Meghna P Mansukhani1, Bhanu Prakash Kolla2, John G Park3. 1. Center for Sleep Medicine, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA. Electronic address: mansukhani.meghna@mayo.edu. 2. Department of Psychiatry and Psychology, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA. Electronic address: kolla.bhanuprakash@mayo.edu. 3. Center for Sleep Medicine, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 2nd Street SW, Rochester, MN, 55905, USA. Electronic address: park.john@mayo.edu.
Abstract
OBJECTIVES: Stimulant medications are indicated in patients with obstructive sleep apnea (OSA) who experience sleepiness despite optimal control of sleep-disordered breathing. The safety of stimulant medications in patients with OSA and co-morbid cardiomyopathy is unknown. We performed a case-control study to assess cardiovascular outcomes and mortality risk associated with stimulant use in this group of patients. METHODS: A total of 162 subjects with OSA and cardiomyopathy were identified. Subjects who used stimulant medications for ≥1 month were designated as cases. Age-and-sex-matched controls not taking these medications were randomly chosen from the same cohort. Outcomes assessed were mortality, implantable cardioverter-defibrillator (ICD) and pacemaker insertion. RESULTS: Twenty-two cases and 44 controls were included in the analyses. Mean age was 62.6 ± 15 years, 72% were male. Median duration of medication use was 27 months (range 1-98). There were four deaths among cases versus eight among controls. Four cases had a pacemaker and six had an ICD inserted, compared to six and eight respectively in the control group. Age (p = 0.01) and positive airway pressure (PAP) compliance (p = 0.01), but not stimulant medication use (p = 1.00) were associated with mortality on univariate analysis. In multiple logistic regression analyses accounting for body mass index, apnea-hypopnea index/respiratory disturbance index, PAP compliance, ejection fraction and duration of follow up, use of stimulant medication was not associated with mortality (p = 0.50), pacemaker (p = 0.20) or ICD (p = 0.90) implantation. CONCLUSIONS: Stimulant medications were not associated with elevated risk of mortality, pacemaker or ICD implantation in this case-control study, even after accounting for multiple confounders.
OBJECTIVES: Stimulant medications are indicated in patients with obstructive sleep apnea (OSA) who experience sleepiness despite optimal control of sleep-disordered breathing. The safety of stimulant medications in patients with OSA and co-morbid cardiomyopathy is unknown. We performed a case-control study to assess cardiovascular outcomes and mortality risk associated with stimulant use in this group of patients. METHODS: A total of 162 subjects with OSA and cardiomyopathy were identified. Subjects who used stimulant medications for ≥1 month were designated as cases. Age-and-sex-matched controls not taking these medications were randomly chosen from the same cohort. Outcomes assessed were mortality, implantable cardioverter-defibrillator (ICD) and pacemaker insertion. RESULTS: Twenty-two cases and 44 controls were included in the analyses. Mean age was 62.6 ± 15 years, 72% were male. Median duration of medication use was 27 months (range 1-98). There were four deaths among cases versus eight among controls. Four cases had a pacemaker and six had an ICD inserted, compared to six and eight respectively in the control group. Age (p = 0.01) and positive airway pressure (PAP) compliance (p = 0.01), but not stimulant medication use (p = 1.00) were associated with mortality on univariate analysis. In multiple logistic regression analyses accounting for body mass index, apnea-hypopnea index/respiratory disturbance index, PAP compliance, ejection fraction and duration of follow up, use of stimulant medication was not associated with mortality (p = 0.50), pacemaker (p = 0.20) or ICD (p = 0.90) implantation. CONCLUSIONS: Stimulant medications were not associated with elevated risk of mortality, pacemaker or ICD implantation in this case-control study, even after accounting for multiple confounders.
Authors: Meghna P Mansukhani; Bhanu Prakas Kolla; James M Naessens; Peter C Gay; Timothy I Morgenthaler Journal: J Clin Sleep Med Date: 2019-01-15 Impact factor: 4.062