Background: Obstructive sleep apnea (OSA) affects nearly one billion people worldwide, with increasing prevalence. Most of the OSA-related morbidity and mortality is linked to an increased risk of developing and/or progressing cardiovascular disease (CVD). The marker most often used to define both the disease severity and the risk for organ damage is the apnea-hypopnea-index (AHI). The search for predictors of OSA is in continuous progress. The aim of this study was to evaluate the predictors of moderate and severe disease in a large unselected sample of patients affected by OSA and investigate the association of nocturnal oximetry parameters with CV organ damage. Methods: Observational cross-sectional study on 618 consecutive outpatients referred to our unit at INRCA-IRCCS (Ancona, Italy), between October 2018 and January 2020, diagnosed with OSA after performing home cardiorespiratory polygraphic recording. In addition to the polygraphic parameters, several other clinical parameters have also been collected: anthropometric data, symptoms and signs, comorbidities, laboratory parameters, blood pressure (BP) parameters and drug therapy, and their associations with OSA have been analyzed. The main oximetry parameters were grouped using a factor analysis into a single parameter (Oxy-score) and its association with CV organ damage has been investigated. Results: Mean age was 61.0±13.6 years with male prevalence (72.5%). Prevalence of overweight/obesity was 90.3%. Arterial hypertension and dyslipidemia were the most prevalent CV risk factors (77.7% and 78.7%, respectively), while hypertensive heart disease and peripheral arterial disease were the most prevalent CVD (69.9% and 63.8%, respectively). The prevalence of oAHI≥15 and oAHI≥30 was 71.7% and 35.8%, respectively. Macroglossia (OR=4.2, p<0.001), neck circumference >43cm (OR=3.0, p=0.008), witnessed breathing pauses (OR=2.3, p=0.019), excessive daytime sleepiness (OR=5.4, p=0.049), and arterial hypertension (OR=3.0, p=0.003) were independent predictors of moderate OSA. Neck circumference >43cm (OR=4.5, p<0.001), nocturia (OR=3.5, p=0.013) and a non-dipper/reverse dipper BP pattern (OR=6.3, p=0.003) were independent predictors of severe OSA. Oxy-score was associated with the presence of CVD, especially hypertensive heart disease, even after adjusting for covariates (OR=0.45, p=0.044), regardless oAHI. Conclusion: This study confirms the role of several clinical features, such as neck circumference, nocturia, excessive daytime sleepiness, arterial hypertension and a non-dipper/reverse dipper BP pattern as predictors of moderate and severe OSA. It also highlights the association between oximetry parameters and CVD, especially hypertensive heart disease, regardless of oAHI, thus providing interesting insights for future prospective studies aimed at further defining the predictors of OSA and the role of oximetry parameters in determining both the disease severity and the risk of OSA-related CVD.
Introduzione: L’apnea ostruttiva nel sonno (OSA) colpisce quasi un miliardo di persone nel mondo, con prevalenza crescente. La maggior parte del rischio di morbilità e mortalità associato all'OSA è legato ad aumentato rischio di sviluppo e/o progressione di malattie cardiovascolari (CV). Il marker più usato per definire sia gravità di malattia che rischio di danno d'organo è l'indice-apnea-ipopnea (AHI). La ricerca di predittori di OSA è in continuo sviluppo. Lo scopo di questo studio è stato valutare i predittori di malattia di grado moderato e grave in un ampio campione non selezionato di pazienti affetti da OSA e indagare l'associazione dei parametri ossimetrici notturni con il danno d'organo CV. Metodi: Studio osservazionale trasversale su 618 pazienti ambulatoriali consecutivi giunti alla nostra unità presso INRCA-IRCCS di Ancona (Italia), tra ottobre 2018 e gennaio 2020, cui è stata diagnosticata OSA con monitoraggio cardio-respiratorio notturno domiciliare. Oltre ai parametri poligrafici, sono stati raccolti anche numerosi altri parametri clinici: dati antropometrici, sintomi e segni, comorbilità, esami di laboratorio, parametri pressori e terapia, e sono state analizzate le loro associazioni con l'OSA. I principali parametri ossimetrici sono stati raggruppati mediante analisi fattoriale in un unico parametro (Oxy-score) ed è stata studiata la sua associazione con il danno d'organo CV. Risultati: L'età media era 61,0±13,6 anni con prevalenza maschile (72,5%). La prevalenza di sovrappeso/obesità era 90,3%. L'ipertensione arteriosa e la dislipidemia erano i fattori di rischio CV più prevalenti (77,7% e 78,7%, rispettivamente), mentre la cardiopatia ipertensiva e la vasculopatia periferica erano le malattie CV più prevalenti (69,9% e 63,8%, rispettivamente). La prevalenza