Is Cumulative Time of Oxygen Desaturation a Better Predictor of Cardiovascular Mortality than Apnoea Hypopnoea Index?

In this paper, we explored the link between sleep apnoea and cardiovascular disease (CVD) using a time-series statistical measure of sleep apnoea-related oxygen desaturation. We compared the performance of a hypoxic measure derived from the polysomnogram with the Apnoea Hypopnoea Index (AHI) in predicting CVD mortality in patients of the Sleep Heart Health Study.We estimated the relative cumulative time of SpO2 below 90% (Tr90) using pulse oximetry signals from polysomnogram recordings as the hypoxic measure of desaturation patterns. Then, the survival curves for hypoxia quintiles were evaluated for the prediction of CVD mortality and were compared with the results using AHI for prediction. We also calculated the Cox hazard ratios for Tr90 and AHI. Our results show that the Tr90 was a better predictor of CVD mortality outcomes than AHI.

[1]  P. Sanders,et al.  Assessment and interpretation of sleep disordered breathing severity in cardiology: Clinical implications and perspectives. , 2018, International journal of cardiology.

[2]  F. del Campo,et al.  Sleep Apnea and Cardiovascular Diseases , 2014, Pulmonary medicine.

[3]  Guo-Qiang Zhang,et al.  The National Sleep Research Resource: towards a sleep data commons , 2018, BCB.

[4]  J S Floras,et al.  Risk factors for central and obstructive sleep apnea in 450 men and women with congestive heart failure. , 1999, American journal of respiratory and critical care medicine.

[5]  Bonnie K. Lind,et al.  Methods for obtaining and analyzing unattended polysomnography data for a multicenter study. Sleep Heart Health Research Group. , 1998, Sleep.

[6]  R. Speich,et al.  Daytime Measurements Underestimate Nocturnal Oxygen Desaturations in Pulmonary Arterial and Chronic Thromboembolic Pulmonary Hypertension , 2012, Respiration.

[7]  J. Victor Marcos,et al.  Assessment of four statistical pattern recognition techniques to assist in obstructive sleep apnoea diagnosis from nocturnal oximetry. , 2009, Medical engineering & physics.

[8]  P. Terrill.  A review of approaches for analysing obstructive sleep apnoea‐related patterns in pulse oximetry data , 2020, Respirology.

[9]  M. Böhm,et al.  Nocturnal hypoxemic burden is associated with epicardial fat volume in patients with acute myocardial infarction , 2018, Sleep and Breathing.

[10]  Catherine P. Jayapandian,et al.  Scaling Up Scientific Discovery in Sleep Medicine: The National Sleep Research Resource. , 2016, Sleep.

[11]  W. McNicholas,et al.  Pathophysiology of obstructive sleep apnoea. , 1995, The European respiratory journal.

[12]  S. Redline,et al.  The hypoxic burden of sleep apnoea predicts cardiovascular disease-related mortality: the Osteoporotic Fractures in Men Study and the Sleep Heart Health Study , 2018, European heart journal.

[13]  H. Rickli,et al.  Clinical impact of screening for sleep related breathing disorders in atrial fibrillation. , 2012, International journal of cardiology.

[14]  P. Lavie,et al.  Obstructive sleep apnea: diagnosis, risk factors, and pathophysiology. , 2011, Handbook of clinical neurology.

[15]  Dieter Horstkotte,et al.  Nocturnal hypoxaemia is associated with increased mortality in stable heart failure patients. , 2016, European heart journal.

[16]  T. Young,et al.  Epidemiology of obstructive sleep apnea: a population health perspective. , 2002, American journal of respiratory and critical care medicine.

[17]  J. Haze,et al.  Obstructive sleep apnea. , 1987, Cranio : the journal of craniomandibular practice.

[18]  B. Grant,et al.  Prediction of the apnea-hypopnea index from overnight pulse oximetry. , 2003, Chest.

[19]  Sleep apnea: is your patient at risk? National Heart, Lung, and Blood Institute Working Group on Sleep Apnea. , 1996, American family physician.

[20]  R. Rogers,et al.  Obstructive sleep apnea. , 1996, The New England journal of medicine.

[21]  S. Gottlieb,et al.  Importance and management of chronic sleep apnoea in cardiology. , 2013, European heart journal.

[22]  Atul Malhotra,et al.  Pathophysiology of adult obstructive sleep apnea. , 2008, Proceedings of the American Thoracic Society.

[23]  S. Quan,et al.  Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the Scoring of Sleep and Associated Events. Deliberations of the Sleep Apnea Definitions Task Force of the American Academy of Sleep Medicine. , 2012, Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine.

[24]  J. Kurths,et al.  Is dynamic desaturation better than a static index to quantify the mortality risk in heart failure patients with Cheyne-Stokes respiration? , 2018, Chaos.