Symptom Subtypes of Obstructive Sleep Apnea Predict Incidence of Cardiovascular Outcomes.

作者：D. Mazzotti, B. Keenan, D. Lim, D. Gottlieb, Jinyoung Kim, A. Pack · 发表于：American Journal of Respiratory and Critical Care Medicine · 年份：2019 · DOI：10.1164/rccm.201808-1509OC · 研究领域：Medicine

RATIONALE Symptom subtypes have been described in clinical and population samples of obstructive sleep apnea (OSA) patients. It is unclear whether these subtypes have different cardiovascular consequences. OBJECTIVES This study aimed to characterize OSA symptom subtypes and assess their association with prevalent and incident cardiovascular disease in the Sleep Heart Health Study. METHODS Data from 1,207 OSA patients (apnea-hypopnea index [AHI]≥15 events/hour) were used to evaluate the existence of symptom subtypes using latent class analysis. Associations between subtypes and prevalence of overall cardiovascular disease (CVD), as well as its components (coronary heart disease [CHD]), heart failure [HF] and stroke) were assessed using logistic regression. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether subtypes were associated with incident events, including cardiovascular mortality. MEASUREMENTS AND MAIN RESULTS Four symptom subtypes were identified (Disturbed Sleep [12.2%], Minimally Symptomatic [32.6%], Excessively Sleepy [16.7%], and Moderately Sleepy [38.5%]), similar to prior studies. In adjusted models, while no significant associations with prevalent CVD were found, the Excessively Sleepy subtype was associated with over 3-fold increased risk of prevalent HF compared to each of the other subtypes. Symptom subtype was also associated with incident CVD (p<0.001), CHD (p=0.015) and HF (p=0.018), with the Excessively ...