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

Mouth taping is a sleep technique that has been promoted widely across social media. Although mouth breathing during sleep is associated with severity of obstructive sleep apnea (OSA), research recently published in JAMA Otolaryngology–Head & Neck Surgery suggests that it may be important to maintain airflow in some patients with nasal obstruction.

Circulation, Volume 150, Issue Suppl_1, Page A4136963-A4136963, November 12, 2024. Background:There is increasing evidence of a strong association between obstructive sleep apnea (OSA) and ischemic heart disease. Previous studies have demonstrated OSA to be a significant predictor of incident CAD, while recent studies have confirmed individuals with OSA to have 3.9 times greater incidence of major adverse cardiac and cerebrovascular events (MACCE) at one year following acute myocardial infarction (AMI) than individuals without OSA. Whether treatment with continuous positive airway pressure (CPAP) after AMI in OSA patients reduces MACCE is not known. This study investigated the long-term cardiovascular outcomes associated with CPAP therapy after AMI in OSA patients, and is the first study to evaluate the effect of CPAP on secondary prevention after AMI.Methods:This retrospective study was conducted from 2015 to 2019 and included adults with AMI. Patients with at least moderate OSA (n=180) were followed for at least 1 year and categorized as either AMI and compliant to CPAP (54 patients) or AMI and non-compliant to CPAP (126 patients). We estimated the incidence of MACCE (early rehospitalization, re-catheterization, CABG, recurrent MI, CHF, arrhythmia, stroke, and death) in each group during follow-up from the index event. Continuous and categorical variables were analyzed for significance with Wilcoxon’s test and Fisher’s exact test respectively. Multivariate analyses were performed to adjust for confounders.Results:Most participants were male, the average age was 66 years old, and no significant demographic difference was identified between the two groups. Compared with non-compliant patients, CPAP-compliant patients exhibited significantly lower overall MACCE incidence (22.2% vs 40.5%, p=0.03) and repeat catheterization rate (1.9% vs 11.1%, p=0.04) after AMI.Conclusion:Long-term, compliant CPAP therapy, as compared with non-compliant CPAP therapy, significantly reduces recurrent cardiovascular events and provides effective secondary prevention after AMI in patients with at least moderate OSA.

Circulation, Volume 150, Issue Suppl_1, Page A4136996-A4136996, November 12, 2024. Introduction:Insomnia and obstructive sleep apnea (OSA) each increase risk for hypertension (HTN). Among older adults, there is a negative synergistic association of comorbid insomnia and OSA (i.e., COMISA) on incident cardiovascular disease (CVD) but it is unknown if this comorbidity is associated with HTN risk earlier in the lifespan.Research Questions:1) Is COMISA associated with incident HTN among younger adults? 2) Do COMISA-HTN associations differ by sex?Hypotheses:We hypothesized that 1) COMISA would be associated with a greater risk of HTN than having no sleep disorder, 2) the hazard would be larger than for insomnia and OSA alone, and 3) distinct COMISA-HTN associations would be observed among men and women, respectively.Methods:Analyses included Veterans who enrolled in Veterans Health Administration (VA) care 2001-2021, a group selected because of its early adult age distribution. We merged administrative data, including outpatient and inpatient encounters, diagnoses, (ICD-9-CM/10 codes/dates) and pharmacy records. Veterans without demographic data, a history of other sleep disorders or CVD, or

Circulation, Volume 150, Issue Suppl_1, Page A4140180-A4140180, November 12, 2024. Introduction:Sleep apnea is a common sleep disorder that can worsen atrial fibrillation(AF) prognosis. Benzodiazepines(BZD) are commonly prescribed for insomnia, which often accompanies sleep apnea. However, BZDs have been associated with worsening of sleep apnea due to respiratory depression, pharyngeal muscle relaxation, and increase of arousal threshold, which all may lead to prolonged hypoxia. There is little research on the effect of BZD use in AF patients with sleep apnea. Therefore, the objective of this study is to investigate the effects of BZD usage on outcomes in the AF population with sleep apnea.Methods:Data from patients with AF and sleep apnea seen at Tulane Medical Center between 2010 and 2019 was obtained from Research Action for Health Network(REACHnet), a Clinical Research Network in PCORnet®. Patients with AF and sleep apnea were divided between those with a prescription of BZD and those without BZD. These two groups were compared using the Kaplan-Meier method for time-to outcome for all-cause mortality, ischemic stroke, myocardial infarction(MI), and hospitalizations in the five years following their AF diagnosis. Cox regression analysis was used to investigate proportional hazards and control for demographics, comorbidities, and medication use.Results:There were 524 total patients included with AF and sleep apnea. Of these, 413(78.8%) were not prescribed BZDs, while 111(21.1%) were taking BZDs. Use of BZDs was associated with worse outcomes. In the no BZD and the BZD group over the 5 years following AF diagnosis, the rate of mortality was 6.1% and 12.6%(p