di oAHI≥15 e di oAHI≥30 era 71,7% e 35,8%, rispettivamente. Macroglossia (OR=4,2, p<0,001), circonferenza del collo >43 cm (OR=3,0, p=0,008), pause respiratorie testimoniate (OR=2,3, p=0,019), eccessiva sonnolenza diurna (OR=5,4, p=0,049) e ipertensione arteriosa (OR=3,0, p=0,003) sono risultati predittori indipendenti di OSA moderata. Circonferenza del collo >43 cm (OR=4,5, p<0,001), nicturia (OR=3,5, p=0,013) e profilo pressorio non dipper/reverse dipper (OR=6,3, p=0,003) sono risultati predittori indipendenti di OSA grave. L'Oxy-score si associava alla presenza di malattie CV, in particolare cardiopatia ipertensiva, anche dopo aggiustamento per le covariate (OR=0.45, p=0.044), indipendentemente da oAHI. Conclusione: Questo studio conferma il ruolo di diverse caratteristiche cliniche, come circonferenza del collo, nicturia, eccessiva sonnolenza diurna, ipertensione arteriosa e profilo pressorio non dipper/reverse dipper, come predittori di OSA moderata e grave. Inoltre, evidenzia anche l'associazione tra parametri ossimetrici e danno d'organo CV, in particolare cardiopatia ipertensiva, indipendentemente dall'oAHI, fornendo così interessanti spunti per futuri studi prospettici volti a definire ulteriormente i predittori di OSA e il ruolo dei parametri ossimetrici nel determinare sia la gravità che il rischio di malattie CV correlate all'OSA.
Predictors of moderate and severe obstructive sleep apnea and association of nocturnal oximetry parameters with cardiovascular organ damage / Giulietti, Federico. - (2022 Mar 24).
Predictors of moderate and severe obstructive sleep apnea and association of nocturnal oximetry parameters with cardiovascular organ damage
GIULIETTI, FEDERICO
2022-03-24
Abstract
Background: Obstructive sleep apnea (OSA) affects nearly one billion people worldwide, with increasing prevalence. Most of the OSA-related morbidity and mortality is linked to an increased risk of developing and/or progressing cardiovascular disease (CVD). The marker most often used to define both the disease severity and the risk for organ damage is the apnea-hypopnea-index (AHI). The search for predictors of OSA is in continuous progress. The aim of this study was to evaluate the predictors of moderate and severe disease in a large unselected sample of patients affected by OSA and investigate the association of nocturnal oximetry parameters with CV organ damage. Methods: Observational cross-sectional study on 618 consecutive outpatients referred to our unit at INRCA-IRCCS (Ancona, Italy), between October 2018 and January 2020, diagnosed with OSA after performing home cardiorespiratory polygraphic recording. In addition to the polygraphic parameters, several other clinical parameters have also been collected: anthropometric data, symptoms and signs, comorbidities, laboratory parameters, blood pressure (BP) parameters and drug therapy, and their associations with OSA have been analyzed. The main oximetry parameters were grouped using a factor analysis into a single parameter (Oxy-score) and its association with CV organ damage has been investigated. Results: Mean age was 61.0±13.6 years with male prevalence (72.5%). Prevalence of overweight/obesity was 90.3%. Arterial hypertension and dyslipidemia were the most prevalent CV risk factors (77.7% and 78.7%, respectively), while hypertensive heart disease and peripheral arterial disease were the most prevalent CVD (69.9% and 63.8%, respectively). The prevalence of oAHI≥15 and oAHI≥30 was 71.7% and 35.8%, respectively. Macroglossia (OR=4.2, p<0.001), neck circumference >43cm (OR=3.0, p=0.008), witnessed breathing pauses (OR=2.3, p=0.019), excessive daytime sleepiness (OR=5.4, p=0.049), and arterial hypertension (OR=3.0, p=0.003) were independent predictors of moderate OSA. Neck circumference >43cm (OR=4.5, p<0.001), nocturia (OR=3.5, p=0.013) and a non-dipper/reverse dipper BP pattern (OR=6.3, p=0.003) were independent predictors of severe OSA. Oxy-score was associated with the presence of CVD, especially hypertensive heart disease, even after adjusting for covariates (OR=0.45, p=0.044), regardless oAHI. Conclusion: This study confirms the role of several clinical features, such as neck circumference, nocturia, excessive daytime sleepiness, arterial hypertension and a non-dipper/reverse dipper BP pattern as predictors of moderate and severe OSA. It also highlights the association between oximetry parameters and CVD, especially hypertensive heart disease, regardless of oAHI, thus providing interesting insights for future prospective studies aimed at further defining the predictors of OSA and the role of oximetry parameters in determining both the disease severity and the risk of OSA-related CVD.File | Dimensione | Formato | |
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