Tetyana Kendzerska1,2,3, Richard S Leung3,4, Andrea S Gershon1,2,3, George Tomlinson3,5, Najib Ayas6. 1. 1 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 2. 2 Sunnybrook Research Institute, Toronto, Ontario, Canada. 3. 3 University of Toronto, Toronto, Ontario, Canada. 4. 4 Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. 5. 5 Department of Medicine, University Health Network/Mount Sinai Hospital, Toronto, Ontario, Canada; and. 6. 6 Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
RATIONALE: The interrelationships between obstructive sleep apnea (OSA) and obesity are complex and bidirectional; however, current evidence regarding their combined effect on cardiovascular risk is limited and conflicting. Animal studies suggest that obesity may exacerbate the cardiovascular consequences of intermittent hypoxemia. OBJECTIVES: In this historical observational study, we investigated whether obesity increases the effect of nocturnal hypoxemia on the incidence of cardiovascular events in adults with suspected OSA. METHODS: All adults with suspected OSA who underwent diagnostic polysomnography at a large academic hospital between 1994 and 2010 were linked to provincial health administrative data to determine a composite cardiovascular outcome (hospitalization due to heart failure, myocardial infarction, stroke, or revascularization procedures). Using a competing-risk model and controlling for confounders, hazards were compared between four groups: group 1 comprised obese patients (body mass index >30 kg/m2) with oxygen desaturation (>9 min of sleep spent with SaO2 <90%); group 2 comprised obese patients without desaturation; group 3 comprised nonobese patients with desaturation; and group 4 comprised nonobese patients without desaturation. Interaction was measured using the relative excess risk due to interaction. MEASUREMENTS AND MAIN RESULTS: A total of 10,149 participants were followed, with 17%, 25%, 8%, and 50% in groups 1-4, respectively. Over a median of 7.8 years, 896 (8.8%) first cardiovascular events occurred. Group 1 was associated with the highest hazard compared with the other groups, using group 4 as a reference (hazard ratio [HR] for group 1, 1.84; 95% confidence interval [CI], 1.46-2.32; HR for group 2, 1.59, 95% CI, 1.29-1.95; HR for group 3, 1.51; 95% CI, 1.15-1.98). The relative excess risk due to interaction was -0.25 (95% CI, -0.78 to 0.27), indicating no interaction. CONCLUSIONS: In adults with suspected OSA, the highest cardiovascular risk was found in obese patients with nocturnal oxygen desaturation; however, the effect of these two factors together does not exceed the effect of each factor considered individually.
RATIONALE: The interrelationships between obstructive sleep apnea (OSA) and obesity are complex and bidirectional; however, current evidence regarding their combined effect on cardiovascular risk is limited and conflicting. Animal studies suggest that obesity may exacerbate the cardiovascular consequences of intermittent hypoxemia. OBJECTIVES: In this historical observational study, we investigated whether obesity increases the effect of nocturnal hypoxemia on the incidence of cardiovascular events in adults with suspected OSA. METHODS: All adults with suspected OSA who underwent diagnostic polysomnography at a large academic hospital between 1994 and 2010 were linked to provincial health administrative data to determine a composite cardiovascular outcome (hospitalization due to heart failure, myocardial infarction, stroke, or revascularization procedures). Using a competing-risk model and controlling for confounders, hazards were compared between four groups: group 1 comprised obesepatients (body mass index >30 kg/m2) with oxygen desaturation (>9 min of sleep spent with SaO2 <90%); group 2 comprised obesepatients without desaturation; group 3 comprised nonobese patients with desaturation; and group 4 comprised nonobese patients without desaturation. Interaction was measured using the relative excess risk due to interaction. MEASUREMENTS AND MAIN RESULTS: A total of 10,149 participants were followed, with 17%, 25%, 8%, and 50% in groups 1-4, respectively. Over a median of 7.8 years, 896 (8.8%) first cardiovascular events occurred. Group 1 was associated with the highest hazard compared with the other groups, using group 4 as a reference (hazard ratio [HR] for group 1, 1.84; 95% confidence interval [CI], 1.46-2.32; HR for group 2, 1.59, 95% CI, 1.29-1.95; HR for group 3, 1.51; 95% CI, 1.15-1.98). The relative excess risk due to interaction was -0.25 (95% CI, -0.78 to 0.27), indicating no interaction. CONCLUSIONS: In adults with suspected OSA, the highest cardiovascular risk was found in obesepatients with nocturnal oxygen desaturation; however, the effect of these two factors together does not exceed the effect of each factor considered individually.
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