Morbidity and mortality in patients with cardiovascular risk factors and obstructive sleep apnoea: results from the DIAST-CHF cohort

Haarmann, Helge; Koch, Jennifer; Bonsch, Nina; Mende, Meinhard; Werhahn, Stefanie Maria; Lüers, Claus; Stahrenberg, Raoul; Edelmann, Frank; Holzendorf, Volker; Haehling, Stephan von; Pieske, Burkert; Andreas, Stefan; Lüthje, Lars; Wachter, Rolf

doi:10.1016/j.rmed.2019.06.019

Cited by 18 publications

(15 citation statements)

References 29 publications

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“…Recently, a prospective cohort study, named Diastolic Chronic Heart Failure Study (DIAST-CHF), has assessed the adverse effects of OSA on cardiovascular morbidity and mortality in patients with cardiovascular risk factors, 23 but it did not nd a signi cant association, in which the effective pharmacological interventions and a limited number of severe OSA patients might have been the possible reasons. Similarly, all subjects in our study were prescribed individualized antihypertensive regimens after systemic evaluation of hypertension, and lipid-lowering drugs, antidiabetic drugs, and antiplatelet drugs were given if necessary.…”

Section: Discussionmentioning

confidence: 99%

OSA remains a risk factor for cardiac events even in hypertensive patients under treatment: The UROSAH data

Yao

Heizhati

et al. 2023

Preprint

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Objectives: Both obstructive sleep apnea (OSA) and hypertension are risk factors of cardiovascular diseases (CVDs). The study aimed to observe the effect of the coexistence of OSA and hypertension on CVDs and evaluate the impact of antihypertensive treatment on CVDs outcomes in this population. Study Design: This is a retrospective cohortstudy. Methods: Hypertensive patients who underwent polysomnography (PSG) test in Jan 2011 to Dec 2013 were enrolled. OSA was defined as apnea hypopnea index(AHI)≥ 5. Outcomes were extended major adverse cardiovascular and cerebrovascular events (MACCE), including the first occurrence of non-fatal myocardial infarction, non-fatal stroke, revascularization, cardiac rehospitalization due to unstable angina or heart failure and all-cause death. The effect of the coexistence of OSA and hypertension on MACCE was explored by Cox regression analysis. Results: Overall, 415 individuals out of 3329 hypertensives experienced extended MACCE. At a median follow-up of 7.0 years, the incidence of extended MACCE was significantly higher in OSA group than in non-OSA group (hazard ratio [HR]: 1.59; 95% confidence interval [CI]:1.27-1.99; P<0.001). Totally, OSA patients had a 57% increased risk of cardiac events than subjects without OSA [HR(95%CI):1.57 (1.04-2.39), P=0.034] and the association did not change in further sensitivity analysis. Especially in uncontrolled hypertension, OSA showed a 93% increased risk of cardiac events compared to patients without OSA(P=0.036) . Conclusion: OSA remains a risk factor of cardiac events, while the association between OSA and cardiac events would be attenuated by the pharmacological-induced blood pressure control.

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Section: Discussionmentioning

confidence: 99%

OSA remains a risk factor for cardiac events even in hypertensive patients under treatment: The UROSAH data

Yao

Heizhati

et al. 2023

Preprint

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“…Its rationale and design have been previously described 16,17 . The design of the CNHF and the many analyses of DIAST‐CHF have been previously published 18–23 . Briefly, the DIAST‐CHF investigated outpatients aged 50–85 years who were recruited between 2004 and 2006 with a history of overt HF or at least one risk factor.…”

Section: Methodsmentioning

confidence: 99%

“…16,17 The design of the CNHF and the many analyses of DIAST-CHF have been previously published. [18][19][20][21][22][23] Briefly, the DIAST-CHF investigated outpatients aged 50-85 years who were recruited between 2004 and 2006 with a history of overt HF or at least one risk factor. These risk factors included a history of HF, coronary disease, diabetes mellitus, sleep apnoea syndrome, or arterial hypertension.…”

