TY - JOUR
T1 - Low Prognostic Value of Novel Nocturnal Metrics in Patients With OSA and High Cardiovascular Event Risk
T2 - Post Hoc Analyses of the SAVE Study
AU - Linz, Dominik
AU - Loffler, Kelly A.
AU - Sanders, Prashanthan
AU - Catcheside, Peter
AU - Anderson, Craig S.
AU - Zheng, Danni
AU - Quan, WeiWei
AU - Barnes, Mary
AU - Redline, Susan
AU - McEvoy, Doug
AU - Baumert, Mathias
AU - Investigators, SAVE (Sleep Apnea Cardiovascular Endpoints)
PY - 2020/12
Y1 - 2020/12
N2 - Background: Traditional methods for the quantification of OSA severity may not encapsulate potential relationships between hypoxemia in OSA and cardiovascular risk. Research Question: Do novel nocturnal oxygen saturation (SpO
2) metrics have prognostic value in patients with OSA and high cardiovascular event risk? Study Design and Methods: We conducted post hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial. In 2687 individuals, Cox proportional hazards models that were stratified for treatment allocation were used to determine the associations between clinical characteristics, pulse oximetry-derived metrics that were designed to quantify sustained and episodic features of hypoxemia, and cardiovascular outcomes. Metrics included oxygen desaturation index, time <90% SpO
2, average SpO
2 for the entire recording (mean SpO
2), average SpO
2 during desaturation events (desaturation SpO
2), average baseline SpO
2 interpolated across episodic desaturation events (baseline SpO
2), episodic desaturation event duration and desaturation/resaturation-time ratio, and mean and SD of pulse rate. Results: Neither apnea-hypopnea index, oxygen desaturation index, nor any of the novel SpO
2 metrics were associated with the primary SAVE composite cardiovascular outcome. Mean and baseline SpO
2 were associated with heart failure (hazard ratio [HR], 0.81; 95% CI, 0.69-0.95; P = .009; and HR, 0.78; 95% CI, 0.67-0.90; P = .001, respectively) and myocardial infarction (HR, 0.86; 95% CI, 0.77-0.95; P = .003; and HR, 0.81; 95% CI, 0.73-0.90; P < .001, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted future heart failure (area under the curve, 0.86; 95% CI, 0.79-0.93). Interpretation: Apnea-hypopnea index and oxygen desaturation index were not associated with cardiovascular outcomes. In contrast, the pattern of oxygen desaturation was associated with heart failure and myocardial infarction. However, concomitant risk factors remained the predominant determinants for secondary cardiovascular events and thus deserve the most intensive management.
AB - Background: Traditional methods for the quantification of OSA severity may not encapsulate potential relationships between hypoxemia in OSA and cardiovascular risk. Research Question: Do novel nocturnal oxygen saturation (SpO
2) metrics have prognostic value in patients with OSA and high cardiovascular event risk? Study Design and Methods: We conducted post hoc analyses of the Sleep Apnea Cardiovascular Endpoints (SAVE) trial. In 2687 individuals, Cox proportional hazards models that were stratified for treatment allocation were used to determine the associations between clinical characteristics, pulse oximetry-derived metrics that were designed to quantify sustained and episodic features of hypoxemia, and cardiovascular outcomes. Metrics included oxygen desaturation index, time <90% SpO
2, average SpO
2 for the entire recording (mean SpO
2), average SpO
2 during desaturation events (desaturation SpO
2), average baseline SpO
2 interpolated across episodic desaturation events (baseline SpO
2), episodic desaturation event duration and desaturation/resaturation-time ratio, and mean and SD of pulse rate. Results: Neither apnea-hypopnea index, oxygen desaturation index, nor any of the novel SpO
2 metrics were associated with the primary SAVE composite cardiovascular outcome. Mean and baseline SpO
2 were associated with heart failure (hazard ratio [HR], 0.81; 95% CI, 0.69-0.95; P = .009; and HR, 0.78; 95% CI, 0.67-0.90; P = .001, respectively) and myocardial infarction (HR, 0.86; 95% CI, 0.77-0.95; P = .003; and HR, 0.81; 95% CI, 0.73-0.90; P < .001, respectively). Desaturation duration and desaturation/resaturation time ratio, with established risk factors, predicted future heart failure (area under the curve, 0.86; 95% CI, 0.79-0.93). Interpretation: Apnea-hypopnea index and oxygen desaturation index were not associated with cardiovascular outcomes. In contrast, the pattern of oxygen desaturation was associated with heart failure and myocardial infarction. However, concomitant risk factors remained the predominant determinants for secondary cardiovascular events and thus deserve the most intensive management.
KW - sleep apnea
KW - cardiovascular risk
KW - Hypoxemia
KW - heart failure
KW - SAVE
KW - hypoxemia
UR - http://www.scopus.com/inward/record.url?scp=85096633731&partnerID=8YFLogxK
U2 - 10.1016/j.chest.2020.06.072
DO - 10.1016/j.chest.2020.06.072
M3 - Article
SN - 0012-3692
VL - 158
SP - 2621
EP - 2631
JO - Chest
JF - Chest
IS - 6
ER -