Circulation, Volume 150, Issue Suppl_1, Page A4145118-A4145118, November 12, 2024. Background:Obstructive Sleep Apnea (OSA) is the most common sleep related disorder and shares common pathophysiological mechanisms with Peripheral Arterial Disease (PAD). Studies exploring the influence of OSA on PAD have largely focused on subclinical markers of PAD such as ankle brachial indices and pulse wave velocities. We sought to investigate the association of OSA with Major Adverse Limb Events (MALE) in patients with PAD.Methods:National Inpatient Sample 2018-2020 was utilized for this analysis. MALE was the primary outcome, defined as a composite of Acute Limb Ischemia, Limb Revascularization (either percutaneous or surgical), limb amputation and All-Cause mortality. ICD-10 codes were utilized to identify the diagnoses of choice. Propensity score matching was performed between the 2 groups of OSA and no OSA using the caliper match method for the variables, Age, Gender, Stroke, Obesity, Hypertension, Anemia, Coagulopathy, ESRD, Diabetes, Chronic Pulmonary Disease, Congestive Heart Failure, Cardiac Arrythmias and Valvular Heart Disease. Weighted samples were utilized and p

Circulation, Volume 150, Issue Suppl_1, Page A4147561-A4147561, November 12, 2024. Introduction:Recent evidence from the literature has shown that obstructive sleep apnea (OSA) may contribute to worsening outcomes of patients with heart failure. However, most OSA studies were conducted in the HFrEF population. There remains scarce data on the impact of OSA in HFpEF hence, we aimed to study this population.Methods:We conducted a retrospective analysis of the 2020 National Inpatient Sample (NIS) database. Using the ICD-10 codes, we identified the codes for HFpEF and OSA. We adjusted for cofounders and used multivariate logistic regression model to analyze the odds ratio (adjusted odds ratio (aOR)) of our outcomes of interest.Result:There were 2,115,015 hospitalizations for HFpEF, and 18.1% (383,624) had a diagnosis of obstructive sleep apnea. The mean age was 69.5 years, with males having a prevalence of 51%. Of these, 74% were Caucasians, 17.26% were Blacks, and 5.24% were Hispanics. Following multivariate analysis, we found that HFpEF patients with OSA had significant odds of atrial fibrillation, adjusted odds ratio (aOR) 1.28(1.26 -1.31 p=0.000), coronary artery disease 1.23(1.20-1.26 p=0.000), obesity 3.49(3.41-3.57 p=0.000), diabetes mellitus 1.11(1.08-1.14 p=0.000), second-degree heart block 1.2(1.09-1.34 p=0.000), bifascicular heart block 1.08(1.02-1.14 p=0.003), defibrillator use 1.36 (1.04-1.77 p=0.026). However, OSA was not significantly associated with atrial flutter 1.03(0.99-1.06 p=0.13), third-degree heart block 1.07(0.99-1.15 p=0.072), ventricular tachycardia 1.01(0.95-1.07 p= 0.762).Conclusion:This analysis showed that HFpEF patients with OSA had higher likelihood of arrhythmias, and ischemic cardiac events. Lifestyle modifications including weight loss, healthy diet, and appropriate CPAP use should be encouraged in these patients.

