Sleep apnea and risk of aortic dissection: A nonrandomized, pair-matched cohort study

Teng, Hsin I.; Huang, Chin Chou; Chiang, Chi‐Lu; Huang, Po Hsun; Chung, Chia Min; Lin, Shing Jong; Chen, Jaw Wen; Leu, Hsin Bang; Chan, Wan Leong; Lee, Chiu Yang

doi:10.1016/j.jcma.2015.10.014

Cited by 8 publications

(21 citation statements)

References 25 publications

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“…In this regard, a recent case control study utilizing a large national health insurance database of about 50,000 people in Taiwan is of interest. This study, however, found no association between the diagnosis of OSA and future incidence of aortic dissection [33]. However, bias may be present as individuals with undiagnosed OSA would have been misclassified as not having OSA.…”

Section: Discussionmentioning

confidence: 89%

Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

et al. 2019

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Background: Structural and functional properties of the proximal thoracic aorta have important implications in clinical and subclinical cardiovascular disease (CVD). We examined whether obstructive sleep apnea (OSA) is associated with proximal aortic size and aortic stiffness in a multi-ethnic community-based cohort. Methods: The sample included the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep Ancillary study participants without known CVD who underwent cardiac magnetic resonance imaging. The main exposure variable was OSA severity based on the polysomnography-derived apnea hypopnea index (AHI; normal, AHI <5/h; mild, 5≤ AHI <15/h; moderate to severe, AHI ≥15/h). The study outcomes were ascending aortic diameter (AoD, cm), aortic pulse wave velocity (AoPWV, m/s), and ascending aortic distensibility (AAD, %/mm Hg). Analyses were performed in the overall sample and in sex-specific strata, adjusted for multiple potential confounders. Results: The 708 participants were 55.9% female and on average 68 years old (54–93 years). There was a significant trend (p < 0.0001) of greater mean (SD) AoD across the three OSA groups: normal (n = 87), 3.13 cm (0.35); mild (n = 215), 3.25 (0.34); moderate to severe (n = 406), 3.37 (0.36). In adjusted analysis, participants with moderate to severe OSA had a greater mean AoD compared with the normal group: adjusted mean difference (95% CI), 0.12 cm (0.05, 0.20), p = 0.002. This AoD gradient was observed in women but not in men (p for interaction = 0.02). No differences were found in AoPWV or AAD among the OSA groups. Conclusion: In a diverse community-based cohort, moderate to severe OSA (vs. no OSA) was associated with a larger ascending AoD in women.

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Section: Discussionmentioning

confidence: 89%

Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

et al. 2019

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“…Totally three publications were identified for this analysis including one cohort and two case-controls. 16,21,24 Data pooled showed an association between OSA (AHI ! 5) and AD (Figure 2, OR 1.60; 95% CI 1.01-2.53; p ¼ 0.04), though two of them showed no significance within the comparison.…”

Section: Discussionmentioning

confidence: 99%

“…Finally seven publications containing one cohort study, four case-controls, and two cross-sectional researches, with total 56,291 participants were analyzed in this study. 16,[21][22][23][24][25][26] The researches were all single center and six of them were from Asia. The only cohort study which included the most population was conducted in Taiwan.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Using the NOS, specific ratings for each study were included in Table 1. Bias encompassed in the assessment of the study by Teng et al 21 included comparability for lack of BMI data, which is an important factor for exposure, and not selecting an adequate follow-up period for outcome to occur. All case-control studies had good exposure measure method, as well as comparability; however, they all used hospital controls instead of community controls.…”

Section: Quality Of Bias Controlmentioning

confidence: 99%

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Obstructive sleep apnea and risk of aortic dissection: A meta-analysis of observational studies

et al. 2018

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Objectives Obstructive sleep apnea acts as a potential risk factor for the development of cardiovascular disease. We undertook collaborative meta-analyses to clarify the risk of aortic dissection among adults suffering obstructive sleep apnea. Methods A systematic search of the databases (PubMed, Embase, and Cochrane Library) was performed. Studies reporting on the association between obstructive sleep apnea and aortic dissection were included. Information on 424 cases of aortic dissection in 56,291 patients from one cohort, four case-controls, and two cross-sectional studies were included in this study. Results The summary suggested that patients with obstructive sleep apnea are associated with an overall significant 60% increase in the risk of aortic dissection, compared to unexposed patients (odds ratios 1.60; 95% confidence interval 1.01-2.53), with a significantly higher apnea-hypopnea index (mean difference 10.71; 95% confidence interval 7.46-13.96). Moreover, a greater relation was found between moderate-to-severe obstructive sleep apnea and aortic dissection (odds ratios 4.43; 95% confidence interval 2.59-7.59). Adverse outcomes obtained by sleep study such as oxygen desaturation index (mean difference 10.51; 95% confidence interval 7.54-13.48), average SaO (-1.36; 95% confidence interval -2.63 to -0.09), and minimum SaO (-3.63; 95% confidence interval -5.27 to -1.98) were correspondingly related to patients with aortic dissection. Conclusions Obstructive sleep apnea, especially moderate-to-severe obstructive sleep apnea, may impose an additional risk of suffering from aortic dissection with a potential mechanism including intermittent hypoxia.

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“…One study showed that patients with aortic diseases such as AA have a high incidence of moderate-to-severe OSA [17]. By contrast, another study including an Asian population revealed that OSA was not associated with an increased risk of aortic dissection [31]. Age, male sex, hyperlipidaemia, hypertension, obesity, and tobacco use are well-known risk factors for AA [32].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Sleep apnea and risk of aortic dissection: A nonrandomized, pair-matched cohort study

Abstract: SA was not associated with an increased risk of AD using a large nationwide cohort database. Nonetheless, larger prospective studies or meta-analyses are recommended to confirm our findings.

Cited by 8 publications

References 25 publications

Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

Obstructive sleep apnea and risk of aortic dissection: A meta-analysis of observational studies

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

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