Risultati per: Prima terapia farmacologica per l’apnea notturna (OSAS)

Circulation, Volume 146, Issue Suppl_1, Page A15887-A15887, November 8, 2022. Introduction:Previous studies have demonstrated that obstructive sleep apnea (OSA) and obesity independently increase the risk for development of atrial fibrillation (AF). However, it is unknown whether weight changes in an OSA cohort also increase the risk of AF.Methods:This was a case control study from a single tertiary institution analyzing patients with a confirmed OSA diagnosis from 2013-2020. Patients with missing data on any of the key variables were excluded from these analyses. The covariates included smoking history, hypertension, congestive heart failure, chronic obstructive pulmonary disease, heart failure, and coronary artery disease. Patients’ weight at the time of AF diagnosis by electrocardiogram (ECG) was compared to the weight documented one year earlier. Weight at the time of the ECG closest to the sleep study date was compared to the weight one year prior for the control group. ​​Multivariate logistic regression analysis to examine the association between AF cases (versus controls) and weight percent change greater than 5%.Results:Among the 182 patients included in the analysis, the incidence of AF was 32.4% and the median weight change was -1.32± 11.69 lb (Table 1). About 36% of those diagnosed with AF had weight changes (gain or loss) above 5% compared to 23% in the control group (p = 0.07). The average weight change for those with diagnosed AF compared to individuals without AF was -2.5 ±11.8 lb vs. -0.76 ± 11.6 lb (p=0.19). The change in the adjusted odds of AF diagnosis among those with more than 5% weight gain or loss was 2.27 (95% CI =1.01, 5.09) compared to those with less or no weight change.Conclusions:Among individuals with OSA, those who exhibited weight changes greater than 5% over a one year period have increased odds for developing AF. Further large-scale studies need to be undertaken to understand the link between intentional versus unintentional weight loss.

Circulation, Volume 146, Issue Suppl_1, Page A10345-A10345, November 8, 2022. Introduction:The prevalence of obstructive sleep apnea (OSA) in heart failure (HF) patients varies from 30 to 50%. The differences in clinical characteristics, healthcare resource utilization (HCRU), and positive airway pressure (PAP) usage between HF with preserved ejection fraction (HFpEF) vs. HF with reduced ejection fraction (HFrEF) in OSA patients are not well known.Objective:To compare clinical characteristics, PAP usage, and HCRU in OSA patients with HFpEF vs HFrEF.Methods:Retrospective cohort study using US administrative claims data linked to objective PAP usage data over one year. HFpEF and HFrEF were identified by ICD-9/10 codes associated with healthcare encounters 1 year before starting PAP therapy. Pearson’s Chi-squared and Wilcoxon rank-sum tests were used as applicable to compare baseline characteristics and PAP usage, and the pre to post-PAP initiation difference in the number of health care encounters.Results:In total, 7,419 patients with HF and OSA were identified, of which 57% had HFpEF. HFpEF patients were majority female (54%) and older than those with HFrEF (64.1 ± 11.52 vs 59.7 ± 11.24 years, p

Circulation, Volume 146, Issue Suppl_1, Page A11760-A11760, November 8, 2022. Background:​​Depression is a frequently encountered comorbidity in patients with Obstructive Sleep Apnea (OSA), with a higher prevalence than the general population. However, there is limited data on the impact of psychiatric comorbidities on the outcomes of OSA.Methods:We identified OSA hospitalizations using the National Inpatient Sample (2018) and relevant ICD-10 codes. After propensity score matching, demographics and comorbidities were compared between the two groups of OSA with (OSA-D+) vs without depression (OSA-D-). The odds of in-hospital outcomes between them were analysed using multivariable regression analyses.Results:Of the 2169730 OSA hospitalizations, 20.1% had comorbid depression. Matched cohorts included 846150 admissions in both groups – OSA-D+ and OSA-D-.The OSA-D+ cohort often consisted of younger (median age, 64 vs 65); females (55.5% vs 55.2%) with both cohorts predominantly including white, Medicare enrollees. The OSA-D+ cohort had significantly higher rates (all p