Circulation, Volume 150, Issue Suppl_1, Page A4142056-A4142056, November 12, 2024. Background:Obstructive sleep apnea (OSA) has been reported in a sizable proportion of adults with hypertrophic cardiomyopathy (HCM) and has been associated with higher incidence of adverse outcomes including arrhythmias (atrial fibrillation, non-sustained ventricular tachycardia) and sudden cardiac death when untreated. We aimed to evaluate the impact of OSA on in-hospital outcomes of patients with HCM.Methods:National Inpatient Sample 2016-2020 was queried to identify admissions for HCM patients with (HCM+OSA) and without (HCM-OSA) OSA. In-hospital outcomes were compared with use of logistic regression.Results:From 2016-2020, 271,085 adults with HCM were admitted to hospital of whom 45,135 (16.6%) were identified to also have OSA. Age was similar between both groups. (Table) Comorbidities (diabetes, coronary artery disease, hyperlipidemia, and chronic kidney disease) were more prevalent among HCM+OSA [Table]. Additionally, HCM+OSA more often had the obstructive phenotype (43.8 vs. 42.87%, p

Circulation, Volume 150, Issue Suppl_1, Page A4117927-A4117927, November 12, 2024. Background:Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice and is associated with significant morbidity, mortality, and health system costs. Obstructive sleep apnea (OSA) is a highly prevalent condition affecting more than one third of the global adult population and, among patients with comorbid AF, contributes to poor AF related quality of life. However, the prevalence of undiagnosed OSA in the general AF population is unknown.Methods:In this pragmatic, phase IV prospective cohort study, we performed sleep testing on consecutively enrolled ambulatory AF patients for OSA using a cloud-based disposable home sleep test (the WatchPAT system). The primary outcome of our study was the prevalence of undiagnosed mild (5≤AHI

Circulation, Volume 150, Issue Suppl_1, Page A4145962-A4145962, November 12, 2024. Introduction:Obstructive sleep apnea (OSA) affects nearly a billion adults worldwide, and is associated with an increased risk of coronary artery disease, heart attack, heart failure, and arrhythmias – notably atrial fibrillation (AF). Low cost, point of care mobile electrocardiograms (MobileECGs) record and detect heart rhythm abnormalities in 30 seconds. This study aims to assess the effectiveness of the KardiaMobile (AliveCor) MobileECG device as an AF screen in the OSA patient population.Methods:The MobileECG Sleep Study enrolled 500 adult University of Florida Health patients in an observational study between March 2021 and March 2024. After providing consent and completing a brief survey regarding pre-existing health conditions and overall sleep health, a trained research assistant performed the AF screening with the KardiaMobile ECG device. ECG readings were marked for previously undetected abnormalities (potential AF, tachycardia, bradycardia, etc.) and statistically analyzed to determine stroke risk using the CHA2DS2-VASc scoring system. CHA2DS2-VASc criteria includes congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74 and sex category (female).Results:A total of 500 participants were enrolled over a 3 year period at University of Florida Health Sleep Center. Of which 276 (55.2%) were female and 224 (44.8%) were male, with a mean age of 56.34 (SD 15.74) and a mean weight of 222.50 (SD 63.25). Of those tested, 68 (13.6%) had irregular, previously undetected AF readings. Patients with irregular AF readings using the KardiaMobile ECG device had CHA2DS2-VASc scores of t(68) = 2.15, p = .042, d = 0.26 indicating an intermediate risk for stroke. Oral anticoagulation is recommended for a score of ≥ 2 if the patient has no contraindication. After prior 12-lead ECG data for patients is obtained the determinations will be compared to the KardiaMobile ECG readings using Cohen’s Kappa.Conclusion:MobileECGs offer a rapid, point of care screening tool for AF in an outpatient sleep clinic setting. Early detection of AF in the OSA patient population can result in improved outcomes and reduced instances of stroke events through anticoagulation therapy guided by CHA2DS2-VASc scores. Further research is necessary to understand the long term impact of surveillance AF screening in high risk patient populations on mortality and cost of healthcare.

