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Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death

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...

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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
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container_title Journal of the American College of Cardiology
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creator Gami, Apoor S., MD, MSc
Olson, Eric J., MD
Shen, Win K., MD
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Ballman, Karla V., PhD
Hodge, Dave O., MS
Herges, Regina M., BS
Howard, Daniel E., MD, MPH
Somers, Virend K., MD, PhD
description 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 
doi_str_mv 10.1016/j.jacc.2013.04.080
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Scott, MD ; Ballman, Karla V., PhD ; Hodge, Dave O., MS ; Herges, Regina M., BS ; Howard, Daniel E., MD, MPH ; Somers, Virend K., MD, PhD</creator><creatorcontrib>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</creatorcontrib><description>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 &gt;60 years (HR: 5.53), apnea-hypopnea index &gt;20 (HR: 1.60), mean nocturnal O2 sat &lt;93% (HR: 2.93), and lowest nocturnal O2 sat &lt;78% (HR: 2.60; all p &lt; 0.0001). Conclusions In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/j.jacc.2013.04.080</identifier><language>eng</language><publisher>New York: Elsevier Inc</publisher><subject>arrhythmia ; Cardiac arrhythmia ; Cardiology ; Cardiovascular ; Cardiovascular disease ; Heart attacks ; heart disease ; Internal Medicine ; Medical records ; risk factor ; sleep apnea ; Sleep disorders ; sudden cardiac death</subject><ispartof>Journal of the American College of Cardiology, 2013-08, Vol.62 (7), p.610-616</ispartof><rights>American College of Cardiology Foundation</rights><rights>2013 American College of Cardiology Foundation</rights><rights>Copyright Elsevier Limited Aug 13, 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2720-66419637ed69618c53b3a1d5bfc50ed9f8a7d441e4ae8fbf40abaad13d7864b3</citedby><cites>FETCH-LOGICAL-c2720-66419637ed69618c53b3a1d5bfc50ed9f8a7d441e4ae8fbf40abaad13d7864b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids></links><search><creatorcontrib>Gami, Apoor S., MD, MSc</creatorcontrib><creatorcontrib>Olson, Eric J., MD</creatorcontrib><creatorcontrib>Shen, Win K., MD</creatorcontrib><creatorcontrib>Wright, R. Scott, MD</creatorcontrib><creatorcontrib>Ballman, Karla V., PhD</creatorcontrib><creatorcontrib>Hodge, Dave O., MS</creatorcontrib><creatorcontrib>Herges, Regina M., BS</creatorcontrib><creatorcontrib>Howard, Daniel E., MD, MPH</creatorcontrib><creatorcontrib>Somers, Virend K., MD, PhD</creatorcontrib><title>Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death</title><title>Journal of the American College of Cardiology</title><description>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 &gt;60 years (HR: 5.53), apnea-hypopnea index &gt;20 (HR: 1.60), mean nocturnal O2 sat &lt;93% (HR: 2.93), and lowest nocturnal O2 sat &lt;78% (HR: 2.60; all p &lt; 0.0001). Conclusions In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD.</description><subject>arrhythmia</subject><subject>Cardiac arrhythmia</subject><subject>Cardiology</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Heart attacks</subject><subject>heart disease</subject><subject>Internal Medicine</subject><subject>Medical records</subject><subject>risk factor</subject><subject>sleep apnea</subject><subject>Sleep disorders</subject><subject>sudden cardiac death</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNp9kc9q20AQh5eQQpy0L5CToGepM9o_kqC0BKdpCwFD7fuy2h2RVRzJ2ZUMfhs_i58sEi4EeuhpLr9vZvh-jN0iZAiovrRZa6zNckCegcighAu2QCnLlMuquGQLKLhMEariil3H2AKAKrFasO-rOg5htIPfU7LeEu2Su11HJjGdS4YnSv74-Hw69s3puB6do-50XJrgvLHJPZnh6SP70JhtpE9_5w3bPPzYLH-lj6ufv5d3j6nNixxSpQRWihfkVKWwtJLX3KCTdWMlkKua0hROCCRhqGzqRoCpjXHIXVEqUfMb9vm8dhf615HioNt-DN10UaMSkueSC5xS-TllQx9joEbvgn8x4aAR9OxJt3r2pGdPGoSePE3Q1zNE0_t7T0FH66mz5HwgO2jX-__j3_7B7dZ33prtMx0ovr-pY65Br-ci5h6QQ55LRP4GyD6Gug</recordid><startdate>20130813</startdate><enddate>20130813</enddate><creator>Gami, Apoor S., MD, MSc</creator><creator>Olson, Eric J., MD</creator><creator>Shen, Win K., MD</creator><creator>Wright, R. 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Scott, MD ; Ballman, Karla V., PhD ; Hodge, Dave O., MS ; Herges, Regina M., BS ; Howard, Daniel E., MD, MPH ; Somers, Virend K., MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2720-66419637ed69618c53b3a1d5bfc50ed9f8a7d441e4ae8fbf40abaad13d7864b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>arrhythmia</topic><topic>Cardiac arrhythmia</topic><topic>Cardiology</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Heart attacks</topic><topic>heart disease</topic><topic>Internal Medicine</topic><topic>Medical records</topic><topic>risk factor</topic><topic>sleep apnea</topic><topic>Sleep disorders</topic><topic>sudden cardiac death</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gami, Apoor S., MD, MSc</creatorcontrib><creatorcontrib>Olson, Eric J., MD</creatorcontrib><creatorcontrib>Shen, Win K., MD</creatorcontrib><creatorcontrib>Wright, R. Scott, MD</creatorcontrib><creatorcontrib>Ballman, Karla V., PhD</creatorcontrib><creatorcontrib>Hodge, Dave O., MS</creatorcontrib><creatorcontrib>Herges, Regina M., BS</creatorcontrib><creatorcontrib>Howard, Daniel E., MD, MPH</creatorcontrib><creatorcontrib>Somers, Virend K., MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Nursing &amp; Allied Health Premium</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gami, Apoor S., MD, MSc</au><au>Olson, Eric J., MD</au><au>Shen, Win K., MD</au><au>Wright, R. Scott, MD</au><au>Ballman, Karla V., PhD</au><au>Hodge, Dave O., MS</au><au>Herges, Regina M., BS</au><au>Howard, Daniel E., MD, MPH</au><au>Somers, Virend K., MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death</atitle><jtitle>Journal of the American College of Cardiology</jtitle><date>2013-08-13</date><risdate>2013</risdate><volume>62</volume><issue>7</issue><spage>610</spage><epage>616</epage><pages>610-616</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><abstract>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 &gt;60 years (HR: 5.53), apnea-hypopnea index &gt;20 (HR: 1.60), mean nocturnal O2 sat &lt;93% (HR: 2.93), and lowest nocturnal O2 sat &lt;78% (HR: 2.60; all p &lt; 0.0001). Conclusions In a population of 10,701 adults referred for polysomnography, OSA predicted incident SCD, and the magnitude of risk was predicted by multiple parameters characterizing OSA severity. Nocturnal hypoxemia, an important pathophysiological feature of OSA, strongly predicted SCD independently of well-established risk factors. These findings implicate OSA, a prevalent condition, as a novel risk factor for SCD.</abstract><cop>New York</cop><pub>Elsevier Inc</pub><doi>10.1016/j.jacc.2013.04.080</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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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
title Obstructive Sleep Apnea and the Risk of Sudden Cardiac Death
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