Section: Study Design and Subject Populationmentioning

confidence: 99%

Evaluation of the HFA‐PEFF Score: results from the prospective DIAST‐CHF cohort

et al. 2022

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Aims Although the number of patients suffering from heart failure with preserved ejection fraction (HFpEF) increases, the routine diagnosis remains a challenge. In the absence of a pathognomonic sign for HFpEF or specific treatment strategies, a prognosis‐based characterization of suspected patients remains promising for both the risk stratification of the patients and a disease definition. The Heart Failure Association (HFA) of the European Society of Cardiology has introduced an algorithm with different levels of likelihood regarding the diagnosis of HFpEF, the HFA‐PEFF score. We aimed to evaluate the predictive value of this algorithm in a large cohort regarding mortality, symptom burden, and the functional status. Methods and results DIAST‐CHF is a multicentre, population‐based, prospective, observational study in subjects with at least one risk factor for HFpEF between the age of 50 and 85. We calculated the HFA‐PEFF score (n = 1668) and analysed the risk groups for overall mortality, cardiovascular hospitalization, and submaximal functional capacity (6‐min walk distance) at baseline and after a follow‐up period of 10 years. Patients with high HFA‐PEFF score values 5&6 showed a higher mortality than those with an intermediate score (score values 2–4) and low score values (high 21.3% vs. intermediate 10.1% vs. low 4.3%, P < 0.001). Also, the burden of MACE (death, cardiovascular hospitalization, new myocardial infarction, first diagnosis of HF) was increased in the high score values group (high 40.7% vs. intermediate 25.9% vs. low 13.9%, P < 0.001). Similarly, patients with higher scores had higher cumulative incidences of cardiovascular hospitalizations (P = 0.011). Subjects with higher scores also had lower 6‐min walk distance both at baseline and during follow‐up. Conclusions The HFA‐PEFF score provides a reliable instrument to stratify suspected HFpEF patients by their risk for mortality, symptom burden, and functional status in cohort at risk with a follow‐up period of 10 years. As high HFA‐PEFF scores are associated with worse outcome, the HFA‐PEFF algorithm describes a defining approach towards HFpEF.

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“… Score = 2; moderate; study design = 1, robust analyses = 1; others = 0. Haarmann et al, 2019 [ 30 ] Germany Prospective longitudinal study (10 years) 378 Hypertension, diabetes mellitus, atherosclerotic disease, and chronic heart failure; 206 (60%) had OSA. OSA was classified as none (AHI < 5/h), mild (AHI 5–14/h), moderate (AHI 15–29/h), or severe (AHI ≥ 30/h).…”

Section: Methodsmentioning

confidence: 99%

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

2021

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Obstructive sleep apnea (OSA) is a serious, potentially life-threatening condition. Epidemiologic studies show that sleep apnea increases cardiovascular diseases risk factors including hypertension, obesity, and diabetes mellitus. OSA is also responsible for serious illnesses such as congestive heart failure, stroke, arrhythmias, and bronchial asthma. The aim of this systematic review is to evaluate evidence for the association between OSA and cardiovascular disease morbidities and identify risk factors for the conditions. In a review of 34 studies conducted in 28 countries with a sample of 37,599 people, several comorbidities were identified in patients with severe OSA—these were: heart disease, stroke, kidney disease, asthma, COPD, acute heart failure, chronic heart failure, hyperlipidemia, thyroid disease, cerebral infarct or embolism, myocardial infarction, and psychological comorbidities including stress and depression. Important risk factors contributing to OSA included: age > 35 years; BMI ≥ 25 kg/m2; alcoholism; higher Epworth sleepiness scale (ESS); mean apnea duration; oxygen desaturation index (ODI); and nocturnal oxygen desaturation (NOD). Severe OSA (AHI ≥ 30) was significantly associated with excessive daytime sleepiness and oxygen desaturation index. The risk of OSA and associated disease morbidities can be reduced by controlling overweight/obesity, alcoholism, smoking, hypertension, diabetes mellitus, and hyperlipidemia.

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Morbidity and mortality in patients with cardiovascular risk factors and obstructive sleep apnoea: results from the DIAST-CHF cohort

Cited by 18 publications

References 29 publications

OSA remains a risk factor for cardiac events even in hypertensive patients under treatment: The UROSAH data

OSA remains a risk factor for cardiac events even in hypertensive patients under treatment: The UROSAH data

Evaluation of the HFA‐PEFF Score: results from the prospective DIAST‐CHF cohort

Association and Risk Factors for Obstructive Sleep Apnea and Cardiovascular Diseases: A Systematic Review

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