Symptom subtypes and risk of incident cardiovascular and cerebrovascular disease in a clinic-based obstructive sleep apnea cohort

Allen, A J Hirsch; Jen, Rachel; Mazzotti, Diego R.; Keenan, Brendan T.; Goodfellow, Sebastian D.; Taylor, Carolyn; Daniele, Patrick; Peres, Bernardo Urbanetto; Liu, Yu; Mehrtash, M; Ayas, Najib

doi:10.5664/jcsm.9986

Cited by 18 publications

(14 citation statements)

References 28 publications

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“…The relation between OSA and EDS remains controversial [28][29][30]. EDS in OSA may indicate more arousals and is associated with a higher risk of comorbidities [7,31,32]. Nevertheless, recent studies reported the presence of EDS in sleep apnea patients associated with increases the risk of DM, obesity, hypertension, heart failure, and coronary heart disease [6,7,[29][30][31][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Comorbidities in Clinical and Polysomnographic Features of Obstructive Sleep Apnea: A Single Tertiary Care Center Experience

Al‐Jahdali

Ahmed

Al-Harbi

et al. 2022

J Epidemiol Glob Health

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Background Research on obstructive sleep apnea (OSA) is inadequate in Saudi Arabia, particularly among patients with comorbidities. This study investigates comorbidities in patients with different severity of apnea based on the Apnea–Hypopnea Index (AHI). Methods The retrospective charts review that included a cohort of 4391 patients who underwent polysomnography (PSG) between 2003 and 2019. The AHI is classified into four ordinal groups: normal, mild, moderate, and severe. Ordinal logistic regression was used to model proportional odds of a higher AHI category. Results Gender was distributed equally in the study sample. The average age was 49.6 ± 14.8 years and the average AHI was 16.1 ± 22 per hour. Hypertension (43.2%) and diabetes mellitus (37.3%) were the most common comorbidities: Mild OSA 28.9%, Moderate OSA 15.6%, and severe 16.4%. The severity of apnea increased with age and BMI classes. The prevalence of hypertension increased with the severity of apnea: 42.9% in mild, 47.4% in moderate, and 54.6% in severe AHI. The prevalence of coronary artery disease (CAD), congestive heart failure (CHF), and diabetes mellitus (DM) increased with the severity of apnea. Comorbidities was more among OSA patients with excessive sleepiness. After adjustment for age and gender, greater proportional odds of severe AHI were observed in males (aOR = 1.8), 30–59 years (aOR = 2.064), 60 years or above (aOR = 2.873), obese class II (aOR = 2.016), obese class III (aOR = 2.527), and in patients with hypertension (aOR = 1.272). Conclusion Hypertension and obesity were highly prevalent in the study cohort and were associated with greater proportional odds of severe AHI.

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Section: Discussionmentioning

confidence: 99%

Comorbidities in Clinical and Polysomnographic Features of Obstructive Sleep Apnea: A Single Tertiary Care Center Experience

Al‐Jahdali

Ahmed

Al-Harbi

et al. 2022

J Epidemiol Glob Health

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“…10 We and others have identified similar symptom subtypes in clinic based cohorts of obstructive sleep apnoea and have found positive associations between these subtypes and future risk of cardiovascular and cerebrovascular disease. [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.…”

Section: Symptom Clustersmentioning

confidence: 99%

Role of precision medicine in obstructive sleep apnoea

Liu

Ghafoor

Hajipour

et al. 2023

bmjmed

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Obstructive sleep apnoea is a substantial clinical and public health problem because it contributes to harmful effects on quality of life, daytime symptoms, road traffic incidents, and cardiometabolic disease. Increasingly, obstructive sleep apnoea is recognised as a heterogeneous disease, and patients have varied susceptibility to long term complications and different responses to treatment. This narrative review summarises the current knowledge of precision medicine in obstructive sleep apnoea, particularly the role of symptom clusters, polysomnogram phenotypes, physiological endotypes, and circulating biomarkers in defining subtypes. In the near future, the prognostic accuracy of these measures in predicting long term complications in obstructive sleep apnoea will likely be improved, together with better matching of treatments to disease subtypes.

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“…These digital biomarkers have mainly focused on accelerometer data and heart rate due to the well-established sensors from mass-market wearables. In fact, recent studies with wearables are demonstrating a correlation between heart rate variability and sleep disturbance that is linked to multiple health disorders (Allen et al 2022; Chalmers et al 2022). There are now emerging biosensors promising to detect biomarkers noninvasively in sweat, saliva, and exhaled breath, but more studies are needed (Brasier et al 2021).…”

Section: Electronic Dentist–patient Communicationmentioning

confidence: 99%

The Forefront of Dentistry—Promising Tech-Innovations and New Treatments

DaSilva

Robinson

Shi³

et al. 2022

JDR Clinical & Translational Research

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Change in our world is happening quickly. For dentistry, this is no exception, and now is the time to foster new opportunities. Advances in the foundational science of dental, oral, and craniofacial health are expanding and enabling personalized care built on strong discoveries in the fields of microbiology, immunology, and neuroscience. Digital communication through electronic health records, patient portals, and teledentistry is emerging as vital new armamentarium for contemporary dental practice. Wearables linked with smartphone apps are trending to monitor pain levels, postoperative symptoms, wound healing, and home oral health habits. Oral fluid diagnostics are rapidly surfacing for use in diagnostics, drug testing, and hormone detection. Manipulation of the oral microbiome is under investigation for caries management and for potential impact on systemic conditions. Resolving mediators of inflammation are promising for addressing the chronic inflammation that plagues periodontal patients. New imaging modalities paired with digital approaches and 3-dimensional printing are formulating disruptions in the technical aspects of dentistry. Augmented reality and virtual reality are providing great potential as teaching tools for dental students and bear promise for lifelong learning for providers. Optimization of information technology and the incorporation of data science partnered with artificial intelligence and machine learning to improve patient care in a learning health care system approach will benefit large numbers of patients. These are exciting times for our profession, yet we need to navigate these paths carefully. Technology needs to significantly and positively change the experience of those involved (patients, dentists, staff, payors). New technologies need to be backed with solid research and implementation science. Automation should focus on improving care with attention to expanding care to the underserved and not lose the critical human connection that our patients need. There is great potential in the emerging innovations yet also great responsibility to ensure they are evidence based on rigorous science and deployable with equity and sensitivity. Knowledge Transfer Statement: This article discusses innovations in technology and treatments that have enormous potential to revolutionize our dental care, including novel concepts in electronic health records, communication between dentists and patients, biologics around diagnosis and treatment, digital dentistry, and, finally, the real-time optimization of information technology. The early implementation and validation of these innovations can drive down their costs and provide better dental and medical services to all members of our society.

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Symptom subtypes and risk of incident cardiovascular and cerebrovascular disease in a clinic-based obstructive sleep apnea cohort

Cited by 18 publications

References 28 publications

Comorbidities in Clinical and Polysomnographic Features of Obstructive Sleep Apnea: A Single Tertiary Care Center Experience

Comorbidities in Clinical and Polysomnographic Features of Obstructive Sleep Apnea: A Single Tertiary Care Center Experience

Role of precision medicine in obstructive sleep apnoea

The Forefront of Dentistry—Promising Tech-Innovations and New Treatments

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