Beyond the AHI–pulse wave analysis during sleep for recognition of cardiovascular risk in sleep apnea patients

Abstract

Summary Recent evidence supports the use of pulse wave analysis during sleep for assessing functional aspects of the cardiovascular system. The current study compared the influence of pulse wave and sleep study‐derived parameters on cardiovascular risk assessment. In a multi‐centric study design, 358 sleep apnea patients (age 55 ± 13 years, 64% male, body mass index 30 ± 6 kg m−2, apnea–hypopnea index 13 [5–26] events per hr) underwent a standard overnight sleep recording. A novel cardiac risk index was computed based on pulse wave signals derived from pulse oximetry, reflecting vascular stiffness, cardiac variability, vascular autonomic tone and nocturnal hypoxia. Cardiovascular risk was determined using the ESC/ESH cardiovascular risk matrix, and categorized to high/low added cardiovascular risk. Comparisons between cardiac risk index and sleep parameters were performed for cardiovascular risk prediction. Apnea–hypopnea index, oxygen desaturation index and cardiac risk index were associated with high cardiovascular risk after adjustment for confounders (p = .002, .001, < .001, respectively). In a nested reference model consisting of age, gender and body mass index, adding cardiac risk index but not apnea–hypopnea index or oxygen desaturation index significantly increased the area under the receiver operating characteristic curve (p = .012, .22 and .16, respectively). In a direct comparison of oxygen desaturation index and cardiac risk index, only the novel risk index had an independent effect on cardiovascular risk prediction (pCRI < .001, pODI = .71). These results emphasize the association between nocturnal pulse wave and overall cardiovascular risk determined by an established risk matrix. Thus, pulse wave analysis during sleep provides a powerful approach for cardiovascular risk assessment in addition to conventional sleep study parameters.

Integrating Phenotypic Information of Obstructive Sleep Apnea and Deep Representation of Sleep-Event Sequences for Cardiovascular Risk Prediction

“…Recent research has examined the association between OSA and CVDs, including phenotyping OSA using PSG static features and analyzing their differences in cardiovascular risks [13,17,34]. However, it remains to be explored on how to effectively using the OSA-related information for accurate CVD risk prediction modeling.…”

“…There is a recognized link between Obstructive Sleep Apnea (OSA) and increased CVD risk, with OSA prevalence in CVD patients ranging from 40% to 80% [12]. Recent research has focused on OSA phenotyping using polysomnography (PSG) data, identifying distinct CVD risk levels among different OSA phenotypes [13][14][15][16][17]. The pathophysiology of OSA-related cardiovascular complications has been recognized as multifaceted, encompassing four main domains: sleep architecture disturbances, autonomic dysregulation, breathing disturbances, and hypoxemia [18][19][20][21].…”

National Knowledge-Driven Management of Obstructive Sleep Apnea—The Swedish Approach

“…This classification, however, is poorly associated with patients’ symptomatology and long-term outcome [ 5 ]. To overcome limitations of the AHI-based severity classification, several new strategies have been proposed including the metric “hypoxic burden” (cumulative area under the desaturation curve) [ 6 , 7 ] and advanced analysis of the finger pulse wave derived from oximetry [ 8 , 9 ].…”

Obstructive Sleep Apnea with High Pulse Wave Amplitude Drops Index: A Specific Phenotype for Cardiovascular Benefit from Continuous Positive Airway Pressure?

“…Respiratory events are known to affect many physiological functions, including vascular endothelial dysfunction and autonomic function ( 5 ), two important etiologies in cardiovascular outcomes. Pulse-wave amplitude reflects vascular stiffness and vascular autonomic tone ( 6 ), making it a potentially useful prognostic marker for OSA-related cardiovascular risk. In the Journal , Solelhac and colleagues analyzed data from three prospective cohorts and found that a low pulse wave amplitude drops (PWAD) index was independently associated with a higher risk of cardiovascular events in patients with OSA ( 7 ), suggesting that a low PWAD index may be an emerging predictor of adverse cardiovascular outcomes in patients with OSA.…”