High Risk Characteristics for Recurrent Cardiovascular Events among Patients with Obstructive Sleep Apnoea in the...

Area of Science:

• Cardiology
• Sleep Medicine
• Pulmonology

Background:

• Obstructive sleep apnoea (OSA) is a prevalent comorbidity in patients with cardiovascular (CV) disease.
• Understanding OSA clinical phenotypes is crucial for assessing CV event risks and treatment responses.

Purpose of the Study:

• To identify distinct clinical phenotypes of obstructive sleep apnoea (OSA).
• To evaluate the association of these phenotypes with serious cardiovascular (CV) events.
• To determine the impact of continuous positive airway pressure (CPAP) treatment on CV outcomes within identified phenotypes.

Main Methods:

• Post-hoc analysis of the Sleep Apnea Cardiovascular Endpoints (SAVE) study.
• Latent class analysis (LCA) used to define OSA phenotypes based on 19 patient-centered variables.
• Cox regression models and Chi-square tests assessed CV event risks and CPAP treatment response.

Main Results:

• Four OSA phenotypes were identified: CAD + DM (39%), CeVD + DM (9%), CAD alone (15%), and CeVD alone (37%).
• The CAD + DM phenotype exhibited the highest risk of composite CV events (HR 2.08).
• The CeVD + DM phenotype showed the highest stroke risk (HR 6.84).
• CPAP adherence influenced CV outcome risk (P-interaction = 0.04), with adherent CeVD + DM patients showing the lowest risk (P=0.02).

Conclusions:

• Distinct OSA clinical phenotypes are associated with varying risks of cardiovascular events.
• Targeted therapeutic strategies for OSA patients can be improved by identifying high-risk phenotypes.
• CPAP adherence is a critical factor in mitigating CV risks, especially within specific OSA phenotypes.