Circulation, Volume 146, Issue Suppl_1, Page A15100-A15100, November 8, 2022. Introduction:Obstructive sleep apnea (OSA) is a common and underestimated chronic condition recognized as a risk factor for cardiovascular diseases. OSA and acute coronary syndrome (ACS) have been reported in several cases. This study aims to assess the prevalence of the OSA among patients with ACS.Hypothesis:We hypothesize that there is a correlation between OSA and ACS.Methods:This study is a cross-sectional, descriptive study that included 110 patients with ACS at the Cairo University Hospitals in Egypt between December 2018 and July 2019. We included patients diagnosed with ACS over the age of 40. We excluded patients who had disturbed consciousness levels, were intubated/mechanically ventilated, were on psychiatric medications, or used drugs. Furthermore, we excluded individuals with CKD or liver disease. We collected patients’ demographic characteristics, and chronic medical conditions, and performed a sleep assessment. Every patient had a detailed workup for ACS. We assessed OSA based on the STOP-BANG score. The significance of baseline and clinical characteristics, laboratory and imaging findings, and the severity of ACS and its outcome were studied.Results:The mean age of the patients was 58.2±9.6. The majority of patients were male (74.5%). 70.9% of the patients had metabolic syndrome. The mean body mass index was 28.6±4.8; the majority of patients presented with STEMI (60.9%), while only 26.4% and 12.7% presented with NSTEMI and unstable angina respectively. The prevalence of OSA among ACS patients was 63.6%, and of them, 55.7% presented with STEMI, while only 32.9% and 11.4% presented with NSTEMI and unstable angina respectively. Also, the study revealed a statistically significant relationship between OSA and NSTEMI patients (OR: 2.77 [95% CI 1.02-7.55], p=0.041), while there was no statistically significant relationship between OSA and unstable angina patients (OR: 0.73 [95% CI 0.2-2.3], p=0.579) and between OSA and STEMI patients (OR: 0.54 [95% CI 0.2-1.2], p=0.14).Conclusion:To the best of our knowledge, this is the first study to study the prevalence of OSA in ACS patients in the region of Africa. The study indicated a high prevalence of OSA among ACS patients, with a more significant correlation between OSA and NSTEMI patients.

Circulation, Volume 146, Issue Suppl_1, Page A13607-A13607, November 8, 2022. Introduction:Overlap of type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) increases the risk of heart failure possibly mediated by myocardial fibrosis.Hypothesis:T2DM+OSA overlap increases myocardial fibrosis.Methods:This was a prospective study where 141 participants (Control: 28; T2DM only: 27; OSA only: 29; T2DM+OSA: 57) underwent a sleep study and cardiac magnetic resonance. The measures of interest were LV and RV extracellular volume (ECV), native T1 and cardiomyocyte size (tau). Differences were tested with Kruskal-Wallis. The groups ‘T2DM only’ and ‘OSA only’ were combined (Control; T2DM or OSA; T2DM+OSA) for trend analysis with Jonckheere-Terpstra test.Results:Groups had similar sex [Control (males): 54%; T2DM: 44%; OSA only: 52%; T2DM+OSA: 65%; p=0.31)]; OSA and OSA+T2DM participants were older (46± 15; 51±7.8; 53±10; 56±9.1*#years; respectively p=0.001; *p

Circulation, Volume 146, Issue Suppl_1, Page A14299-A14299, November 8, 2022. Introduction:There is emerging new evidence of an association of atrial septal defects (ASD) with hypoxic conditions such as obstructive sleep apnea (OSA). In this study, we determined in-hospital outcomes of patients with OSA undergoing percutaneous ASD repair (ASDR).Methods:The National Inpatient Sample Database was queried from 2011-2019 for relevant ICD-9 and -10 procedural and diagnostic codes. Baseline characteristics and in-hospital outcomes were compared in patients with and without a history of OSA with a primary diagnosis of ASD who underwent ASDR (Surgical or percutaneous) on the index admission. Logistic-regression was performed to adjust for pre-specified co-variable for different outcomes. p-value was considered significant when

Circulation, Volume 146, Issue Suppl_1, Page A14324-A14324, November 8, 2022. Introduction:Untreated obstructive sleep apnea (OSA) is a major cause of uncontrolled atrial fibrillation (AF). It represents a high prevalence and incidence, as well as significant cause of mortality. Uncontrolled AF with recurrent emergency department (ED) visits and inpatient admissions poses a burden to patient quality of life and increased risk of cardiovascular events, in addition to healthcare costs.Hypothesis:We aim to reduce ED visits and hospitalizations for General Internal Medicine resident clinic patients with OSA and uncontrolled AF over the next year by 10%.Methods:We identified approximately 382 patients with inclusion criteria of age 18-70 years with a history of both AF and OSA without documented CPAP use. Interventions included a week long educational session to all residents starting March 2022, standardizing CPAP device ordering/monitoring, and patient education. A protocol for sleep study ordering and CPAP titration was implemented across clinics. The next phase is inpatient screening and referrals.Results:Prior to our intervention date, 14.7% of our study population presented with uncontrolled AF in the past year. Since our interventions, 2.4% have presented with uncontrolled AF.Conclusions:Our preliminary interventions have shown a numerical trend towards decreasing rates of uncontrolled AF in patients with OSA at our institution. Our interventions are ongoing with periodic evaluation of outcomes. Our findings support the need for a comprehensive approach targeting both providers and patients.

