Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Sleep apnea and cardiovascular mortality in patients with heritable thoracic aortic diseases (HTAD)
N. Geßler1, P. Wohlmuth1, O. Anwar1, S. Debus2, C. Eickholt1, M. A. Gunawardene1, S. Hakmi1, K. Heitmann1, M. Rybczynski3, H. Schüler3, S. Sheikhzadeh4, E. P. Tigges1, G. H. Wiest5, S. Willems1, E. Adam2, Y. von Kodolitsch3
1Kardiologie, Asklepios Klinik St. Georg, Hamburg; 2Universitäres Herzzentrum, Universitätsklinikum Hamburg-Eppendorf, Hamburg; 3Allgemeine und Interventionelle Kardiologie, Universitäres Herz- und Gefäßzentrum Hamburg GmbH, Hamburg; 4Zentrale Notaufnahme, Asklepios Klinik St. Georg, Hamburg; 5Pneumologie und Schlafmedizin, Asklepios Klinikum Harburg, Hamburg;

Aims. Despite a well known relationship between sleep apnea and Marfan Syndrome, the impact of sleep apnea on mortality or progress of the aortic disease in patients with heritable aortic diseases (HTAD) is still unclear. The aim of this study was to evaluate the effect of sleep apnea on cardiovascular death and on aortic events in patients mit HTAD.

Methods and Results. This is an investigator-initiated study with long-term follow-up data of 173 HTAD patients, who were screened for sleep apnea regardless of symptoms. The primary endpoint was cardiovascular death and the secondary outcome was the occurrence of any aortic event.

Sleep apnea with an apnea-hypopnea-index (AHI) >5/h was observed in 22.5% (39/173) with mild sleep apnea in 15% (26/173) and moderate to severe sleep apnea in 7% (13/173). After a follow-up period up to 12 years (median 6.84 years [interquartile range: 5.44, 7.57]), 10% (16/173) of all patients had died, with cardiovascular cause in 81% (13/16). Patients with sleep apnea showed significantly lower survival rates regarding cardiovascular deaths as compared to patients without sleep apnea (p=0.005). After adjusting for age and body-mass-index (BMI), the AHI-score showed to be an independent risk factor for cardiovascular death (hazard ratio 1.089, 95%-confidence interval [1.037-1.144], p<0.001). The secondary outcome aortic events occurred in 30% (48/173). There was only a weak effect of the AHI-score on aortic events after adjusting for age and BMI (hazard ratio 1.013, 95%-confidence interval [0.972-1.057]).

Conclusion. Sleep apnea shows to be an independent risk factor for cardiovascular death in HTAD patients. Although we observed high rates of mild sleep apnea, we could show a significant relationship. These findings highlight the necessity of early sleep apnea treatment in HTAD patients as an important adjunct to the management of the disease. 

Figure legends:

Figure 1: Kaplan-Meier curves for the primary outcome: A) For HTAD patients without sleep apnea (No OSA) at baseline (AHI≤5); B) For HTAD patients with sleep apnea (OSA) at baseline (AHI>5).

The first primary outcome was a death from cardiovascular causes.


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