A J Hirsch Allen1, Rachel Jen1, Diego R Mazzotti2, Brendan T Keenan3, Sebastian D Goodfellow4, Carolyn M Taylor1, Patrick Daniele5, Bernardo Peres6, Yu Liu1,7, Morvarid Mehrtash1, Najib T Ayas1. 1. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 2. Division of Medical Informatics, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas. 3. Division of Sleep Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 4. Faculty of Applied Science and Engineering, University of Toronto, Toronto, Ontario, Canada. 5. School of Population and Public, University of British Columbia, Vancouver, British Columbia, Canada. 6. Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada. 7. Department of Pharmacology, Shanxi Medical University, Taiyuan, Shanxi, China.
Abstract
STUDY OBJECTIVES: Patients with obstructive sleep apnea (OSA) are at increased risk of cardiovascular and cerebrovascular disease, but predicting those at greatest risk is challenging. Using latent class analysis, patients with OSA can be placed into discrete symptom subtypes. The aim of this study was to determine whether symptom subtypes are associated with future cerebrovascular disease in patients with OSA in a clinic-based cohort. METHODS: Patients with suspected OSA referred for a polysomnogram at an academic sleep center completed a comprehensive symptom survey. Patients with OSA (apnea-hypopnea index ≥ 5 events/h) were then placed into symptom subtypes based on responses to survey questions using latent class analysis. Cardiovascular events (stroke, myocardial infarction, unstable angina, bypass grafting, percutaneous coronary intervention, cardiac resynchronization therapy, defibrillation) occurring within 8 years of polysomnogram were identified by linkage to provincial health databases. RESULTS: 1,607 patients were studied, of whom 1,292 had OSA. One hundred forty first events occurred within 8 years of polysomnogram. Patients in the excessively sleepy with disturbed sleep subtype had a significantly increased rate of events compared to the minimally symptomatic subtype (hazard ratio = 2.25, 95% confidence interval: 1.02-4.94; P = .04). Two symptoms (restless legs and dozing off or sleeping while talking to someone) were significantly associated with future risk of cerebrovascular disease (hazard ratio = 1.68, 1.12-2.49 and 4.23, 1.61-11.16, respectively). CONCLUSIONS: Patients with OSA in the clinic who are in the excessively sleepy with disturbed sleep subtype are significantly more likely to have a future cardiovascular event. This underscores the importance of understanding clinical heterogeneity and incorporating symptom subtype definitions into routine clinical care. CITATION: Allen AJH, Jen R, Mazzotti DR, et al. Symptom subtypes and risk of incident cardiovascular and cerebrovascular disease in a clinic-based obstructive sleep apnea cohort. J Clin Sleep Med. 2022;18(9):2093-2102.
STUDY OBJECTIVES: Patients with obstructive sleep apnea (OSA) are at increased risk of cardiovascular and cerebrovascular disease, but predicting those at greatest risk is challenging. Using latent class analysis, patients with OSA can be placed into discrete symptom subtypes. The aim of this study was to determine whether symptom subtypes are associated with future cerebrovascular disease in patients with OSA in a clinic-based cohort. METHODS: Patients with suspected OSA referred for a polysomnogram at an academic sleep center completed a comprehensive symptom survey. Patients with OSA (apnea-hypopnea index ≥ 5 events/h) were then placed into symptom subtypes based on responses to survey questions using latent class analysis. Cardiovascular events (stroke, myocardial infarction, unstable angina, bypass grafting, percutaneous coronary intervention, cardiac resynchronization therapy, defibrillation) occurring within 8 years of polysomnogram were identified by linkage to provincial health databases. RESULTS: 1,607 patients were studied, of whom 1,292 had OSA. One hundred forty first events occurred within 8 years of polysomnogram. Patients in the excessively sleepy with disturbed sleep subtype had a significantly increased rate of events compared to the minimally symptomatic subtype (hazard ratio = 2.25, 95% confidence interval: 1.02-4.94; P = .04). Two symptoms (restless legs and dozing off or sleeping while talking to someone) were significantly associated with future risk of cerebrovascular disease (hazard ratio = 1.68, 1.12-2.49 and 4.23, 1.61-11.16, respectively). CONCLUSIONS: Patients with OSA in the clinic who are in the excessively sleepy with disturbed sleep subtype are significantly more likely to have a future cardiovascular event. This underscores the importance of understanding clinical heterogeneity and incorporating symptom subtype definitions into routine clinical care. CITATION: Allen AJH, Jen R, Mazzotti DR, et al. Symptom subtypes and risk of incident cardiovascular and cerebrovascular disease in a clinic-based obstructive sleep apnea cohort. J Clin Sleep Med. 2022;18(9):2093-2102.
Authors: Douglas S Lee; Audra Stitt; Xuesong Wang; Jeffery S Yu; Yana Gurevich; Kori J Kingsbury; Peter C Austin; Jack V Tu Journal: Med Care Date: 2013-04 Impact factor: 2.983
Authors: Adam V Benjafield; Najib T Ayas; Peter R Eastwood; Raphael Heinzer; Mary S M Ip; Mary J Morrell; Carlos M Nunez; Sanjay R Patel; Thomas Penzel; Jean-Louis Pépin; Paul E Peppard; Sanjeev Sinha; Sergio Tufik; Kate Valentine; Atul Malhotra Journal: Lancet Respir Med Date: 2019-07-09 Impact factor: 30.700
Authors: Jinyoung Kim; Brendan T Keenan; Diane C Lim; Seung Ku Lee; Allan I Pack; Chol Shin Journal: J Clin Sleep Med Date: 2018-03-15 Impact factor: 4.062
Authors: N B Kribbs; A I Pack; L R Kline; P L Smith; A R Schwartz; N M Schubert; S Redline; J N Henry; J E Getsy; D F Dinges Journal: Am Rev Respir Dis Date: 1993-04