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Obstructive sleep apnoea tied to higher rates of ACPE recurrence, CV events

28 Sep 2017

Obstructive sleep apnoea (OSA) appears to be associated with acute cardiogenic pulmonary oedema (ACPE) recurrence, as well as poor cardiovascular (CV) prognosis after an episode of ACPE, according to a study.

The study included 104 ACPE patients who underwent a sleep study following clinical stabilization. OSA was defined as an apnoea-hypopnea index (AHI) of ≥15 events/hour.

During a mean follow-up of 1 year, the primary outcome of ACPE recurrence occurred with greater frequency among ACPE patients with OSA than in those without the condition (25 vs 6 episodes; p=0.01). The incidence of myocardial infarction was similarly higher in the OSA group (15 vs 0 episodes; p=0.0004). A total of 17 deaths were recorded, all occurring in the OSA group (p=0.0001).

Cox proportional hazards regression analysis showed OSA to be independently associated with ACPE recurrence (hazard ratio [HR], 3.3; 95 percent CI, 1.2 to 8.8; p=0.01), incidence of myocardial infarction (HR, 2.3; 1.1 to 9.5; p=0.02), cardiovascular death (HR, 5.4; 1.4 to 48.4; p=0.004) and total death (HR, 6.5; 1.2 to 64.0; p=0.005).

When analysis was limited to patients with OSA, patients with ACPE recurrence or those who died had higher levels of AHI and hypoxaemic burden and rates of sleep-onset ACPE compared with patients without recurrence or who survived.

The present data suggest that untreated OSA promotes increased healthcare costs and poor cardiovascular prognosis following an episode of ACPE, researchers said, adding that the study should set the stage for a randomized controlled trial aimed at evaluating the efficacy of OSA treatments in ameliorating risks associated with ACPE.

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