Cardiovascular correlates of sleep apnea phenotypes: Results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Abstract

Background Identifying Obstructive Sleep Apnea (OSA) phenotypes among middle-aged and older Hispanics/Latinos can facilitate personalized care, better inform treatment decisions, and could lead to improved clinical outcomes. Methods We focused on middle-aged and older adults (ages ≥45–74 years at baseline) with an apnea-hypopnea index (AHI) ≥5 from the HCHS/SOL (2008–2011) (unweighted n = 3,545). We used latent class analyses (LCA) to identify empirical and clinically meaningful OSA phenotypes. Sleep variables included AHI, percent sleep time SpO2<90%, Epworth Sleepiness Scale (ESS), Women’s Health Initiative Insomnia Rating Scale (WHIIRS) score, self-reported average sleep duration, restless legs symptoms, napping frequency, and self-reported sleep quality. We used survey logistic and Poisson regression to test the associations between our OSA phenotypes and prevalent and incident cardiovascular measures (cardiovascular disease, heart failure, Stroke/TIA, hypertension, diabetes, and the Framingham Cardiovascular Risk Score). Results Average AHI, ESS, WHIIRS, and sleep duration were 18.1±19.5, 6.3±6.1, 7.4±6.6, and 7.8±1.7 hours, respectively, and 2.9% had zero percent time SpO2 <90%. We identified a three-class solution that clustered individuals into (1) insomnia OSA (44.3%), (2) asymptomatic mild OSA, (36.2%) and (3) symptomatic OSA (19.5%). Elevated WHIIRS and AHI scores primarily drove classification into groups one and three, respectively. In covariate adjusted models, OSA phenotypes were differentially associated with prevalence (baseline and seven years later) and incidence of cardiovascular measures. Conclusions OSA subtypes in diverse U.S. Hispanic/Latino adults have different cardiovascular complications. More targeted research, that takes these variations into account, could help ameliorate Hispanic/Latino sleep and cardiovascular health disparities.

Positive Airway Pressure Therapy Predicts Lower Mortality and Major Adverse Cardiovascular Events Incidence in Medicare Beneficiaries with Obstructive Sleep Apnoea

“…Results were also corroborated by stronger effects of greater PAP utilization against MI among those with evidence of hypersomnia. These results support the well-established epidemiological relationship between excessive daytime sleepiness and increased CV risk among those with OSA 14,15,64,65 . It is important to note that granular measures of excessive daytime sleepiness might provide a more robust phenotype when compared to claims for hypersomnia.…”

“…Many patients present with excessive daytime sleepiness, which was an important exclusion criterion in these trials, due to the ethical reason of randomising patients that are excessively sleepy into control arms 29 . However, we 14,62 and others 15,63 have demonstrated this subgroup is at increased risk for incident CV diseases. These observations suggest that alternative approaches using causal inference in well-designed observational studies could provide more generalisable evidence towards the role of PAP therapy on CV outcomes risk.…”

Role of precision medicine in obstructive sleep apnoea

“…[16][17][18] Although the main limitation is the lack of external validation, other cluster analyses on obstructive sleep apnoea have been published. 19 In a 2022 study, subpopulations of patients with obstructive sleep apnoea were defined with latent class analysis in a cohort of Hispanic patients based in the community, and an association between symptom clusters of obstructive sleep apnoea and cardiovascular disease was identified 20 ; the insomnia obstructive sleep apnoea phenotype (apnoea-hypopnoea index mean 10.5 events/h (standard deviation 5.2)) was associated with an increased incidence of cardiovascular and cerebrovascular disease (heart failure, hypertension, and diabetes) compared with those with no obstructive sleep apnoea. Other studies have shown a potential increased risk of cardiovascular and cerebrovascular disease in relation to symptoms of insomnia; for example, in the study by Labarca and colleagues, the disturbed sleep cluster had an increased but non-significant hazard ratio for cardiovascular events (2.87, P=0.11).…”

Sleep and Stroke: Opening Our Eyes to Current Knowledge of a Key Relationship

“…The risk of stroke is directly related to OSA severity [23]; however, a definite phenotype of OSA, such as biomarkers predictive of cerebrovascular injury, is still missing. Recent evidence suggests that incidence of stroke is significantly higher in patients with OSA showing excessive daytime sleepiness (EDS) [24,25]. Conversely, another recent research did not show any association between OSA symptoms and risk of cardiovascular diseases [26], but identified hypoxic burden, defined as the area under the desaturation curve associated with respiratory events, as a promising marker of cardiovascular risk in OSA population [26,27].…”