Obstructive Sleep Apnoea and Aortic Aneurysm: A Nationwide Population-Based Retrospective Study

Abstract

Objective: To determine whether patients with obstructive sleep apnoea (OSA) have an increased risk of aortic aneurysm (AA). Methods: The data for the nationwide population-based retrospective cohort study described here were obtained from the Taiwan National Health Insurance Research Database (NHIRD). We selected adult patients who had been newly diagnosed as having OSA and were followed up between 2000 and 2010. We excluded patients who had been diagnosed as having AA before the date of the new OSA diagnosis. The control cohort consisted of individuals who had no OSA history. The patients and the control cohort were selected by 1: 4 matching according to the following baseline variables: sex, age, index year, and comorbidities. The outcome measure was AA diagnosis. Results: In total, 31,274 patients diagnosed as having OSA were identified. Compared to patients without OSA, they had no significantly discrepant cumulative risk of developing AA in subsequent years (p from log-rank test = 0.442). We used the Cox proportional-hazards regression model, which found that only male sex, older age, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and coronary artery disease were independently associated with AA occurrence among subjects with an OSA diagnosis. OSA was not associated with AA development. On the other hand, in the subgroup of COPD, patients with OSA had a higher incidence of risk of AA than those without OSA. Conclusion: When compared to those without OSA, patients with OSA do not have an increased AA risk.

Effects of obstructive sleep apnea on the thoracic aorta and the main pulmonary artery: assessment by CT

“…31 A meta-analysis and a prospective study recently evidenced, respectively, a higher risk of aortic dissection in patients with OSA and a higher prevalence of OSA in patients with thoracic aortic aneurysms, compared to the general population. 32,33 However, a recent nationwide retrospective analysis by Shih et al 34 did not find an association between OSA and aortic aneurysm, in the Taiwan population.…”

Impact of obstructive sleep apnea on aortic disease occurrence: A meta-analysis

“…All the eligible studies had an J o u r n a l P r e -p r o o f observational (cross-sectional or cohort) design. Seven of the studies were cross-sectional studies [24][25][26][27][28][29][30] , 2 were cohort studies 31,32 , and 1 publication reported both a cross-sectional data and a prospective cohort 33 . A total of 214,127 participants were included in this meta-analysis in which most studies had a higher proportion of male participants.…”

“…Among the included studies, 3 studies with 548 participants accessed the OSA prevalence in participants with or without AA or AD 29,30,33 , 3 studies with 212,160 participants accessed the AA or AD incidence in participants with or without OSA [31][32][33] , and 5 studies with 1419 participants reported the aortic diameter in participants with or without OSA [24][25][26][27][28] . Eight studies were carried out in Asia (China and Singapore) [24][25][26][27][31][32][33] , 2 studies were carried out in Europe (Spain and Switzerland) 29,30 and 1 study was done in USA 28 . Polysomnography or respiratory polygraphy was performed to define OSA in most of studies except that 2 studies 31,32 used ICD codes.…”

“…Eight studies were carried out in Asia (China and Singapore) [24][25][26][27][31][32][33] , 2 studies were carried out in Europe (Spain and Switzerland) 29,30 and 1 study was done in USA 28 . Polysomnography or respiratory polygraphy was performed to define OSA in most of studies except that 2 studies 31,32 used ICD codes. Aortic root diameter or ascending aortic diameter was measured by echocardiography or cardiac MRI [24][25][26][27][28] .…”

“…Three studies used echocardiography or computed tomography to identify AA and AD 29,33 , 2 studies used ICD codes 31,32 , and only 1 study did not refer to the diagnostic criteria 30 . Table 5 and Table 6 summarized the quality assessment of the included cross-sectional studies and cohort studies respectively.…”