439 Continuous Positive Airway Pressure and Cardiovascular Risk in a Large Clinical Sample of Obstructive Sleep Apnea Patients. (3rd May 2021)

• Record Type: Journal Article
• Authors: Mazzotti, Diego; Chen, Aiyu; An, Jaejin; Arguelles, Jessica; Keenan, Brendan; Maislin, Greg; Sawyer, Amy; Glick, Henry; Pack, Allan; Hwang, Dennis; Shi, Jiaxiao
• Is Part Of: Sleep. Volume 44(2021)Supplement 2
• Page Start: A173
• Page End: A174
• Publication Date: 2021-05-03
• Subjects: Sleep -- Physiological aspects -- Periodicals; Sleep disorders -- Periodicals; Sommeil -- Aspect physiologique -- Périodiques; Sommeil, Troubles du -- Périodiques; Sleep disorders; Sleep -- Physiological aspects; Sleep -- physiological aspects; Sleep Wake Disorders; Psychophysiology; Electronic journals; Periodicals; 616.8498
• DOI: 10.1093/sleep/zsab072.438
• Languages: English
• ISSNs: 0161-8105

Abstract

Abstract: Introduction: While studies support the beneficial short-term role of continuous positive airway pressure (CPAP) therapy on cardiometabolic risk in adults with obstructive sleep apnea (OSA), its sustained effect on cardiovascular disease (CVD) risk is unknown. CPAP use data linked to electronic health records (EHR) offer opportunities to understand the role of OSA treatment for preventing CVD. We evaluated the association between CPAP use and CVD incidence in patients referred to a sleep study at a large health system. Methods: We included adult patients with available apnea-hypopnea index (AHI) between 01/2018-02/2020 in Kaiser Permanente Southern California. At baseline, eligible participants had >1 year of continuous insurance coverage allowing gaps <90 days and were free of CVD 1 year prior to OSA diagnosis. Participants were distributed into three groups: no OSA (AHI<5), OSA (AHI≥5) with any CPAP use (median[IQR] 2.5[0.7–5.0] h/day) and OSA without evidence of CPAP use. CVD incidence was defined as first occurrence of myocardial infarction, stroke, unstable angina, heart failure or CVD death, based on validated EHR algorithms. We used Cox proportional hazards models to assess the association between OSA with or without CPAP use and CVD incidence, adjusted for baseline age, sex, body mass index, race/ethnicity, Charlson comorbidity index, and use of anti-hypertensives and lipid-lowering medications. Stratified analyses were conducted based on OSA severity. Results: We included 11, 145 patients without OSA, 13, 898 with OSA and CPAP use, and 20, 884 patients without CPAP use. Median follow-up was 262 days (IQR=129–409). CVD incidence rates were, respectively, 0.26%, 0.45% and 0.56%. In adjusted models, moderate-severe OSA (AHI≥15) without CPAP use was associated with increased CVD incidence when compared to no OSA (HR=1.71; 95%CI=1.11–2.64; p=0.016). OSA with any CPAP use was associated with lower CVD incidence (HR=0.68; 95%CI=0.50–0.93; p=0.016) when compared to OSA patients with no CPAP use. Stronger effects were observed when restricting the sample to moderate-severe OSA (HR=0.56; 95%CI=0.39–0.81; p=0.002). Conclusion: Our analysis in a large observational clinical sample suggests that moderate-severe OSA with no CPAP use is associated with increased CVD incidence. Moreover, OSA with CPAP use was associated with decreased CVD incidence relative to no CPAP use. Support (if any): AASM Foundation (194-SR-18;205-SR-19); AHA (20CDA35310360).