The Sleep Apnea-Specific Hypoxic Burden Predicts Incident Heart Failure

Azarbarzin, Ali; Sands, Scott A.; Taranto‐Montemurro, Luigi; Vena, Daniel; Sofer, Tamar; Kim, Sang–Wook; Stone, Katie L.; White, David P.; Wellman, Andrew; Redline, Susan

doi:10.1016/j.chest.2020.03.053

Cited by 106 publications

(72 citation statements)

References 53 publications

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“…Thus, our findings suggest that individuals whose desaturation events are more severe at baseline develop more of these less severe events. Azarbarzin et al have also shown that the severity of hypoxic burden predicts cardiovascular mortality ( Azarbarzin et al, 2019 ) and incident heart failure ( Azarbarzin et al, 2020 ). Therefore, the nocturnal hypoxic burden seems to play a potential prognostic role in the worsening of sleep apnea and the development of related comorbidities.…”

Section: Discussionmentioning

confidence: 99%

“…To address these shortcomings, we have introduced novel SpO 2 -derived parameters ( Kulkas et al, 2013a ) to quantify the severity of the hypoxic burden and physiological stress experienced by a patient. An elevated hypoxic burden has been associated with several sleep apnea-related comorbidities ( Stone et al, 2016 ; Azarbarzin et al, 2019 , 2020 ), while the AHI and ODI have not. Therefore, novel parameters considering the severities of individual desaturation events could describe the true severity of sleep apnea better than the AHI and ODI ( Otero et al, 2012 ; Kulkas et al, 2013a ).…”

Section: Introductionmentioning

confidence: 99%

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Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study

et al. 2021

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Study ObjectivesObesity, older age, and male sex are recognized risk factors for sleep apnea. However, it is unclear whether the severity of hypoxic burden, an essential feature of sleep apnea, is associated with the risk of sleep apnea worsening. Thus, we investigated our hypothesis that the worsening of sleep apnea is expedited in individuals with more severe desaturations.MethodsThe blood oxygen saturation (SpO2) signals of 805 Sleep Heart Health Study participants with mild sleep apnea [5 ≤ oxygen desaturation index (ODI) < 15] were analyzed at baseline and after a mean follow-up time of 5.2 years. Linear regression analysis, adjusted for relevant covariates, was utilized to study the association between baseline SpO2-derived parameters and change in sleep apnea severity, determined by a change in ODI. SpO2-derived parameters, consisting of ODI, desaturation severity (DesSev), desaturation duration (DesDur), average desaturation area (avg. DesArea), and average desaturation duration (avg. DesDur), were standardized to enable comparisons between the parameters.ResultsIn the group consisting of both men and women, avg. DesDur (β = 1.594, p = 0.001), avg. DesArea (β = 1.316, p = 0.004), DesDur (β = 0.998, p = 0.028), and DesSev (β = 0.928, p = 0.040) were significantly associated with sleep apnea worsening, whereas ODI was not (β = −0.029, p = 0.950). In sex-stratified analysis, avg. DesDur (β = 1.987, p = 0.003), avg. DesArea (β = 1.502, p = 0.024), and DesDur (β = 1.374, p = 0.033) were significantly associated with sleep apnea worsening in men.ConclusionLonger and deeper desaturations are more likely to expose a patient to the worsening of sleep apnea. This information could be useful in the planning of follow-up monitoring or lifestyle counseling in the early stage of the disease.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study

et al. 2021

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“…This is a significant result as the socalled 'hypoxic burden' is now considered as the major determinant and predictor of long-term cardiometabolic outcomes. 35,36 Our cluster analysis also had limitations. The daily routine in sleep practices may vary from one academic centre to another with different percentages of diagnoses conducted using PSG versus respiratory PG.…”

Section: Discussionmentioning

confidence: 99%

“…The ESADA contained clusters that diverged in terms of severity of nocturnal hypoxia. This is a significant result as the so‐called ‘hypoxic burden’ is now considered as the major determinant and predictor of long‐term cardiometabolic outcomes 35,36 …”

Section: Discussionmentioning

confidence: 99%

Clusters of sleep apnoea phenotypes: A large pan‐European study from the European Sleep Apnoea Database (ESADA)

et al. 2020

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Background and objective To personalize OSA management, several studies have attempted to better capture disease heterogeneity by clustering methods. The aim of this study was to conduct a cluster analysis of 23 000 OSA patients at diagnosis using the multinational ESADA. Methods Data from 34 centres contributing to ESADA were used. An LCA was applied to identify OSA phenotypes in this European population representing broad geographical variations. Many variables, including symptoms, comorbidities and polysomnographic data, were included. Prescribed medications were classified according to the ATC classification and this information was used for comorbidity confirmation. Results Eight clusters were identified. Four clusters were gender‐based corresponding to 54% of patients, with two clusters consisting only of men and two clusters only of women. The remaining four clusters were mainly men with various combinations of age range, BMI, AHI and comorbidities. The preferred type of OSA treatment (PAP or mandibular advancement) varied between clusters. Conclusion Eight distinct clinical OSA phenotypes were identified in a large pan‐European database highlighting the importance of gender‐based phenotypes and the impact of these subtypes on treatment prescription. The impact of cluster on long‐term treatment adherence and prognosis remains to be studied using the ESADA follow‐up data set.

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“…The hypoxic burden was demonstrated to be associated with an increased CVD mortality among adults aged >40 years in two cohort studies (the Outcomes of Sleep Disorders in Older Men [MrOS] and the Sleep Heart Health Study [SHHS]) adjusted for multiple covariates, including the AHI. 15 In addition, a higher blood pressure 37 and the risk of incident heart failure in men 38 were demonstrated to be associated with this hypoxic burden after adjusting for confounding factors such as comorbidities.…”

Section: Novel and Promising Parameters In Reinventing The Use Of Psgmentioning

confidence: 98%

<p>A Review of Current Tools Used for Evaluating the Severity of Obstructive Sleep Apnea</p>

Cao

Luo

Xiao

2020

NSS

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The Sleep Apnea-Specific Hypoxic Burden Predicts Incident Heart Failure

Cited by 106 publications

References 53 publications

Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study

Longer and Deeper Desaturations Are Associated With the Worsening of Mild Sleep Apnea: The Sleep Heart Health Study

Clusters of sleep apnoea phenotypes: A large pan‐European study from the European Sleep Apnoea Database (ESADA)

<p>A Review of Current Tools Used for Evaluating the Severity of Obstructive Sleep Apnea</p>

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