Circulation, Volume 146, Issue Suppl_1, Page A13856-A13856, November 8, 2022. Introduction:Type 2 diabetes mellitus (T2DM) and obstructive sleep apnea (OSA) are independently associated with adverse left (LV) and right (RV) ventricular remodeling. However, the effect of continuous positive airway pressure (CPAP) is unknown.Hypothesis:CPAP prevents adverse remodeling in T2DM+OSA overlap.Methods:In this prospective study, 141 participants (Control: 28; T2DM only: 27; OSA only: 29; T2DM+OSA: 57) were recruited and underwent home sleep testing and cardiac magnetic resonance. Subsequently, 53 adults from the T2DM+OSA group were enrolled in a 3-month, parallel-arm, randomized, placebo-controlled trial comparing active and sham CPAP. The measures of interest were LV and RV remodeling indices (mass/volume). Kruskal-Wallis for multiple groups and Wilcoxon rank-sum and signed-rank tests for paired samples for two groups were applied.Results:Groups were of similar sex [Control (males): 54%; T2DM: 44%; OSA only: 52%; T2DM+OSA: 65%; p=0.31)]; OSA and T2DM+OSA participants were older (age in years: 46± 15; 51±7.8; 53±10; 56±9.1*#; respectively p=0.001; *p

Circulation, Volume 146, Issue Suppl_1, Page A11028-A11028, November 8, 2022. Introduction:Heart failure patients with preserved ejection fraction (HFpEF) frequently have co-morbid obstructive sleep apnea (OSA), although the impact of OSA treatment remains unclear in this patient population. We assessed the association between adherence to positive airway pressure (PAP) therapy and healthcare resource utilization in patients with OSA and HFpEF.Methods:Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFpEF were used to measure the association of PAP adherence and healthcare resource utilization, defined by hospitalizations and emergency room (ER) visits. US Medicare defines PAP compliance as use for at least 4 hours/night for 70% of nights in a consecutive 30-day period over 90 days. PAP adherent patients met this criteria for all 4 90-day periods, while PAP non-adherent patients did not meet this criteria for any 90-day period over one year. Propensity score methods were used to create well matched groups with differing PAP adherence levels.Results:The study cohort consisted of 4,237 eligible patients (54.0% female, mean age 64.1 years), of whom 40% were considered adherent to PAP therapy (30% intermediate-adherent, 30% non-adherent). After propensity score matching on prior year covariates, during the year after PAP prescription, PAP adherent patients had fewer hospital visits than non-adherent patients, with a 57% reduction in hospitalizations and a 36% reduction in ER visits for PAP adherent patients (Table 1a). These results remained consistent with inverse probability weighting, and furthermore showed a significant difference in hospitalizations between intermediate-adherent and non-adherent patients, but no significant difference in ER visits (Table 1b).Conclusions:Treating OSA with PAP therapy in patients with HFpEF is associated with a reduction in hospitalizations and ER visits. Adherence to PAP therapy is required to realize these clinical benefits.

Circulation, Volume 146, Issue Suppl_1, Page A15443-A15443, November 8, 2022. Introduction:Central sleep apnea (CSA) is common in patients with heart failure and is associated with a poor prognosis. A number of studies have linked the P2Y12 inhibitor, ticagrelor, with CSA. We aimed to evaluate CSA prevalence in patients with coronary heart disease (CHD) and whether ticagrelor use is associated with CSA in this population.Methods:We reviewed consecutive patients with CHD data who underwent a clinically indicated polysomnography (PSG) test over a 5-year period from three academic sleep centers. We sampled patients who were on ticagrelor or clopidogrel during their PSG test at a 1:4 ticagrelor:clopidogrel ratio. Patients with an active opioid prescription at time of PSG test were excluded. Age, left ventricle (LV) dysfunction (ejection fraction 50% of AHI) were present in 16 (11.3%) and 5 (3.5%) patients, respectively. High CSA burden and strict CSA were more common in patients on ticagrelor than in those on clopidogrel (7 [23.3%] vs. 9 [8.1%] and 3 [10.0%] vs. 2 [1.8%]). In multivariable analysis ticagrelor use was associated with high CSA burden adjusting for LV dysfunction and age (OR 3.27, 95% CI 0.99-10.7, p=0.048). No variables were associated with strict CSA.Conclusions:Ticagrelor use was associated with high CSA burden in patients with coronary heart disease. Future studies should verify these results in a larger cohort and explore their clinical significance.

