Obstructive sleep apnea and cardiovascular events in elderly patients

Serra, Pablo Catalán; Soler, Xavier

doi:10.1080/17476348.2022.2030225

Cited by 7 publications

(4 citation statements)

References 149 publications

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“…Also, BMI, age, OSA duration and sex do not appear in these models, despite their potential impact on the occurrence of comorbidities and on the category of comorbidities. 73 , 74 …”

Section: Discussionmentioning

confidence: 99%

Impact of Desaturation Patterns versus Apnea–Hypopnea Index in the Development of Cardiovascular Comorbidities in Obstructive Sleep Apnea Patients

N¹,

Bold²,

Mettay³

et al. 2022

NSS

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Various phenotypes of obstructive sleep apnea (OSA) have been recently described and are poorly assessed by the commonly used polysomnographic indices, such as the apnea-hypopnea index and oxygen desaturation index. Nocturnal hypoxemia is the hallmark of OSA and new quantitative markers, as hypoxic burden or desaturation severity, have been shown to be associated with cardiovascular (CV) mortality. The purpose of this overview is to review the endophenotypical and clinical characteristics of OSA, the current metrics, and to analyze different measurements of hypoxemia in OSA to predict the cardiovascular impact (eg hypoxic burden). Potential interest of multidimensional models to classify OSA, such as BAVENO classification, is also discussed, with the goal of focusing on specific endophenotypes that are likely to develop CV comorbidities, in order to guide clinicians to more aggressive management of OSA in these individuals.

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“…Also, BMI, age, OSA duration and sex do not appear in these models, despite their potential impact on the occurrence of comorbidities and on the category of comorbidities. 73 , 74 …”

Section: Discussionmentioning

confidence: 99%

Impact of Desaturation Patterns versus Apnea–Hypopnea Index in the Development of Cardiovascular Comorbidities in Obstructive Sleep Apnea Patients

N¹,

Bold²,

Mettay³

et al. 2022

NSS

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show abstract

“…Obstructive sleep apnea (OSA) is an extremely common condition characterized by periods of nocturnal apneas and/or hypopneas, which if left untreated may result in excessive daytime sleepiness, impaired cognition, and increased risk of cardiovascular comorbidities. [1][2][3][4][5] The condition affects 15%-30% of men and 10%-15% of women in the United States and is more commonly found in patients of older age, male sex, obesity, and with upper airway abnormalities. [6][7][8] The pathogenesis of OSA is multifactorial; contributors include ventilatory instability caused by low arousal threshold, in which a patient may experience an arousal in response to a relatively mild airway obstruction, and high loop gain, in which a patient might "over-correct" a mild elevation in PaCO 2 with hyperventilation resulting in subsequent hypocapnia.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Systematic Review and Meta‐Analysis

Saba,

Kim,

Huynh

et al. 2023

The Laryngoscope

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ObjectiveOrofacial myofunctional therapy (OMT) is an alternative form of treatment of obstructive sleep apnea (OSA), that incorporates various exercises to optimize tongue placement and increase oropharyngeal tone. The objective of this systematic review and meta‐analysis is to determine the efficacy of OMT in OSA patients.Data SourcesPubMed/Medline, EMBASE, Cochrane, Web of Science.Review MethodsUsing PRISMA guidelines, a directed search strategy was performed for randomized control trials (RCTs) published prior to March 24, 2023, featuring 10+ patients with OSA undergoing mono‐therapeutic OMT. The primary outcome of interest was apnea‐hypopnea index (AHI). Secondary outcomes included subjective sleepiness, sleep‐related quality‐of‐life, and snoring frequency.ResultsOf the 1244 abstracts that were identified, 7 RCTs involving 310 patients met inclusion criteria. Adult OMT patients had a statistically significant improvement in AHI (MD −10.2; 95% CI, −15.6, −4.8, p < 0.05), subjective sleepiness (Epworth Sleepiness Scale; MD −5.66; 95% CI, −6.82, −4.5, p < 0.05), sleep‐related quality‐of‐life (Pittsburgh Sleep Quality Index; MD −3.00; 95% CI, −4.52, −1.49, p < 0.05), and minimum oxygen saturation (MD 2.71; 95% CI, 0.23, 5.18, p < 0.05) when compared with sham OMT or no therapy. Within the single RCT featuring pediatric OMT patients, patients had poor compliance (<50%) and did not show any improvements in AHI, minimum oxygen saturation, or snoring frequency.ConclusionOMT may provide a reasonable alternative for OSA patients who cannot tolerate CPAP or other more established treatment options. OMT benefits appear limited in children due to poor compliance. More studies are required to evaluate compliance and the long‐term effects of OMT on OSA outcomes.Level of EvidenceI Laryngoscope, 2023

