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Prognostic Implications of OSA in Acute Coronary Syndrome by Obesity Status. Chest 2023:S0012-3692(23)00173-3. [PMID: 36764513 DOI: 10.1016/j.chest.2023.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/20/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND A close relationship exists between OSA and obesity. The impact of obesity on the prognostic significance of OSA in patients with acute coronary syndrome (ACS) remains unclear. RESEARCH QUESTION Do the effects of OSA on subsequent cardiovascular events in patients with ACS vary with obesity status? STUDY DESIGN AND METHODS This is a prospective cohort study. Patients 18 to 85 years of age and hospitalized for ACS were consecutively enrolled and underwent portable sleep monitoring after clinical stabilization. OSA was defined as an apnea hypopnea index ≥ 15 events/h. The primary end point was major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, hospitalization for ACS, stroke, ischemia-driven revascularization, or hospitalization for heart failure. RESULTS Among 1,920 patients enrolled (84.5% men; mean age ± SD, 56.4 ± 10.5 years), 1,013 (52.8%) had OSA, and 718 (37.4%) were obese (BMI ≥ 28 kg/m2). During 2.9 years (1.5, 3.6) follow up, the incidence of MACCE was significantly higher in patients with obesity than in patients without obesity (hazard ratio [HR], 1.29; 95% CI, 1.06-1.58; P = .013). Although the prevalence of OSA was lower in patients without obesity than in those with obesity (43.9% vs 67.5%, P < .001), OSA independently predicted the incidence of MACCE only in patients without obesity (adjusted HR, 1.34; 95% CI, 1.03-1.75; P = .03), but not in patients with obesity (adjusted HR, 1.10; 95% CI, 0.78-1.55; P = .58). No significant interaction between obesity and OSA was noted (P for interaction = .35). The incremental risk associated with OSA in patients without obesity might be explained by more hospitalization for ACS and ischemia-driven revascularization. INTERPRETATION For patients with ACS, OSA was independently associated with an increased risk of subsequent events, particularly among patients without obesity. These findings highlight the importance of identifying OSA in nonobese patients with ACS. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; No.: NCT03362385; URL: www. CLINICALTRIALS gov.
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Huang M, Bliwise DL, Shah A, Johnson DA, Clifford GD, Hall MH, Krafty RT, Goldberg J, Sloan R, Ko YA, Da Poian G, Perez-Alday EA, Murrah N, Levantsevych OM, Shallenberger L, Abdulbaki R, Vaccarino V. The temporal relationships between sleep disturbance and autonomic dysregulation: A co-twin control study. Int J Cardiol 2022; 362:176-182. [PMID: 35577169 PMCID: PMC10197091 DOI: 10.1016/j.ijcard.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sleep disturbance is associated with autonomic dysregulation, but the temporal directionality of this relationship remains uncertain. The objective of this study was to evaluate the temporal relationships between objectively measured sleep disturbance and daytime or nighttime autonomic dysregulation in a co-twin control study. METHODS A total of 68 members (34 pairs) of the Vietnam Era Twin Registry were studied. Twins underwent 7-day in-home actigraphy to derive objective measures of sleep disturbance. Autonomic function indexed by heart rate variability (HRV) was obtained using 7-day ECG monitoring with a wearable patch. Multivariable vector autoregressive models with Granger causality tests were used to examine the temporal directionality of the association between daytime and nighttime HRV and sleep metrics, within twin pairs, using 7-day collected ECG data. RESULTS Twins were all male, mostly white (96%), with mean (SD) age of 69 (2) years. Higher daytime HRV across multiple domains was bidirectionally associated with longer total sleep time and lower wake after sleep onset; these temporal dynamics were extended to a window of 48 h. In contrast, there was no association between nighttime HRV and sleep measures in subsequent nights, or between sleep measures from previous nights and subsequent nighttime HRV. CONCLUSIONS Daytime, but not nighttime, autonomic function indexed by HRV has bidirectional associations with several sleep dimensions. Dysfunctions in autonomic regulation during wakefulness can lead to subsequent shorter sleep duration and worse sleep continuity, and vice versa, and their influence on each other may extend beyond 24 h.