Circulation, Volume 146, Issue Suppl_1, Page A13798-A13798, November 8, 2022. Background:Obstructive sleep apnea (OSA) is associated with right ventricular (RV) remodeling, RV dysfunction and pulmonary hypertension. Myocardial flow reserve (MFR), the ratio of stress-to-rest myocardial blood flow (MBF), is an index of coronary microvascular health. Recent evidence suggests that severe OSA is associated with abnormal left ventricular MFR (LVFR). However, little is known about MFR in the RV of patients with OSA. In this study we examined the relationship between measures of OSA severity and RV MFR (RVFR) in humans.Methods:We conducted RV MBF assessment in 47 persons with OSA who had a cardiac positron emission tomographic (PET) perfusion scan. All participants had in-laboratory polysomnography. RVFR

Circulation, Volume 146, Issue Suppl_1, Page A11871-A11871, November 8, 2022. Introduction:Obstructive sleep apnea (OSA) effects up to 30% of men and 15% of women in North America. Untreated, OSA is associated with the development of hypertension, heart failure, coronary artery disease, cardiac arrhythmia, and stroke. Treatment reduces these risks. The American Academy of Sleep Medicine outlines the first line treatment of OSA as continuous positive airway pressure (CPAP). However, many patients are unable to tolerate CPAP. One of the newest therapies approved in 2014 is implantation of a hypoglossal nerve stimulator (HNS) which functions by stimulating the tongue protrudor muscles to reduce upper airway obstruction. However, there is minimal research investigating HNS’s effects on comorbidities. Currently there are two published studies showing improved blood pressure control and heart rate variability, but each study only included 46 patients. Several factors warrant a comparison including the lack of data, procedural risks, and procedural cost; especially, when considering the proven efficacy and low cost of CPAP. We present a retrospective analysis of blood pressure after HNS implantation.Hypothesis:We hypothesize that HNS implantation will improve blood pressure control.Methods:All cases of HNS implantation at MercyOne North Iowa Mason City, Iowa were retrospectively reviewed. Each case was manually reviewed for pre- and post-surgery blood pressure, heart failure exacerbations, arrhythmia, hemoglobin A1c, stroke, and acute coronary syndrome.Results:Fifty-nine patients had a mean change in blood pressure of +1.76 systolic and +0.76 diastolic with a standard error of 2.10 and 1.29 respectively. The mean follow-up time was 5.7 months after the fine-tuning sleep titration study. Five patients needed one less blood pressure medication and 6 patients needed one more. Preliminary regression analysis does not support gender, age, apnea-hypopnea index, or body mass index being predictive of change in blood pressure with HNS implantation. There was no statistically significant effect on other comorbidities.Conclusion:This study showed no clinically significant change in blood pressure after HNS implantation. Limitations include the small sample size and only one follow-up blood pressure.

Circulation, Volume 146, Issue Suppl_1, Page A13554-A13554, November 8, 2022. Introduction:Obstructive sleep apnea (OSA) is common in heart failure, although the impact of OSA treatment remains unclear. We assessed the association between adherence to positive airway pressure (PAP) therapy and healthcare resource utilization in patients with OSA and heart failure with reduced ejection fraction (HFrEF).Methods:Administrative insurance claims data linked with objective PAP therapy usage data from patients with OSA and HFrEF were used to measure the association of PAP adherence and a composite clinical outcome of hospitalization and emergency room (ER) visits. US Medicare defines PAP compliance as usage of the device for at least 4 hours/night for 70% of nights in a consecutive 30-day period over 90 days. PAP adherent patients met these criteria for all 4 90-day periods, while PAP non-adherent patients did not meet these criteria for any 90-day period over one year. Propensity score methods were used to create well matched groups with differing PAP adherence levels.Results:The study cohort consisted of 3,182 eligible patients (69.9% male, mean age 59.7 years) of whom 39% were considered adherent to PAP therapy (29% intermediate-adherent, 31% non-adherent). In the year after PAP prescription, after propensity score matching, PAP adherent patients had fewer hospital visits than non-adherent patients, driven by a 24% reduction in ER visits for adherent patients (Table 1a). These results remained consistent with inverse probability weighting and furthermore showed there were no statistically significant differences between intermediate-adherent and non-adherent patients for any outcome (Table 1b).Conclusions:Treating OSA with PAP therapy in patients with HFrEF is associated with a reduction in the composite outcome of hospitalization and ER visits, driven primarily by a reduction in ER visits. Consistent adherence to PAP therapy is required to realize these benefits.