Reduced Cardiovascular Morbidity in Obesity-Hypoventilation Syndrome

Lavie, Lena; Lavie, Peretz

doi:10.1016/j.chest.2016.02.659

Cited by 6 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Last, although we applied multivariable adjustment for demographic and clinical confounders, there is possibility of unaccounted for confounding variables. Notwithstanding these limitations, our results were consistent with previous research 2,7,23,28 .…”

Section: Discussionsupporting

confidence: 93%

The Snoring Survivors

OGBU

Hakobyan

Sossou³

et al. 2023

Preprint

View full text Add to dashboard Cite

Background: The routine administration of supplemental oxygen to non-hypoxic patients with acute myocardial infarction has been abandoned for lack of mortality benefit. However, the benefits of continuous positive airway pressure (CPAP) use in patients hospitalized with acute cardiovascular disease and concomitant obstructive sleep apnea (OSA) remain to be elucidated. Methods: Using ICD-10-CM codes, we searched the 2016-2019 Nationwide Inpatient Sample for patients diagnosed with unstable angina, acute myocardial infarction (AMI), acute decompensated heart failure (ADHF), and atrial fibrillation with rapid ventricular response (AFRVR), who also carried a diagnosis of OSA. We identified in-hospital CPAP use with ICD-10-PCS codes. In-hospital death, length of stay (LOS) and hospital charges were compared between patients with and without OSA, and between OSA patients with and without CPAP use. Results: Our sample included 2,959,991 patients, of which 1.5% were diagnosed with UA, 30.3% with AMI, 37.5% with ADHF, and 45.8% with AF. OSA was present in 12.3%. Patients with OSA were more likely to be younger, male, smokers, obese, have chronic obstructive pulmonary disease, renal failure, and heart failure (p < 0.001 for all). Patients with OSA had significantly lower in-hospital mortality (aOR: 0.71, 95% CI [0.7-0.73]). Among patients with OSA, CPAP use significantly increased the odds of in-hospital death (aOR: 1.51, 95% CI [1.44-1.60]), LOS (adjusted mean difference of 1.49 days, 95% CI [1.43, 1.55]), and hospital charges (adjusted mean difference of $1168, 95% CI [273, 2062]). Conclusion: Our study showed that patients with recognized OSA and hospitalized for AMI, ADHF or AFRVR, who were not treated with CPAP, had significantly lower in-hospital mortality and resource utilization. Keywords: Myocardial infarction, Obstructive sleep apnea, Heart failure, Atrial fibrillation, Ischemic preconditioning

show abstract

Section: Discussionsupporting

confidence: 93%

The Snoring Survivors

OGBU

Hakobyan

Sossou³

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Last, although we applied multivariable adjustment for demographic and clinical confounders, there is possibility of unaccounted confounding variables. Notwithstanding these limitations, our results were consistent with previous research 13 17 18 22 26 27…”

Section: Discussionsupporting

confidence: 92%

“…While acknowledging the myriad reported negative cardiovascular outcomes associated with OSA,7 9 19–21 we postulate that the observed survival benefit may be due to ischaemic preconditioning,22–24 a potential cardioprotective phenomenon caused by OSA-induced chronic intermittent hypoxia, resulting in miniature ischaemic episodes that confer adaptation and protection from future infarctions and life-threatening arrhythmias 18 22 25–29. Our findings also showed that patients with OSA who were hospitalised with acute cardiovascular disease and were treated with CPAP had higher mortality.…”

Section: Discussionsupporting

confidence: 56%

Snoring Survivors: the impact of obstructive sleep apnoea and continuous positive airway pressure use on in-hospital mortality, length of stay and costs among patients hospitalised with acute cardiovascular disease – A retrospective analysis of 2016–2019 National Inpatient Sample Data

