Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes

Symptom subtypes have been described in clinical and population samples of patients with obstructive sleep apnea (OSA). It is unclear whether these subtypes have different cardiovascular consequences. To characterize OSA symptom subtypes and assess their association with prevalent and incident cardi...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2019-08, Vol.200 (4), p.493-506
Main Authors: Mazzotti, Diego R, Keenan, Brendan T, Lim, Diane C, Gottlieb, Daniel J, Kim, Jinyoung, Pack, Allan I
Format: Article
Language:English
Subjects:
Aged
Cardiovascular disease
Cardiovascular Diseases - epidemiology
Cardiovascular Diseases - mortality
Clinical trials
Cluster Analysis
Cohort Studies
Coronary Disease - epidemiology
Coronary vessels
Female
Health risk assessment
Heart attacks
Heart failure
Heart Failure - epidemiology
Humans
Incidence
Kaplan-Meier Estimate
Male
Medicine
Middle Aged
Mortality
Neurosciences
Older people
Original
Proportional Hazards Models
Prospective Studies
Sleep apnea
Sleep Apnea, Obstructive - classification
Sleep Apnea, Obstructive - epidemiology
Sleep Apnea, Obstructive - physiopathology
Sleepiness
Stroke
Stroke - epidemiology
Survival analysis
Systematic review
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Summary:Symptom subtypes have been described in clinical and population samples of patients with obstructive sleep apnea (OSA). It is unclear whether these subtypes have different cardiovascular consequences. To characterize OSA symptom subtypes and assess their association with prevalent and incident cardiovascular disease in the Sleep Heart Health Study. Data from 1,207 patients with OSA (apnea-hypopnea index ≥ 15 events/h) were used to evaluate the existence of symptom subtypes using latent class analysis. Associations between subtypes and prevalence of overall cardiovascular disease and its components (coronary heart disease, heart failure, and stroke) were assessed using logistic regression. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether subtypes were associated with incident events, including cardiovascular mortality. Four symptom subtypes were identified (disturbed sleep [12.2%], minimally symptomatic [32.6%], excessively sleepy [16.7%], and moderately sleepy [38.5%]), similar to prior studies. In adjusted models, although no significant associations with prevalent cardiovascular disease were found, the excessively sleepy subtype was associated with more than threefold increased risk of prevalent heart failure compared with each of the other subtypes. Symptom subtype was also associated with incident cardiovascular disease (  
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201808-1509oc