The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: The Osteoporotic Fractures in Men Study and the Sleep Heart Health Study

Ali Azarbarzin, Scott A. Sands, Katie L. Stone, Luigi Taranto-Montemurro, Ludovico Messineo, Philip I. Terrill, Sonia Ancoli-Israel, Kristine Ensrud, Shaun Purcell, David P. White, Susan Redline, Andrew Wellman

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Aims: Apnoea-hypopnoea index (AHI), the universal clinical metric of sleep apnoea severity, poorly predicts the adverse outcomes of sleep apnoea, potentially because the AHI, a frequency measure, does not adequately capture disease burden. Therefore, we sought to evaluate whether quantifying the severity of sleep apnoea by the 'hypoxic burden' would predict mortality among adults aged 40 and older. Methods and results: The samples were derived from two cohort studies: The Outcomes of Sleep Disorders in Older Men (MrOS), which included 2743 men, age 76.3 ± 5.5 years; and the Sleep Heart Health Study (SHHS), which included 5111 middle-aged and older adults (52.8% women), age: 63.7 ± 10.9 years. The outcomes were all-cause and Cardiovascular disease (CVD)-related mortality. The hypoxic burden was determined by measuring the respiratory event-associated area under the desaturation curve from pre-event baseline. Cox models were used to calculate the adjusted hazard ratios for hypoxic burden. Unlike the AHI, the hypoxic burden strongly predicted CVD mortality and all-cause mortality (only in MrOS). Individuals in the MrOS study with hypoxic burden in the highest two quintiles had hazard ratios of 1.81 [95% confidence interval (CI) 1.25-2.62] and 2.73 (95% CI 1.71-4.36), respectively. Similarly, the group in the SHHS with hypoxic burden in the highest quintile had a hazard ratio of 1.96 (95% CI 1.11-3.43). Conclusion: The 'hypoxic burden', an easily derived signal from overnight sleep study, predicts CVD mortality across populations. The findings suggest that not only the frequency but the depth and duration of sleep related upper airway obstructions, are important disease characterizing features.

Original languageEnglish (US)
Pages (from-to)1149-1157a
JournalEuropean heart journal
Volume40
Issue number14
DOIs
StatePublished - Apr 7 2019

Fingerprint

Osteoporotic Fractures
Sleep Apnea Syndromes
Sleep
Cardiovascular Diseases
Apnea
Mortality
Health
Confidence Intervals
Airway Obstruction
Proportional Hazards Models
Area Under Curve
Cohort Studies
Population

Keywords

  • Apnoea-hypopnoea index
  • CVD mortality
  • Hypoxic burden
  • Polysomnography
  • Sleep apnoea

Cite this

The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality : The Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. / Azarbarzin, Ali; Sands, Scott A.; Stone, Katie L.; Taranto-Montemurro, Luigi; Messineo, Ludovico; Terrill, Philip I.; Ancoli-Israel, Sonia; Ensrud, Kristine; Purcell, Shaun; White, David P.; Redline, Susan; Wellman, Andrew.

In: European heart journal, Vol. 40, No. 14, 07.04.2019, p. 1149-1157a.

Research output: Contribution to journalArticle

Azarbarzin, A, Sands, SA, Stone, KL, Taranto-Montemurro, L, Messineo, L, Terrill, PI, Ancoli-Israel, S, Ensrud, K, Purcell, S, White, DP, Redline, S & Wellman, A 2019, 'The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: The Osteoporotic Fractures in Men Study and the Sleep Heart Health Study', European heart journal, vol. 40, no. 14, pp. 1149-1157a. https://doi.org/10.1093/eurheartj/ehy624
Azarbarzin, Ali ; Sands, Scott A. ; Stone, Katie L. ; Taranto-Montemurro, Luigi ; Messineo, Ludovico ; Terrill, Philip I. ; Ancoli-Israel, Sonia ; Ensrud, Kristine ; Purcell, Shaun ; White, David P. ; Redline, Susan ; Wellman, Andrew. / The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality : The Osteoporotic Fractures in Men Study and the Sleep Heart Health Study. In: European heart journal. 2019 ; Vol. 40, No. 14. pp. 1149-1157a.
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abstract = "Aims: Apnoea-hypopnoea index (AHI), the universal clinical metric of sleep apnoea severity, poorly predicts the adverse outcomes of sleep apnoea, potentially because the AHI, a frequency measure, does not adequately capture disease burden. Therefore, we sought to evaluate whether quantifying the severity of sleep apnoea by the 'hypoxic burden' would predict mortality among adults aged 40 and older. Methods and results: The samples were derived from two cohort studies: The Outcomes of Sleep Disorders in Older Men (MrOS), which included 2743 men, age 76.3 ± 5.5 years; and the Sleep Heart Health Study (SHHS), which included 5111 middle-aged and older adults (52.8{\%} women), age: 63.7 ± 10.9 years. The outcomes were all-cause and Cardiovascular disease (CVD)-related mortality. The hypoxic burden was determined by measuring the respiratory event-associated area under the desaturation curve from pre-event baseline. Cox models were used to calculate the adjusted hazard ratios for hypoxic burden. Unlike the AHI, the hypoxic burden strongly predicted CVD mortality and all-cause mortality (only in MrOS). Individuals in the MrOS study with hypoxic burden in the highest two quintiles had hazard ratios of 1.81 [95{\%} confidence interval (CI) 1.25-2.62] and 2.73 (95{\%} CI 1.71-4.36), respectively. Similarly, the group in the SHHS with hypoxic burden in the highest quintile had a hazard ratio of 1.96 (95{\%} CI 1.11-3.43). Conclusion: The 'hypoxic burden', an easily derived signal from overnight sleep study, predicts CVD mortality across populations. The findings suggest that not only the frequency but the depth and duration of sleep related upper airway obstructions, are important disease characterizing features.",
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AU - Stone, Katie L.

AU - Taranto-Montemurro, Luigi

AU - Messineo, Ludovico

AU - Terrill, Philip I.

AU - Ancoli-Israel, Sonia

AU - Ensrud, Kristine

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