Risk for CV mortality elevated in Hispanic adults with OSA, excessive sleepiness

Use of a symptom-based approach validated different subtypes of obstructive sleep apnea and showed an association between excessive sleepiness and increased risk for cardiovascular mortality in Hispanic adults with moderate to severe OSA.

“The Latino population is underrepresented in the scientific literature. Therefore, validation data regarding novel approaches to better identify a subtype of OSA patients at high risk of CV mortality is strongly needed,” Gonzalo Labarca, MD, research fellow in the division of sleep and circadian disorders at Brigham and Women’s Hospital and Harvard Medical School, told Healio. “In this study, we explored different approaches in a cohort of patients with moderate to severe OSA from a sleep clinic based in Santiago, Chile. As a result, the symptom-based approach was reproducible in our cohort and the ‘excessive sleepiness’ subtype was independently associated with CV mortality.”

Labarca and colleagues assessed the reproducibility of four OSA-related cluster analyses and their ability to predict incident CV mortality in adults living in Chile. The researchers reproduced four cluster analyses (the Sleep Heart Health Study, Icelandic Sleep Apnea Cohort, Sleep Apnea Cardiovascular Endpoints and The Institute de Recherche en Sante Respiratoire des Pays de la Loire cohorts) using the SantOSA cohort of 780 adults with moderate to severe OSA (mean age, 55.7 years; 83.4% men).

“The primary motivation for this study was to fill the gap regarding the lack of information about the Latino population from South America and the interest in determining the risk of CV mortality to improve public health and the decision-making process,” Labarca said.

The researchers identified the following three patient subtypes in the Icelandic Sleep Apnea Cohort and the Sleep Heart Health Study: “minimally symptomatic”; “disturbed sleep”; and “excessive sleepiness.” In addition, for the Sleep Heart Health Study, researchers also identified a “moderate sleepiness” subtype.

In the SantOSA cohort, the researchers reported a significant association between excessive sleepiness and incident CV mortality after 5 follow-up years using the Sleep Heart Health Study (HR= 5.47; 95% CI, 1.74-8.29; P < .01) and the Icelandic Sleep Apnea Cohort (HR = 3.23; 95% CI, 1.21-8.63; P = .02) cluster analyses.

“The main surprise was the consistent association between the excessive sleepiness subtype and the risk of CV mortality across approaches included in our study. This finding provides robust data that a symptom-based approach can be used in clinics,” Labarca told Healio.

Labarca said future research should include prospective identification of the excessive sleepiness subtype, including this subtype in new clinical trials aimed to determine the efficacy of different OSA treatments.

For more information:

Gonzalo Labarca, MD, can be reached at glabarca@bwh.harvard.edu.