Abstract
Background and Objectives: To evaluate the influence of obstructive sleep apnea (OSA)-related symptoms on prevalent cardiovascular disease (CVD) in a large clinical population of patients. Materials and Methods: A total of 2127 patients (mean age 55 years, 24% women) underwent diagnostic polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Athens Insomnia Scale (AIS), and the Beck Depression Inventory (BDI). We investigated the predictive value of OSA-associated symptoms for prevalent cardiovascular disease, after adjustment for relevant confounding factors including age, obesity, and co-morbidities. Results: Patients with OSA and CVD were older and had a higher Body Mass Index (BMI); the percentage of obese patients was also higher (83% vs. 70%, p < 0001). They also had greater neck, waist, and hip circumferences and a higher waist-to-hip ratio. Excessive daytime sleepiness (ESS ≥ 10) [odds ratio (95% CI) 1.112 (0.708–1.748), p = 0.64], insomnia symptoms (AIS ≥ 6) [odds ratio (95% CI) 0.748 (0.473–1.184), p = 0.21], frequent awakenings [odds ratio (95% CI) 1.599 (1.019–2.508), p = 0.06], and nocturia [odds ratio (95% CI) 1.359 (0.919–2.009), p = 0.124] were not associated with CVD after adjustment for the previous confounders. On the other hand, depressive symptoms (BDI ≥ 10) independently predicted prevalent CVD [odds ratio (95% CI) 1.476 (1.154–1.887), p = 0.002]. Further analysis in subgroups stratified by age, BMI, and gender demonstrated that depressive symptoms predicted prevalent CVD but only in the subgroup of younger (age group < 60 years), obese (BMI group ≥ 30), and male (OR = 1.959, 95% CI = 1.209–3.175, p = 0.006) OSA patients. Conclusions: OSA patients with CVD were more likely to complain of less typical OSA symptoms and depressive symptoms compared to patients without CVD in this large clinical patient cohort, supportingthecomplexity and heterogeneityof OSA.
Highlights
Obstructive sleep apnea (OSA) is a major and under-recognized public health problem.OSA has a high prevalence, comparable to that of other chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease [1,2]
We examined in OSA patients the association of OSArelated symptoms with cardiovascular disease (CVD) after adjustment for various potential explanatory variables, including age (>60 years), Body Mass Index (BMI)(≥30 kg/m2 ), apnea–hypopnea index (AHI), waist/hip ratio, neck circumference, smoking status, type 2 diabetes, dyslipidemia, chronic obstructive pulmonary disease (COPD), asthma and depression (BDI ≥ 10)
Further analysis in subgroups stratified by age, BMI, and gender demonstrated that depressive symptoms predicted prevalent CVD but only in the subgroup of younger, obese (BMI group ≥ 30), and males (OR = 1.959, 95% CI = 1.209–3.175, p = 0.006)
Summary
Obstructive sleep apnea (OSA) is a major and under-recognized public health problem. OSA has a high prevalence, comparable to that of other chronic respiratory diseases, such as asthma and chronic obstructive pulmonary disease [1,2]. Its prevalence seems to be increasing in epidemiological studies over time, probably due to different diagnostic tests, definitions of events, study designs, and the effect of the increasing rates of obesity and other co-morbidities, as well as of increased human longevity [3,4]. Untreated OSA is associated with numerous long-term health consequences, has a negative impact on quality of life and cognitive function, and has even been shown to have a causative role in traffic accidents, resulting in injury and fatality [5,6].
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