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“…This condition is defined by repeated episodes of the airway completely collapsing while sleeping, leading to low oxygen levels and disrupted sleep patterns [4]. OSA has been associated with an increased likelihood of events such as myocardial infarction, strokes, and sudden cardiac arrests [5]. According to the latest European Guidelines on cardiovascular disease, obstructive sleep apnea (OSA) has emerged as a significant factor influencing the risk of major adverse cardiovascular and cerebrovascular events (MACCE) [6].…”

Section: Introductionmentioning

confidence: 99%

Major Adverse Cardiac and Cerebrovascular Events in Geriatric Patients with Obstructive Sleep Apnea: An Inpatient Sample Analysis

Desai,

Mellacheruvu,

Akella

et al. 2023

Medical Sciences

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Background: Obstructive sleep apnea (OSA) is associated with an increased risk of major cardiac and cerebrovascular events (MACCE). However, data on the burden and predictors of MACCE in geriatric patients with OSA (G-OSA) remain limited. Methods: Using the National Inpatient Sample from 2018, we identified G-OSA admissions (age ≥ 65 years) and divided them into non-MACCE vs. MACCE (all-cause mortality, stroke, acute myocardial infarction, and cardiac arrest). We compared the demographics and comorbidities in both cohorts and extracted the odds ratio (multivariate analysis) of MACCE and associated in-hospital mortality. Results: Out of 1,141,120 geriatric obstructive sleep apnea G-OSA admissions, 9.9% (113,295) had MACCE. Males, Asians, or the Pacific Islander/Native American race, and patients from the lowest income quartile revealed a higher MACCE rate. Significant clinical predictors of MACCE in elderly OSA patients on multivariable regression analysis in decreasing odds were pulmonary circulation disease (OR 1.47, 95% CI 1.31–1.66), coagulopathy (OR 1.43, 95% CI 1.35–1.50), peripheral vascular disease (OR 1.34, 95% CI 1.28–1.40), prior sudden cardiac arrest (OR 1.34, 95% CI 1.11–1.62), prior myocardial infarction (OR 1.27, 95% CI 1.22–1.33), fluid and electrolyte imbalances (OR 1.25, 95% CI 1.20–1.29), male sex (OR 1.22, 95% CI-1.18–1.26), hyperlipidemia (OR 1.20, 95% CI 1.16–1.24), low household income (OR 1.19, CI 1.13–1.26), renal failure (OR 1.15, 95% CI 1.12–1.19), diabetes (OR 1.14, 95% CI 1.10–1.17), metastatic cancer (OR 1.14, 95% CI 1.03–1.25), and prior stroke or TIA (OR 1.12, 95% CI 1.07–1.17) (All p value < 0.05). Conclusions: This study emphasizes the significant association between obstructive sleep apnea (OSA) and major cardiac and cerebrovascular events (MACCE) in the geriatric population. Among the elderly OSA patients, a substantial 9.9% were found to have MACCE, with specific demographics like males, Asian or Pacific Islander/Native American individuals, and those from the lowest income quartile being particularly vulnerable. The study sheds light on several significant clinical predictors, with pulmonary circulation disease, coagulopathy, and peripheral vascular disease topping the list. The highlighted predictors provide valuable insights for clinicians, allowing for better risk stratification and targeted interventions in this vulnerable patient cohort. Further research is essential to validate these findings and inform how tailored therapeutic approaches for geriatric OSA patients can mitigate MACCE risk. Clinical Implications: Elderly individuals with a high risk for MACCE should undergo routine OSA screening using tools like the sensitive STOP-BANG Questionnaire. Implementing CPAP treatment can enhance cardiovascular outcomes in these patients.

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Obstructive sleep apnea and cardiovascular events in elderly patients

Cited by 7 publications

References 149 publications

Impact of Desaturation Patterns versus Apnea–Hypopnea Index in the Development of Cardiovascular Comorbidities in Obstructive Sleep Apnea Patients

Impact of Desaturation Patterns versus Apnea–Hypopnea Index in the Development of Cardiovascular Comorbidities in Obstructive Sleep Apnea Patients

Orofacial Myofunctional Therapy for Obstructive Sleep Apnea: A Systematic Review and Meta‐Analysis

Major Adverse Cardiac and Cerebrovascular Events in Geriatric Patients with Obstructive Sleep Apnea: An Inpatient Sample Analysis

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