Nav: Home

OSA patients with excessive daytime sleepiness at greatest risk of cardiovascular disease

February 15, 2019

Feb. 15, 2019--Adults with obstructive sleep apnea (OSA) who experience excessive sleepiness while awake appear to be at far greater risk for cardiovascular diseases than those without excessive daytime sleepiness, according to new research published online in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.

In "Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes," Diego R. Mazzotti, PhD, and co-authors report on a study of adults with moderate to severe OSA who were categorized into four subtypes according to the symptoms they report: disturbed sleep, minimally symptomatic, moderately sleepy and excessively sleepy.

Previous studies have linked OSA and cardiovascular disease. To understand this association better, researchers have begun to categorize patients with OSA based on their symptoms.

"Multiple studies from our group have shown that patients with moderate to severe OSA throughout the world can be categorized into specific subtypes based on their reported symptoms," said Dr. Mazzotti, lead study author and a sleep researcher at the University of Pennsylvania. "However, until now, it was unclear whether these subtypes had different clinical consequences, especially in regard to future cardiovascular risk."

The current study analyzed data from 1,207 adults participating in the Sleep Heart Health Study, available from the National Sleep Research Resource. Patients were 40 years old or older at enrollment and were followed for nearly 12 years. The patients had moderate to severe OSA, which was defined as having at least 15 episodes per hour while sleeping when they stopped breathing (apnea) or had reduced breathing (hypopnea). The metric is known as the apnea-hypopnea index, or AHI.

Participant-reported symptoms, such as difficulty falling and staying asleep, snoring, fatigue, drowsy driving and daytime sleepiness, and responses to a widely used questionnaire called the Epworth Sleepiness Scale were used to determine the patient's subtype.

The study found participants exhibiting the excessively sleepy subtype were:
  • More than three times as likely to have been diagnosed with heart failure at enrollment than the other three subtypes.

  • About twice as likely to experience a cardiovascular event (heart attack, heart failure, stroke or cardiovascular death) during the follow-up period than the other three subtypes.

  • The only group that had higher rates of cardiovascular disease at enrollment when compared to individuals without OSA.

  • More likely to experience a new or recurrent cardiovascular event during the follow-up period.
The authors said that their study indicates the increased risk of cardiovascular disease associated with OSA appears to be driven by patients in the excessively sleepy subtype.

Given the observational study design, they could not prove that excessively sleepy subtype was a causal factor for cardiovascular disease. Ultimately, excessive sleepiness could be a "surrogate marker of underlying cardiovascular risk pathways," they wrote.

However, the authors demonstrate that the association is independent of a number of demographic and health factors that might have biased results, including age, body mass index , smoking, diabetes, hypertension, cholesterol and medications.

The authors suggest their findings should guide future research studies. For instance, the researchers believe that studies of the cardiovascular benefits of continuous positive airway pressure, or CPAP, treatment for OSA should focus on the excessively sleepy subtype, who are likely to benefit the most from what is considered the gold standard OSA treatment.

"Even without further research, clinicians should recognize that patients with OSA who complain of feeling tired when they wake up and sleepy during the day and have a high score on the Epworth Sleepiness Scale are at greater risk for cardiovascular disease," Dr. Mazzotti said.

He added that the research team is developing a simple tool to facilitate the accurate classification of patients into symptom subtypes, which should improve the clinical utility of their findings.
-end-
The Sleep Heart Health Study and the National Sleep Research Resource were supported by the National Heart, Lung, and Blood Institute.

About the American Journal of Respiratory and Critical Care Medicine

The AJRCCM is a peer-reviewed journal published by the American Thoracic Society. The Journal takes pride in publishing the most innovative science and the highest quality reviews, practice guidelines and statements in pulmonary, critical care and sleep medicine. With an impact factor of 15.239, it is one of the highest ranked journals in pulmonology. Editor: Jadwiga Wedzicha, MD, professor of respiratory medicine at the National Heart and Lung Institute (Royal Brompton Campus), Imperial College London, UK.

About the American Thoracic Society

Founded in 1905, the American Thoracic Society is the world's leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society's 15,000 members prevent and fight respiratory disease around the globe through research, education, patient care and advocacy. The ATS publishes three journals, the American Journal of Respiratory and Critical Care Medicine, the American Journal of Respiratory Cell and Molecular Biology and the Annals of the American Thoracic Society.

The ATS will hold its 2019 International Conference, May 17-22, in Dallas, Texas, where world-renowned experts will share the latest scientific research and clinical advances in pulmonary, critical care and sleep medicine.

American Thoracic Society

Related Heart Failure Articles:

New hope for treating heart failure
Heart failure patients who are getting by on existing drug therapies can look forward to a far more effective medicine in the next five years or so, thanks to University of Alberta researchers.
Activated T-cells drive post-heart attack heart failure
Chronic inflammation after a heart attack can promote heart failure and death.
ICU care for COPD, heart failure and heart attack may not be better
Does a stay in the intensive care unit give patients a better chance of surviving a chronic obstructive pulmonary disease (COPD) or heart failure flare-up or even a heart attack, compared with care in another type of hospital unit?
Tissue engineering advance reduces heart failure in model of heart attack
Researchers have grown heart tissue by seeding a mix of human cells onto a 1-micron-resolution scaffold made with a 3-D printer.
Smoking may lead to heart failure by thickening the heart wall
Smokers without obvious signs of heart disease were more likely than nonsmokers and former smokers to have thickened heart walls and reduced heart pumping ability.
After the heart attack: Injectable gels could prevent future heart failure (video)
During a heart attack, clots or narrowed arteries block blood flow, harming or killing cells in the heart.
Heart failure after first heart attack may increase cancer risk
People who develop heart failure after their first heart attack have a greater risk of developing cancer when compared to first-time heart attack survivors without heart failure, according to a study today in the Journal of the American College of Cardiology.
Scientists use 'virtual heart' to model heart failure
A team of researchers have created a detailed computational model of the electrophysiology of congestive heart failure, a leading cause of death.
Increase in biomarker linked with increased risk of heart disease, heart failure, death
In a study published online by JAMA Cardiology, Elizabeth Selvin, Ph.D., M.P.H., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, and colleagues examined the association of six-year change in high-sensitivity cardiac troponin T with incident coronary heart disease, heart failure and all-cause mortality.
1 in 4 patients develop heart failure within 4 years of first heart attack
One in four patients develop heart failure within four years of a first heart attack, according to a study in nearly 25,000 patients presented today at Heart Failure 2016 and the 3rd World Congress on Acute Heart Failure by Dr.

Related Heart Failure Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Digital Manipulation
Technology has reshaped our lives in amazing ways. But at what cost? This hour, TED speakers reveal how what we see, read, believe — even how we vote — can be manipulated by the technology we use. Guests include journalist Carole Cadwalladr, consumer advocate Finn Myrstad, writer and marketing professor Scott Galloway, behavioral designer Nir Eyal, and computer graphics researcher Doug Roble.
Now Playing: Science for the People

#529 Do You Really Want to Find Out Who's Your Daddy?
At least some of you by now have probably spit into a tube and mailed it off to find out who your closest relatives are, where you might be from, and what terrible diseases might await you. But what exactly did you find out? And what did you give away? In this live panel at Awesome Con we bring in science writer Tina Saey to talk about all her DNA testing, and bioethicist Debra Mathews, to determine whether Tina should have done it at all. Related links: What FamilyTreeDNA sharing genetic data with police means for you Crime solvers embraced...