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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| Veröffentlicht in: | American journal of respiratory and critical care medicine 2019-08, Vol.200 (4), p.493-506 |
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| creator | Mazzotti, Diego R Keenan, Brendan T Lim, Diane C Gottlieb, Daniel J Kim, Jinyoung Pack, Allan I |
| description | 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 (
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| doi_str_mv | 10.1164/rccm.201808-1509OC |
| format | Article |
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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 (
< 0.001), coronary heart disease (
= 0.015), and heart failure (
= 0.018), with the excessively sleepy again demonstrating increased risk (hazard ratios, 1.7-2.4) compared with other subtypes. When compared with individuals without OSA (apnea-hypopnea index < 5), significantly increased risk for prevalent and incident cardiovascular events was observed mostly for patients in the excessively sleepy subtype.
OSA symptom subtypes are reproducible and associated with cardiovascular risk, providing important evidence of their clinical relevance.</description><identifier>ISSN: 1073-449X</identifier><identifier>EISSN: 1535-4970</identifier><identifier>DOI: 10.1164/rccm.201808-1509OC</identifier><identifier>PMID: 30764637</identifier><language>eng</language><publisher>United States: American Thoracic Society</publisher><subject>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</subject><ispartof>American journal of respiratory and critical care medicine, 2019-08, Vol.200 (4), p.493-506</ispartof><rights>Copyright American Thoracic Society Aug 15, 2019</rights><rights>Copyright © 2019 by the American Thoracic Society 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c496t-f9b76ef7e030a2cf0ce5a1558b02a9fe9a7fc99f314626828126b5272c5a004d3</citedby><cites>FETCH-LOGICAL-c496t-f9b76ef7e030a2cf0ce5a1558b02a9fe9a7fc99f314626828126b5272c5a004d3</cites><orcidid>0000-0003-3924-9199 ; 0000-0002-9070-847X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,4011,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30764637$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mazzotti, Diego R</creatorcontrib><creatorcontrib>Keenan, Brendan T</creatorcontrib><creatorcontrib>Lim, Diane C</creatorcontrib><creatorcontrib>Gottlieb, Daniel J</creatorcontrib><creatorcontrib>Kim, Jinyoung</creatorcontrib><creatorcontrib>Pack, Allan I</creatorcontrib><title>Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes</title><title>American journal of respiratory and critical care medicine</title><addtitle>Am J Respir Crit Care Med</addtitle><description>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 (
< 0.001), coronary heart disease (
= 0.015), and heart failure (
= 0.018), with the excessively sleepy again demonstrating increased risk (hazard ratios, 1.7-2.4) compared with other subtypes. When compared with individuals without OSA (apnea-hypopnea index < 5), significantly increased risk for prevalent and incident cardiovascular events was observed mostly for patients in the excessively sleepy subtype.
OSA symptom subtypes are reproducible and associated with cardiovascular risk, providing important evidence of their clinical relevance.</description><subject>Aged</subject><subject>Cardiovascular disease</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Clinical trials</subject><subject>Cluster Analysis</subject><subject>Cohort Studies</subject><subject>Coronary Disease - epidemiology</subject><subject>Coronary vessels</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Heart attacks</subject><subject>Heart failure</subject><subject>Heart Failure - epidemiology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medicine</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Neurosciences</subject><subject>Older people</subject><subject>Original</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - classification</subject><subject>Sleep Apnea, Obstructive - epidemiology</subject><subject>Sleep Apnea, Obstructive - physiopathology</subject><subject>Sleepiness</subject><subject>Stroke</subject><subject>Stroke - epidemiology</subject><subject>Survival analysis</subject><subject>Systematic review</subject><issn>1073-449X</issn><issn>1535-4970</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdkU1r3DAQhkVpyfcf6CEYeunF6UiWJetSCEvzAYEtbAO5CVkeNQ625Urywv77atk0tD1JoGdezcxDyEcKV5QK_iVYO14xoA00Ja1BrVfvyAmtq7rkSsL7fAdZlZyrp2NyGuMLAGUNhSNyXIEUXFTyhDxtduOc_FhsljbtZoyFd8W6jSksNvVbLDYD4lxczxOa4nvArrepuJ9s3-FkcQ-vTOh6vzXRLoMJxXpJ1o8Yz8kHZ4aIF6_nGXm8-fZjdVc-rG_vV9cPpeVKpNKpVgp0EqECw6wDi7Whdd20wIxyqIx0VilXUS6YaHL_TLQ1k8zWBoB31Rn5esidl3bEzuKUghn0HPrRhJ32ptf_vkz9s_7pt1pIoMAhB3x-DQj-14Ix6bGPFofBTOiXqBljiuavFM3op__QF7-EKY-XqSbvnKtmH8gOlA0-xoDurRkKei9O78Xpgzh9EJeLLv8e463kj6nqNxQ2lgU</recordid><startdate>20190815</startdate><enddate>20190815</enddate><creator>Mazzotti, Diego R</creator><creator>Keenan, Brendan T</creator><creator>Lim, Diane C</creator><creator>Gottlieb, Daniel J</creator><creator>Kim, Jinyoung</creator><creator>Pack, Allan I</creator><general>American Thoracic Society</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0003-3924-9199</orcidid><orcidid>https://orcid.org/0000-0002-9070-847X</orcidid></search><sort><creationdate>20190815</creationdate><title>Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes</title><author>Mazzotti, Diego R ; 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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 (
< 0.001), coronary heart disease (
= 0.015), and heart failure (
= 0.018), with the excessively sleepy again demonstrating increased risk (hazard ratios, 1.7-2.4) compared with other subtypes. When compared with individuals without OSA (apnea-hypopnea index < 5), significantly increased risk for prevalent and incident cardiovascular events was observed mostly for patients in the excessively sleepy subtype.
OSA symptom subtypes are reproducible and associated with cardiovascular risk, providing important evidence of their clinical relevance.</abstract><cop>United States</cop><pub>American Thoracic Society</pub><pmid>30764637</pmid><doi>10.1164/rccm.201808-1509OC</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0003-3924-9199</orcidid><orcidid>https://orcid.org/0000-0002-9070-847X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Thoracic Society (ATS) Journals Online; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| 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 |
| title | Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes |
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