TY - JOUR
T1 - The Association of Sleep Apnea and Cardiorespiratory Fitness With Long-Term Major Cardiovascular Events
AU - Barillas-Lara, Maria Irene
AU - Medina-Inojosa, Jose R.
AU - Kolla, Bhanu Prakash
AU - Smith, Joshua R.
AU - Bonikowske, Amanda R.
AU - Allison, Thomas G.
AU - Olson, Thomas
AU - Lopez-Jimenez, Francisco
AU - Somers, Virend K.
AU - Caples, Sean M.
AU - Mansukhani, Meghna P.
N1 - Funding Information:
Grant Support: No funding was received for this work. Dr Somers is supported by research grants from the National Institutes of Health (HL 65176, HL 134808, HL 134885).Potential Competing Interests: Dr Mansukhani was the principal investigator on a research grant funded by ResMed Foundation, evaluating the effects of adaptive servoventilation treatment of central apnea syndromes on health care utilization during 2016 to 2019 that is not relevant to the current work. He is the recipient of the Paul and Ruby Tsai and Family Fund Career Development Award 2017-2020 at Mayo Clinic. Dr Somers is a Consultant for Respicardia, ResMed, U-Health, GlaxoSmithKline, Roche, and Bayer. He is an investigator on the SERVE-HF Steering Committee and is working with Mayo Health Solutions and their industry partners on intellectual property related to sleep and cardiovascular disease. The Philips Respironics Foundation has provided a gift to Mayo Foundation. The other authors report no competing interests.The Rochester Epidemiology Project (REP) is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
The Rochester Epidemiology Project (REP) is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
Grant Support: No funding was received for this work. Dr Somers is supported by research grants from the National Institutes of Health ( HL 65176 , HL 134808 , HL 134885 ).
Funding Information:
Potential Competing Interests: Dr Mansukhani was the principal investigator on a research grant funded by ResMed Foundation , evaluating the effects of adaptive servoventilation treatment of central apnea syndromes on health care utilization during 2016 to 2019 that is not relevant to the current work. He is the recipient of the Paul and Ruby Tsai and Family Fund Career Development Award 2017-2020 at Mayo Clinic . Dr Somers is a Consultant for Respicardia, ResMed, U-Health, GlaxoSmithKline, Roche, and Bayer. He is an investigator on the SERVE-HF Steering Committee and is working with Mayo Health Solutions and their industry partners on intellectual property related to sleep and cardiovascular disease. The Philips Respironics Foundation has provided a gift to Mayo Foundation. The other authors report no competing interests.
Publisher Copyright:
© 2020 Mayo Foundation for Medical Education and Research
PY - 2021/3
Y1 - 2021/3
N2 - Objective: To determine the risk of long-term major adverse cardiovascular events (MACE) when sleep-disordered breathing (SDB) and decreased cardiorespiratory fitness (CRF) co-occur. Methods: We included consecutive patients who underwent symptom-limited cardiopulmonary exercise tests between January 1, 2005, and January 1, 2010, followed by first-time diagnostic polysomnography within 6 months. Patients were stratified based on the presence of moderate-to-severe SDB (apnea/hypopnea index ≥15 per hour) and decreased CRF defined as <70% predicted peak oxygen consumption (VO2). Long-term MACE was a composite outcome of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), stroke or transient ischemic attack (TIA), and death, assessed until May 21, 2018. Cox-proportional hazard models were adjusted for factors known to influence CRF and MACE. Results: Of 498 included patients (60±13 years, 28.1% female), 175 (35%) had MACE (MI=17, PCI=14, CABG=13, stroke=20, TIA=12, deaths=99) at a median follow-up of 8.7 years (interquartile range=6.5 to 10.3 years). After adjusting for age, sex, beta blockers, systemic hypertension, diabetes mellitus, coronary artery disease, cardiac arrhythmia, chronic obstructive pulmonary disease, smoking, and use of positive airway pressure (PAP), decreased CRF alone (hazard ratio [HR]=1.91, 95% confidence interval [CI], 1.15 to 3.18; P=.01), but not SDB alone (HR=1.26, 95% CI, 0.75 to 2.13, P=.39) was associated with increased risk of MACE. Those with SDB and decreased CRF had greater risk of MACE compared with patients with decreased CRF alone (HR=1.85; 95% CI, 1.21 to 2.84; P<.005) after accounting for these confounders. The risk of MACE was attenuated in those with reduced CRF alone after additionally adjusting for adequate adherence to PAP (HR=1.59; 95% CI, 0.77 to 3.31; P=.21). Conclusion: The incidence of MACE, especially mortality, was high in this sample. Moderate-to-severe SDB with concurrent decreased CRF was associated with higher risk of MACE than decreased CRF alone. These results highlight the importance of possibly including CRF in the risk assessment of patients with SDB and, conversely, that of screening for SDB in patients with low peak VO2.
AB - Objective: To determine the risk of long-term major adverse cardiovascular events (MACE) when sleep-disordered breathing (SDB) and decreased cardiorespiratory fitness (CRF) co-occur. Methods: We included consecutive patients who underwent symptom-limited cardiopulmonary exercise tests between January 1, 2005, and January 1, 2010, followed by first-time diagnostic polysomnography within 6 months. Patients were stratified based on the presence of moderate-to-severe SDB (apnea/hypopnea index ≥15 per hour) and decreased CRF defined as <70% predicted peak oxygen consumption (VO2). Long-term MACE was a composite outcome of myocardial infarction (MI), coronary artery bypass graft (CABG), percutaneous coronary intervention (PCI), stroke or transient ischemic attack (TIA), and death, assessed until May 21, 2018. Cox-proportional hazard models were adjusted for factors known to influence CRF and MACE. Results: Of 498 included patients (60±13 years, 28.1% female), 175 (35%) had MACE (MI=17, PCI=14, CABG=13, stroke=20, TIA=12, deaths=99) at a median follow-up of 8.7 years (interquartile range=6.5 to 10.3 years). After adjusting for age, sex, beta blockers, systemic hypertension, diabetes mellitus, coronary artery disease, cardiac arrhythmia, chronic obstructive pulmonary disease, smoking, and use of positive airway pressure (PAP), decreased CRF alone (hazard ratio [HR]=1.91, 95% confidence interval [CI], 1.15 to 3.18; P=.01), but not SDB alone (HR=1.26, 95% CI, 0.75 to 2.13, P=.39) was associated with increased risk of MACE. Those with SDB and decreased CRF had greater risk of MACE compared with patients with decreased CRF alone (HR=1.85; 95% CI, 1.21 to 2.84; P<.005) after accounting for these confounders. The risk of MACE was attenuated in those with reduced CRF alone after additionally adjusting for adequate adherence to PAP (HR=1.59; 95% CI, 0.77 to 3.31; P=.21). Conclusion: The incidence of MACE, especially mortality, was high in this sample. Moderate-to-severe SDB with concurrent decreased CRF was associated with higher risk of MACE than decreased CRF alone. These results highlight the importance of possibly including CRF in the risk assessment of patients with SDB and, conversely, that of screening for SDB in patients with low peak VO2.
UR - http://www.scopus.com/inward/record.url?scp=85101764120&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101764120&partnerID=8YFLogxK
U2 - 10.1016/j.mayocp.2020.03.040
DO - 10.1016/j.mayocp.2020.03.040
M3 - Article
C2 - 33673915
AN - SCOPUS:85101764120
SN - 0025-6196
VL - 96
SP - 636
EP - 647
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 3
ER -