Combined Effect of Obstructive Sleep Apnea and Preserved Ratio Impaired Spirometry on Cardiovascular Outcomes

Obstructive sleep apnea (OSA)-chronic obstructive pulmonary disease overlap syndrome has been linked to worse cardiovascular outcomes. Preserved ratio impaired spirometry (PRISm) is recognized as an early stage of chronic obstructive pulmonary diseas. However, whether the coexistence of OSA and PRISm confers increased cardiovascular risk remains unknown.

Using data from the Sleep Heart Health Study, participants were categorized into 4 groups according to OSA and PRISm status. The primary outcome was major adverse cardiovascular and cerebrovascular events. The secondary outcome was cardiovascular disease mortality. Multivariable Cox regression models were used to evaluate the association of these groups with the risk of cardiovascular outcomes.

During a median follow-up of 11.45 years, the incidence of major adverse cardiovascular and cerebrovascular events was 17.00% in non-OSA with normal lung function, 27.52% in non-OSA with PRISm, 25.28% in OSA with normal lung function, and 49.40% in OSA with PRISm. After multivariable adjustment, compared with non-OSA with normal lung function, the adjusted hazard ratios (HRs) for major adverse cardiovascular and cerebrovascular events were 1.20 (95% CI, 0.82-1.75) in non-OSA with PRISm, 1.04 (95% CI, 0.89-1.21) in OSA with normal lung function, and 1.52 (95% CI, 1.08-2.12) in OSA with PRISm. Corresponding HRs for CVD mortality were 2.02 (95% CI, 1.26-3.24), 1.05 (95% CI, 0.81-1.35), and 2.17 (95% CI, 1.41-3.34), respectively. A significant sex interaction was observed (P for interaction=0.009), with the association present only in women.

The coexistence of OSA and PRISm is independently associated with increased risk of adverse cardiovascular outcomes. This association is observed predominantly in women.