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Affiliation(s)
- Minxuan Huang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Donald L Bliwise
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, USA
| | - Amit Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine (Cardiology), School of Medicine, Emory University, Atlanta, GA, USA; Atlanta Veteran Affairs Medical Center, Decatur, GA, USA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Gari D Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, USA; Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Martica H Hall
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Robert T Krafty
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jack Goldberg
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA; Vietnam Era Twin Registry, Seattle Epidemiologic Research and Information Center, US Department of Veterans Affairs, Seattle, WA, USA
| | - Richard Sloan
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Giulia Da Poian
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Erick A Perez-Alday
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Oleksiy M Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rami Abdulbaki
- Department of Pathology, Georgia Washington University Hospital, Washington, DC, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Medicine (Cardiology), School of Medicine, Emory University, Atlanta, GA, USA.
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Sugiura K, Kohno T, Kohsaka S, Shiraishi Y, Katsumata Y, Hayashida K, Yuasa S, Takatsuki S, Fukuda K. Sleep-disordered breathing is independently associated with elevated natriuretic peptide levels in patients with cardiovascular diseases. Heart Vessels 2021; 37:994-1002. [PMID: 34845539 DOI: 10.1007/s00380-021-01998-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022]
Abstract
Sleep disorders and sleep duration have attracted considerable attention as potential modifiable risk factors for the development and progression of heart failure (HF). However, whether these sleep behaviors could aggravate the underlying cardiac condition remains ambiguous. We evaluated the associations between the levels of plasma B-type natriuretic peptide (BNP) and sleep-disordered breathing (SDB), sleep quality and quantity, or daytime sleepiness in cardiovascular diseases (CVD) patients. A total of 1717 consecutive patients with CVD [median age, 66 years (55-74 years); female, 27.5%] were enrolled. SDB was screened by nocturnal pulse oximetry; sleep quality and quantity were determined by Pittsburg Sleep Quality Index, and daytime sleepiness was examined by Epworth Sleepiness Scale. The median plasma BNP level was 54.9 pg/ml (23.5-146.4 pg/ml). Multiple regression analyses showed that the BNP level in the highest quintile (BNP > 181.8 pg/ml) was associated with SDB (severe: OR, 5.88; 95% CI 3.17-10.88; moderate: OR, 3.62; 95% CI 2.17-6.02; mild: OR, 2.22: 95% CI 1.42-3.47). There were no significant associations between other sleep parameters and higher BNP levels. The relationship between SDB and BNP levels was unchanged regardless of the previous history of symptomatic HF. SDB was independently associated with the elevated plasma BNP level in patients with a variety of CVD.
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Affiliation(s)
- Kohei Sugiura
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
- Department of Cardiovascular Medicine, Faculty of Medicine, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yasuyuki Shiraishi
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshinori Katsumata
- Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shinsuke Yuasa
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Seiji Takatsuki
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Keiichi Fukuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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D'Addio G, De Felice A, Donisi L, Braghiroli A, Maniscalco M. Heart rate turbulence in obstructive sleep apnea syndrome: The effect of short-term CPAP therapy. Eur J Intern Med 2021; 86:111-114. [PMID: 33390320 DOI: 10.1016/j.ejim.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Giovanni D'Addio
- Bioengineering Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy
| | - Alberto De Felice
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy
| | - Leandro Donisi
- Bioengineering Unit, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy; Department of Advanced Biomedical Sciences, University of Naples "Federico II", Napoli, Italy
| | - Alberto Braghiroli
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Veruno, Italy
| | - Mauro Maniscalco
- Pulmonary Rehabilitation Division, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme (BN), Italy.
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