Comparative associations of oximetry patterns in Obstructive Sleep Apnea with incident cardiovascular disease

Abstract

Study Objectives Intermittent hypoxia is a key mechanism linking Obstructive Sleep Apnoea (OSA) to cardiovascular disease (CVD). Oximetry analysis could enhance understanding of which OSA phenotypes are associated with CVD risk. The aim of this study was to compare associations of different oximetry patterns with incident CVD in men and women with OSA. Methods Sleep Heart Health Study data were used for analysis. N=2878 participants (51.8% female; mean age 63.5±10.5 years) with OSA (Apnoea-Hypopnoea Index [AHI] ≥5 events/hour) and no pre-existing CVD at baseline or within the first two years of follow-up were included. Four oximetry analysis approaches were applied: desaturation characteristics, time series analysis, power spectral density, and non-linear analysis. Thirty-one resulting oximetry patterns were compared to incident CVD using proportional hazards regression models adjusted for age, race, smoking, BMI, and sex. Results There were no associations between OSA oximetry patterns and incident CVD in the total sample or in men. In women, there were some associations between incident CVD and time series analysis (e.g. SpO2 distribution standard deviation, HR 0.81, 95% CI 0.68-0.96, P=0.014) and power spectral density oximetry patterns (e.g. Full frequency band mean HR 0.75; 95% CI 0.59 -0.95; P=0.015). Conclusions Comprehensive comparison of baseline oximetry patterns in OSA found none were related to development of CVD. There were no standout individual oximetry patterns that appear to be candidates for CVD risk phenotyping in OSA, but some showed marginal relationships with CVD risk in women. Further work is required to understand whether OSA phenotypes can be used to predict susceptibility to cardiovascular disease.

Time Spent with Saturation below 80% versus 90% in Patients with Obstructive Sleep Apnoea

“…Of note, the excess in mortality was due to malignant rather than cardiovascular diseases [ 11 ]. Our results are in line with a recent study by Sutherland et al, who reported that TST90% was more strongly related to incidental cardiovascular disease than TST80% [ 27 ]. Our study extends the former one, as it also investigated individual components contributing to the cardiovascular risk.…”

“…In a large cohort of community-dwelling older men, in contrast to TST90%, TST80% > 1% was an independent risk factor for all-cause mortality [ 11 ]. On the other hand, in the Sleep Heart Health Study, TST90% but not TST80% was related to incidental cardiovascular disease [ 27 ]. The discrepancy could be due to the different burden of cardiovascular risk factors, such as blood lipids or hypertension, which were not reported in these studies.…”

A comparison of hypoxic burden algorithms using three different methods for calculating baseline oxygen saturation for predicting cardiovascular death in the Sleep Heart Health Study

“…The results of each HB calculation method were considered as three different SpO2 predictors and compared by considering the log-transformed normalised HB value. A log transformed and the resulting distribution of the HB values was more Gaussian and had been previously used by other researcher [12,20]. Normalisation was achieved by converting each set of HBs values to z-scores by subtracting the mean value and dividing by its standard deviation.…”

The Influence of Physiologic Burdens Related to Obstructive Sleep Apnea on Cardiovascular Outcomes

“…Although these metrics are well described in text format, there are still particularities in their implementations ( 10 ). Thus, this is also an opportunity to consider reproducibility and the recent and significant movement by the NIH toward promoting rigorous and transparent research ( 11 ).…”