCD in relation to the presence of OSA, physiological data including the apnea-hypopnea index (AHI), and nocturnal oxygen saturation (O2 sat) parameters, and relevant comorbidities. Results During an average follow-up of 5.3 years, 142 patients had resuscitated or fatal SCD (annual rate 0.27%). In multivariate analysis, independent risk factors for SCD were age, hypertension, coronary artery disease, cardiomyopathy or heart failure, ventricular ectopy or nonsustained ventricular tachycardia, and lowest nocturnal O2 sat (per 10% decrease, hazard ratio [HR]: 1.14; p = 0.029). SCD was best predicted by age >60 years (HR: 5.53), apnea-hypopnea index >20 (HR: 1.60), mean nocturnal O2 sat