Association of Obstructive Sleep Apnea With Risk of Serious Cardiovascular Events

Abstract

Background— The relationship between obstructive sleep apnea (OSA) and cardiovascular events remains unclear. We conducted a systematic review to determine the incident risk of cardiovascular events among patients with OSA. Methods and Results— We searched MEDLINE and EMBASE in January 2011 for prospective studies that followed up patients with OSA for incident ischemic heart disease, stroke, and cardiovascular mortality. Outcomes data were pooled using random effects meta-analysis and heterogeneity assessed with the I 2 statistic. Regression analysis was performed to evaluate the effects of different gradations of OSA severity based on apnea-hypopnea index. We identified 9 relevant studies from 1731 citations. OSA was associated with incident stroke in a meta-analysis of 5 studies (8435 participants), odds ratio (OR) 2.24; 95% confidence interval (CI), 1.57–3.19; I 2 =7%. A significant association was seen in studies that were predominantly on men; OR, 2.87; 95% CI, 1.91–4.31, whereas data on women were sparse. In the overall analysis of 6 studies (8785 participants), OSA was nonsignificantly associated with ischemic heart disease (OR, 1.56; 95% CI, 0.83–2.91), with significant findings in the 5 studies that recruited mainly men (OR, 1.92; 95% CI, 1.06–3.48). Substantial heterogeneity was noted (I 2 =74%). OSA was linked to cardiovascular death in 2 studies involving 2446 participants (OR, 2.09; 95% CI, 1.20–3.65, I 2 =0%). Regression analysis showed greater likelihood of stroke or cardiovascular events with increasing apnea-hypopnea index values. Conclusions— OSA appears to be associated with stroke, but the relationship with ischemic heart disease and cardiovascular mortality needs further research.

Iron deficiency, ischaemic strokes, and right-to-left shunts: From pulmonary arteriovenous malformations to patent foramen ovale?

“…Times when PFO right-to-left shunts would be in operation also include sleep apnoea, now recognised to be associated with ischaemic stroke and other adverse cardiovascular events (19,20). Associated pressure changes are well recognised, but valsalva provocation of right-to-left shunting, allowing the particulate constituents of venous blood to bypass the mechanical filter provided by the pulmonary capillary bed, has not been emphasised to date.…”

Intensiveversusstandard follow-up to improve continuous positive airway pressure compliance

“…Estimates of disease prevalence are in the range of 4-7%, with certain subgroups of the population being at higher risk [2]. OSAHS is associated with neurocognitive and cardiovascular morbidities, public health consequences (driving, accidents at work and home) and a reduced quality of life [3]. Given the important implications of untreated OSAHS, as well as the increased all-cause mortality observed in patients with severe OSAHS [4,5], the need for effective treatment is paramount.…”

Obstructive Sleep Apnea and Sickle Cell Anemia

“…1,2 In adults, untreated OSAS is associated with increased risk of incident cardiovascular disease and stroke. 3 Adenotonsillar hypertrophy is the most commonly identified risk factor for childhood OSAS and adenotonsillectomy is effective treatment. Otherwise normal children with OSAS are more likely to be AfricanAmerican, [4][5][6][7] exposed to environmental tobacco smoke, 7 born preterm, 5 have undergone adenotonsillectomy, 8 and live in disadvantaged neighborhoods.…”