Ogbu,

Hakobyan,

Sossou

et al. 2024

BMJ Open

View full text Add to dashboard Cite

BackgroundThe routine administration of supplemental oxygen to non-hypoxic patients with acute myocardial infarction (AMI) has been abandoned for lack of mortality benefit. However, the benefits of continuous positive airway pressure (CPAP) use in patients hospitalised with acute cardiovascular disease and concomitant obstructive sleep apnoea (OSA) remain to be elucidated.MethodsIn this retrospective case–control analysis, using 10th International Classification of Diseases, Clinical Modification (ICD-10) codes, we searched the 2016–2019 Nationwide Inpatient Sample for patients diagnosed with unstable angina (UA), AMI, acute decompensated heart failure (ADHF) and atrial fibrillation with rapid ventricular response (AFRVR), who also carried a diagnosis of OSA. We identified in-hospital CPAP use with ICD-10-Procedure Coding System codes. In-hospital death, length of stay (LOS) and hospital charges were compared between patients with and without OSA, and between OSA patients with and without CPAP use.ResultsOur sample included 2 959 991 patients, of which 1.5% were diagnosed with UA, 30.3% with AMI, 37.5% with ADHF and 45.8% with AFRVR. OSA was present in 12.3%. Patients with OSA were more likely to be younger, male, smokers, obese and have chronic obstructive pulmonary disease, renal failure and heart failure (p<0.001 for all). Patients with OSA had significantly lower in-hospital mortality (aOR 0.71, 95% CI (0.7 to 0.73)). Among patients with OSA, CPAP use significantly increased the odds of in-hospital death (aOR 1.51, 95% CI (1.44 to 1.60)), LOS (adjusted mean difference of 1.49 days, 95% CI (1.43 to 1.55)) and hospital charges (adjusted mean difference of US$1168, 95% CI (273 to 2062)).ConclusionOur study showed that patients with recognised OSA hospitalised for AMI, ADHF and AFRVR had significantly lower mortality regardless of CPAP use, while CPAP treatment among these patients was associated with significantly higher in-hospital mortality and resource utilisation. The routine use of CPAP during acute cardiovascular encounters could neutralise the impact of chronic intermittent ischaemic preconditioning.

show abstract

“…Interestingly, the study from Masa et al ( 32 ) suggests that severe hypoxemia could be protective at least in certain populations (obesity hypoventilation). A possible explanation is ischemic precondition, an adaptive mechanism where low levels of hypoxemia/ischemia leads to vascular and endothelial changes that “protects” against worse vascular events and possibly explaining the lower mortality rates of older age groups with OSA ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

Obstructive Sleep Apnea Phenotypes and Markers of Vascular Disease: A Review

et al. 2017

View full text Add to dashboard Cite

Obstructive sleep apnea (OSA) is a chronic and heterogeneous disorder that leads to early mortality, stroke, and cardiovascular disease (CVD). OSA is defined by the apnea–hypopnea index, which is an index of OSA severity that combines apneas (pauses in breathing) and hypopneas (partial obstructions in breathing) associated with hypoxemia. Yet, other sleep metrics (i.e., oxygen nadir, arousal frequency), along with clinical symptoms and molecular markers could be better predictors of stroke and CVD outcomes in OSA. The recent focus on personalized medical care introduces the possibility of a unique approach to the treatment of OSA based on its phenotypes, defined by pathophysiological mechanisms and/or clinical presentation. We summarized what is known about OSA and its phenotypes, and review the literature on factors or intermediate markers that could increase stroke risk and CVD in patients with OSA. The OSA phenotypes where divided across three different domains (1) clinical symptoms (i.e., daytime sleepiness), (2) genetic/molecular markers, and (3) experimental data-driven approach (e.g., cluster analysis). Finally, we further highlight gaps in the literature framing a research agenda.

show abstract

Reduced Cardiovascular Morbidity in Obesity-Hypoventilation Syndrome

Cited by 6 publications

References 17 publications

The Snoring Survivors

The Snoring Survivors

Snoring Survivors: the impact of obstructive sleep apnoea and continuous positive airway pressure use on in-hospital mortality, length of stay and costs among patients hospitalised with acute cardiovascular disease – A retrospective analysis of 2016–2019 National Inpatient Sample Data

Obstructive Sleep Apnea Phenotypes and Markers of Vascular Disease: A Review

Contact Info

Product

Resources

About