Circulation, Volume 150, Issue Suppl_1, Page A4147013-A4147013, November 12, 2024. Introduction/Background:Chronic Obstructive Pulmonary Disease (COPD) is a major health issue characterized by long-term breathing problems and poor airflow, leading to significant morbidity and mortality. Obstructive Sleep Apnea (OSA) is a prevalent condition that can exacerbate complications in patients with COPD. The coexistence of COPD and OSA, known as “overlap syndrome,” has been linked to worse patient outcomes, including higher cardiovascular morbidity and all-cause mortality.Research Question:How does the presence of OSA affect mortality patterns in COPD across different age, sex, and racial groups?Goals/Aims:To analyze mortality patterns in COPD with and without the presence of OSA.Methods/Approach:This retrospective study used CDC’s public mortality data from 1999 to 2020 to identify patients aged 35 and older with COPD (ICD-10 codes J40-J44) and those with OSA (ICD-10 code G-47.3). Mortality patterns were assessed across different age ranges, genders, and races. Statistical analyses included an independent two-sample t-test (Welch’s t-test) to compare average ages of death and Chi-Square Tests to assess differences in mortality patterns due to specific causes. Odds Ratios (ORs) with 95% Confidence Intervals (CIs) were calculated, with statistical significance set at p < 0.05.Results/Data:The study identified 5,952,368 deaths in patients with COPD, including 68,935 deaths in patients with both COPD and OSA. Leading causes of death were chronic lower respiratory diseases and diseases of the heart. The highest mortality in COPD-only cohort occurred in the 80-84 age group, while in COPD+OSA group was in the 70-74 age group. The weighted average age of death was 76.56 years for the COPD-only group and 69.34 years for the COPD + OSA group (p < 0.001). Chi-square analysis revealed significant differences in mortality patterns across age groups, with higher heart disease mortality risk in the older (i.e.,55+) COPD+OSA population. Men showed higher crude death rates in both groups. COPD + OSA mortality odds were higher in American Indian or Alaska Native and African American populations compared to Whites.Conclusion(s):OSA significantly impacts cardiac-related mortality in patients with COPD, evidenced by a lower average age of death and increased cardiovascular mortality risk in higher age groups. Early diagnosis and effective management of OSA in COPD patients are crucial for reducing premature mortality and improving outcomes.

Circulation, Volume 150, Issue Suppl_1, Page A4145554-A4145554, November 12, 2024. Background:Cancer and obstructive sleep apnea (OSA) individually elevate cardiovascular diseases (CVD) and stroke risk. However, it is unclear whether OSA contributes additional CVD risk in persons with pre-existing cancer.Methods:Using the TriNetX, an electronic healthcare records-based database from large healthcare organizations, we compared adverse CVD outcomes and ischemic stroke incidence between patients with and without OSA diagnosed with cancer between 01/2012 and 06/2023. Adverse CVD outcomes was defined as a composite of incident heart failure, incident atrial fibrillation / flutter, incident myocardial infarction or all-cause mortality. Patients were eligible to enter the cohort on the day of cancer diagnosis. The follow-up period for outcome events began one year after patients entered the cohort and patients contributed follow-up time till the outcome event occurred or till the end of the study period.After propensity risk score matching on demographics and comorbidities we conducted a time-to-event analyses.Results:A total of 509,477 patients with both cancer and OSA were propensity score matched to 509,477 patients with cancer but without OSA. The table shows the demographic and comorbidities of the matched groups. Among persons with cancer, OSA diagnosis was associated with increased risk of adverse CVD outcomes (HR: 1.37, 95% CI: 1.36 – 1.38). OSA in persons with cancer increased the risk of heart failure, atrial fibrillation / flutter and myocardial infarction. OSA also increased the risk of ischemic stroke. However, total mortality risk was reduced among those with OSA. See the table for details.Conclusion:OSA increases the risk of adverse CVD outcomes and ischemic stroke in persons with cancer. These analyses suggest that persons with cancer should be screened and treated for OSA. Future studies will need to determine the impact of OSA treatment e.g., positive airway pressure (PAP) therapy on CVD related outcomes in persons with cancer. Further investigation into the paradoxical reduction in all-cause mortality with OSA is warranted.

