Prevalence of Undiagnosed Obstructive Sleep Apnea Among Patients Hospitalized for Cardiovascular Disease and Associated In-Hospital Outcomes: A Scoping Review

Abstract

Background: Obstructive sleep apnea (OSA) is associated with long-term cardiovascular morbidity and is highly prevalent in patients with cardiovascular disease (CVD). The objectives of this scoping review were to determine the prevalence of OSA inpatients hospitalized for CVD and to map the range of in-hospital outcomes associated with OSA. Methods: We searched MEDLINE(R), Embase, and Cochrane Databases for articles published from 1946–2018. We included studies involving non-surgical adults with OSA or at high risk of OSA who were hospitalized for CVD. The outcomes were considered as in-hospital if they were collected from admission up to 30 days post-discharge from hospital. Results: After the screening of 4642 articles, 26 studies were included for qualitative synthesis. Eligible studies included patients presenting with acute coronary syndromes (n = 19), congestive heart failure (n = 6), or any cardiovascular disease (n = 1). The pooled prevalence of OSA in cardiac inpatients was 48% (95% CI: 42–53). The in-hospital outcomes reported were mortality (n = 4), length of stay (n = 8), left ventricular ejection fraction (n = 8), peak troponin (n = 7), peak B-type natriuretic peptide (n = 4), and composite cardiovascular complications (n = 2). Conclusions: OSA is highly prevalent in the cardiac inpatient population. The outcomes reported included mortality, cardiac function, cardiac biomarkers, and resource utilization. There are significant knowledge gaps regarding the effect of treatment and OSA severity on these outcomes. The findings from this review serve to inform further areas of research on the management of OSA among patients with CVD.

Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnoea in patients with cardiovascular risk factors: a systematic review and meta-analysis

“…OSA is closely associated with various forms of cardiovascular disease, 15 57–60 including hypertension, stroke, heart failure, atrial fibrillation, coronary artery disease and cerebrovascular disease, with increased risk of adverse outcomes. 16 61 Given the high prevalence 62 of undiagnosed and untreated OSA among patients with cardiovascular disease, a valid, accessible and easy-to-administer screening tool is crucial. The STOP-Bang questionnaire can be quickly administered as it involves a few simple questions and has been found to have a high response rate.…”

Sex-differences in the effect of obstructive sleep apnea on patients hospitalized with pulmonary embolism and on in-hospital mortality

“…Data from regular and critical care wards show a decreased mortality risk in hospitalized patients with OSA and associated diseases, such as pneumonia 27 , 28 , cardiovascular disease 29 , ischemic stroke 30 , and subarachnoid hemorrhage 31 . These results point to a potential protective effect of OSA with respect to mortality, probably as a result of ischemic preconditioning or a higher level of care or vigilance in these patients 32 .…”

Editorial: Clinical aspects of obstructive sleep apnea and cardiovascular consequences

“…A population study in Australia noted a high prevalence in middle-age men and women (57.7 and 41.7%, respectively) ( 3 ). For those admitted with cardiovascular disease or patients with cerebrovascular disease, the prevalence of OSA in both conditions was also high at 48% and 70.4% ( 4 , 5 ).…”