Document Type : Original Article(s)
Authors
- Sayed Mohammad Amin Sayedain 1
- Saedeh Bahrani 2
- Asieh Mansouri 3
- Jamshid Najafian 4
- Mohaddeseh Behjati 5
- Shahin Shirani 3
- Babak Amra 6
- Mohammad Emami Ardestani 7
- Maryam Khosravi 8
- Alireza Khosravi 9
1 MD, Heart failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 MD, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Assistant professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
5 MD, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
6 Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
7 Associate Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
8 Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
9 Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: The occurrence of obstructive sleep apnea (OSA) and its health-related issues, especially cardiovascular diseases (CVD), are increasing in developing countries. With a 3-year follow-up study, the present study aimed to determine the incidence of cardiovascular events in patients with OSA in an Iranian population.
Method: In this prospective cohort study, 415 adults (300 patients with OSA and 115 patients without OSA) with a history of snoring and/or witnessed apneas or other suspected sleep breathing disorders were consecutively enrolled and followed up for three successive years to evaluate the development of cardiovascular events including acute coronary syndrome, cerebrovascular accidents (including ischemic or hemorrhagic strokes or transient ischemic attacks), death due to cardiac causes and all-cause mortality.
Results: 415 patients were studied with a mean age of 56.2 ±15.7 years, 211 (50.8) of whom were male. Cardiovascular events developed in 15 participants (5%) of the OSA group, and 3 participants (2.6 %) of the OSA negative group. No significant differences were observed between the two groups in terms of the incidence of any of these events (P>0.05). Using multiple logistic regression model (with P<0.2 as the significance level), age, OSA, and history of CVD remained as significant predictors for the development of cardiac composite events (incidence of CVD, CVA, death due to cardiac causes, and all-cause mortality) with the odds ratios of (95% confidence interval) 1.03 (1.01, 1.06), 2.41 (1.02, 5.76), and 7.40 (2.91, 18.67), respectively.
Conclusions: The present study showed that OSA is associated with a more than twofold increased risk of cardiovascular events. Thus, obstructive sleep apnea should be considered an independent cardiovascular risk factor.
Highlights
The PubMed and Google Scholar links for Alireza Khosravi.
Keywords
2. Ahmad M, Makati D, Akbar S. Review of and updates on hypertension in obstructive sleep apnea. Int J Hypertens. 2017; 2017.
3. Redline S, Strohl KP. Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med. 1998; 19(1): 1–19.
4. Flemons WW, Tsai W. Quality of life consequences of sleep-disordered breathing. J Allergy Clin Immunol. 1997; 99(2): S750-S756.
5. Purtle MW, Renner CH, McCann DA, Mallen JC, Spilman SK, Sahr SM. Driving with undiagnosed obstructive sleep apnea (OSA): High prevalence of OSA risk in drivers who experienced a motor vehicle crash. Traffic Inj Prev. 2020; 21(1): 38–41.
6. Bucks RS, Olaithe M, Rosenzweig I, Morrell MJ. Reviewing the relationship between OSA and cognition: W here do we go from here? Respirology. 2017; 22(7): 1253–1261.
7. Acker J, Richter K, Piehl A, Herold J, Ficker JH, Niklewski G. Obstructive sleep apnea (OSA) and clinical depression—prevalence in a sleep center. Sleep Breath. 2017; 21(2): 311–318.
8. Leung RST, Douglas Bradley T. Sleep apnea and cardiovascular disease. Am J Respir Crit Care Med. 2001; 164(12): 2147–65.
9. Lavie P, Lavie L. Cardiovascular morbidity and mortality in obstructive sleep apnea. Curr Pharm Des. 2008; 14(32): 3466–73.
10. Ogilvie RP, Lakshminarayan K, Iber C, Patel SR, Lutsey PL. Joint effects of OSA and self-reported sleepiness on incident CHD and stroke. Sleep Med. 2018; 44: 32–37.
11. Reutrakul S, Mokhlesi B. Obstructive sleep apnea and diabetes: a state of the art review. Chest. 2017; 152(5): 1070–86.
12. Lavie L, Lavie P. Smoking interacts with sleep apnea to increase cardiovascular risk. Sleep Med. 2008; 9(3): 247–53.
13. Cao Z, Zhang P, He Z, Yang J, Liang C, Ren Y, et al. Obstructive sleep apnea combined dyslipidemia render additive effect on increasing atherosclerotic cardiovascular diseases prevalence. Lipids Health Dis. 2016; 15(1): 1–6.
14. Zhu HM, Yi HL, Guan J, Xu HJ, Liu SR, Zou JY, et al. Relationship between smoking and the severity of OSA. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019; 33(9): 862–5.
15. Fleiss JL, Levin B, Cho Paik M. Statistical methods for rates and proportions. 3rd Edition. John Wiley & Sons, 2003.
Shahar E, Whitney CW, REdline S, Lee ET, Newman AB, Javier Nieto F, et al. Sleep-disordered breathing and 16. cardiovascular dis ease: cross-sectional results of the Sleep Heart Health Study. Am J Respir Crit Care Med. 2001; 163(1): 19–25.
17. Young T, Peppard PE, Gottlieb DJ. Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med. 2002; 165(9): 1217–39.
18. Cadby G, McArdle N, Briffa T, Hillman DR, Simpson L, Knuiman M, et al. Severity of OSA is an independent predictor of incident atrial fibrillation hospitalization in a large sleep-clinic cohort. Chest. 2015; 148(4): 945–52.
19. Yumino D, Tsurumi Y, Takagi A, Suzuki K, Kasanuki H. Impact of obstructive sleep apnea on clinical and angiographic outcomes following percutaneous coronary intervention in patients with acute coronary syndrome. Am J Cardiol. 2007; 99(1): 26–30.
20. Lavie L. Oxidative stress in obstructive sleep apnea and intermittent hypoxia--revisited--the bad ugly and good: implications to the heart and brain. Sleep Med Rev. 2015; 20: 27–45.
21. Lurie A. Endothelial dysfunction in adults with obstructive sleep apnea. Adv Caradiol. 2011; 46: 139-170.
22. Pedrosa RP, Drager LF, Gonzaga CC, Sousa MG, de Paula LKG, Amaro ACS, et al. Obstructive sleep apnea: the most common secondary cause of hypertension associated with resistant hypertension. Hypertension. 2011; 58(5): 811–7.
23. Appleton SL, Vakulin A, Martin SA, Lang CJ, Wittert GA, Taylor AW, et al. Hypertension is associated with undiagnosed OSA during rapid eye movement sleep. Chest. 2016; 150(3): 495–505.
24. Bielicki P, Trojnar A, Sobieraj P, W\kasik M. Smoking status in relation to obstructive sleep apnea severity (OSA) and cardiovascular comorbidity in patients with newly diagnosed OSA. Adv Respir Med. 2019; 87(2): 103–9.
25. Ji R, Wang D, Shen H, Pan Y, Liu G, Wang P, et al. Interrelationship among common medical complications after acute stroke: pneumonia plays an important role. Stroke. 2013; 44(12): 3436–44.
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