Circulation, Volume 150, Issue Suppl_1, Page A4120332-A4120332, November 12, 2024. Introduction:Sleep apnea (SA) is often underrecognized and undertreated despite its high prevalence in the adult population and its association with adverse cardiovascular outcomes. There are limited estimates of national trends on cardiovascular mortality in older patients with sleep apnea. We aimed to assess the sex and race-related trends of ischemic heart disease (IHD) mortality in the older adults with SA using a large population-based database.Methods:We utilized the Centers for Disease Control and Prevention Wide-Ranging, Online Data for Epidemiologic Research (CDC WONDER) database which provides information from death certificates of all US residents according to the International Classification of Diseases, Tenth Revision (ICD-10). The demographic and mortality data were obtained for the United States population >65 years from 1999 to 2021. Ischemic heart disease (ICD-10 codes I20-I25) was listed as the underlying cause of death, and SA (G47.3) as a contributing cause of death. Age adjusted mortality rates (AAMRs) per 1,000,000 population were calculated by standardizing deaths to the year 2000 US population. We used Jointpoint Regression Program to analyze temporal trends in mortality from 2000 to 2021. Average annual percentage change (AAPC) with 95% CI were calculated to examine trends in AAMR over time.Results:Overall, AAMR of IHD mortality for patients with SA increased from 7.9 per 1,000,000 (95% CI, 6.9-8.8) in 1999 to 53.4 per 1,000,000 (95% CI, 51.4-55.4) in 2021 with an AAPC of 9.1% per year (95% CI, 8.8-9.5). Men had consistently higher AAMR than women throughout the study period (overall AAMR men: 45.51 (95% CI, 44.8-46.2); women: 12.5 (95% CI, 12.2-12.8). Both the groups had a similar increasing trend in AAMR, with men having a steeper increase. [AAPC men: 9.3% (95% CI, 8.5-10.8) versus AAPC women: 8.6%, 95% CI, 8.1-9.7]. Non Hispanic (NH) White population had the greatest AAMR throughout the study period, followed by NH Black and Hispanic or Latino. The NH White population had the largest increase in AAMR from 1999 to 2021 (AAPC 9.4%, 95% CI:8.9-10.1).Conclusion:In the United States, there has been a general increase in IHD mortality related to sleep apnea over the last two decades. This rising trend as noted in our analysis is concerning and underscores the need for more robust cardiovascular surveillance in these patients.

Circulation, Volume 150, Issue Suppl_1, Page A4146184-A4146184, November 12, 2024. Introduction:Increasing evidence shows that obstructive sleep apnea (OSA) is a significant risk factor for cardiovascular disease. OSA may exacerbate recovery from ST-elevation myocardial infarction (STEMI), as chronic hypoxemia and hypercapnia has been shown to be associated with sympathetic hyperactivity, inflammatory response, endothelial dysfunction, and hypercoagulability. Acute outcomes of STEMI patients who have a diagnosis of OSA has not been well-studied.Research Question:Does OSA affect inpatient outcomes in patients with a primary diagnosis of STEMI?Methods:We conducted a retrospective analysis using the National Inpatient Sample database from 2016-2021 to examine the inpatient outcomes of STEMI patients in OSA patients compared to patients without OSA. Inclusion criteria encompassed patients diagnosed with acute STEMI and OSA based on ICD-10 codes.Results:A total of 1,203,915 STEMI patients were identified; among these, 1,128,880 (93.7%) did not have a diagnosis of OSA, while 75,035 (6.3%) had a known diagnosis of OSA. Patients with OSA had lower in-hospital mortality (aOR=0.86, CI 0.80-0.90, p

Circulation, Volume 150, Issue Suppl_1, Page ASa103-ASa103, November 12, 2024. Background:Guidelines for resuscitation of OHCA recommend that advanced airway management be performed without interrupting chest compressions. However, the extent and impact of interrupting ventilation during OHCA resuscitation is unknown. We described the apnea interval that occurs during endotracheal intubation (ETI) and its associated clinical outcomes.Methods:We conducted a cohort investigation of adult ventricular fibrillation (VF)-OHCA patients who underwent attempted paramedic ETI during resuscitation in a metropolitan EMS system from 2017–19. We defined apnea interval as the elapsed time from the last breath delivered before an ETI attempt to the first breath delivered after the attempt. We collected patient, care, apnea interval and outcome data from review of OHCA and airway registries linked to digital defibrillator recordings. The defibrillator recording included an audio channel, ECG, transthoracic impedance, and end-tidal carbon dioxide biosignals. Using multivariable logistic regression, we determined the relationship between apnea interval (longest quartile [ >120s] vs the shorter 3 quartiles [120s compared to 120s was associated with lower likelihood of ROSC but not hospital discharge. Given its variability and relationship to near-term resuscitation outcomes, the apnea interval may be a modifiable intervention that can affect OHCA survival, supporting the need for further investigation.

Circulation, Volume 150, Issue Suppl_1, Page A4120918-A4120918, November 12, 2024. Aim:The association between obstructive sleep apnea and prediabetes using STOP-Bang questionnaire is unknown. We aimed to investigate prevalence of prediabetes among people according to sleep apnea status.Methods:This cross-sectional study included 10131 Korean adults without diabetes with information of STOP-Bang score were identified from the dataset of the Korea National Health and Nutrition Examination Survey 2019-2021. Prediabetes was categorized into three subsets: fasting blood glucose only (fasting blood glucose 100-125 mg/dL, HbA1c