Pulmonology · Cardiology · 2 h ago
Cardiometabolic factors predicted cardiovascular mortality in obstructive sleep apnea
A retrospective cohort study followed 4,368 adults referred for sleep testing, with a median follow-up of 8.6 years. Age, male sex, smoking, hypertension, atrial fibrillation, prior myocardial infarction and diabetes were independently associated with cardiovascular mortality; nocturnal desaturation was not significant after adjustment.
- 335 cardiovascular deaths occurred during median 8.6-year follow-up.
- Conventional cardiovascular risk factors predicted mortality.
- Nocturnal desaturation was not significant after multivariable adjustment.
- CPAP-response association was observational, not proof of mortality benefit.
Researchers conducted a retrospective cohort study of 4,368 consecutive adults referred for diagnostic polysomnography at a tertiary sleep center. National death registry data were used to identify cause-specific cardiovascular deaths over follow-up of up to 20 years. Analyses included competing-risk models and a random survival forest; the primary outcome was cardiovascular mortality. Median follow-up was 8.6 years (interquartile range, 6.7–12.5), during which 335 cardiovascular deaths occurred. Heart failure accounted for 30.4% of these deaths, chronic ischemic heart disease for 14.0%, and acute myocardial infarction for 11.6%.
In adjusted analyses, cardiovascular mortality was associated with age (hazard ratio [HR] 1.08 per year), male sex (HR 1.68), active smoking (HR 1.68), hypertension (HR 1.73), atrial fibrillation (HR 2.16), prior myocardial infarction (HR 1.71), and diabetes (HR 1.37). Nocturnal desaturation was no longer significant after adjustment. Among participants with an apnea-hypopnea index of at least 15 events per hour, a good CPAP response was associated with lower mortality (HR 0.72; 95% CI, 0.55–0.96). The model identified six phenotypes with cardiovascular mortality ranging from 2.9% to 14.4%.
The findings emphasize the prognostic importance of conventional cardiovascular risk factors in this referred OSA cohort. The observational design cannot establish causality, and the CPAP-response association does not show that treatment reduced mortality. The authors suggest comorbidity-focused prevention and phenotype-based risk stratification; whether these approaches improve outcomes requires further study.
In practice
For adults with obstructive sleep apnea referred for polysomnography, this cohort found that conventional factors—including hypertension, atrial fibrillation, diabetes, smoking and prior myocardial infarction—were independently associated with cardiovascular mortality, while nocturnal desaturation was not significant after adjustment. The results support attention to established cardiovascular risk factors when assessing this population, but do not establish that modifying them within an OSA-specific strategy reduces mortality. The reported association between good CPAP response and lower mortality in moderate-to-severe OSA is observational and does not demonstrate a treatment effect.
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SLEEP: Risk Factors for Cardiovascular Mortality in Patients With Obstructive Sleep Apnea ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.