Chest
Volume 97, Issue 1, January 1990, Pages 27-32
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Clinical Investigations
Daytime Sleepiness and Vascular Morbidity at Seven-Year Follow-up in Obstructive Sleep Apnea Patients

https://doi.org/10.1378/chest.97.1.27Get rights and content

To evaluate the morbidity associated with obstructive sleep apnea syndrome (OSAS), we undertook a seven-year follow-up study of 198 OSAS patients seen between 1972 and 1980. The patients had been submitted to tracheostomy (71 patients) or had received a weight-loss recommendation (127 patients). Despite a lower mean apnea index (AI) (43 vs 69) and a lower mean body mass index (BMI) (31 vs 34 kg/m2) at entry, excessive daytime sleepiness (EDS) and vascular morbidity were significantly higher in the conservatively treated group. The relative risk (odds ratio) of finding EDS in the conservatively treated group, after adjustment for BMI at seven-year follow-up, was 3.7 (95 percent confidence interval [CI] = 2.6-5.3). The relative risk of developing new vascular problems in the same population, estimated by Cox models, was 2.3 (95 percent CI = 1.5-3.6). The effect of tracheostomy, independent of age, BMI, and AI at entry, was highly significant. At entry, 56 percent of the population already had a vascular problem, particularly hypertension, thus emphasizing the need for earlier treatment of the sleep-related abnormal breathing.

(Chest 1990; 97:27-32)

Section snippets

METHODS

Criteria for Inclusion in the Study

Before searching our clinic records to form two retrospective cohorts of surgically (tracheostomy) and conservatively treated patients, we established the following requirements for subjects:

  • 1.

    Residence in a western state of the United States (California, Nevada, Arizona, Oregon, or Washington), to facilitate follow-up.

  • 2.

    A previous polygraphic monitoring, with sufficient information in the chart to calculate AI. (Hypopneas or partial obstruction of the upper

Total Population

The initially seen population included 198 patients described in Table 1. At entry, 112 patients (56.6 percent) presented with arterial hypertension. Coronary artery disease had been diagnosed in 33 (16.7 percent) patients (31 men, two women). Previous medical history noted myocardial infarction in 16 (8.1 percent) and stroke in 14 (7.1 percent). Chronic obstructive pulmonary disease was found in 40 cases (20 percent) and EDS in 173 (87.4 percent) patients (Fig 1).

Description of the Two Subgroups

The conservatively treated

DISCUSSION

Our report presents a prospective follow-up study based on two retrospectively selected cohorts of patients, seen as early as 1972 when tracheostomy was the only surgical treatment9 and weight-loss recommendation the only alternative. This is a so-called “Trohort-Cohort” study that will always be weaker than a prospective investigation and that may ignore some issues. At that time, when OSAS (ie, association of clinical complaints with polygraphic finding) was less commonly recognized, patients

ACKNOWLEDGMENTS

We thank Boyd Hayes for providing technical assistance and Alison Grant for editing the manuscript.

REFERENCES (10)

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  • Surgical Treatment of OSA on Cardiovascular Outcomes: A Systematic Review

    2017, Chest
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    Despite the increased prevalence of previous myocardial infarction in the tracheostomy group, these patients had significantly lower mortality (2.8% vs 17.3%; P < .05) and vascular mortality (1.4% vs 11%; P < .05) than the conservatively treated group after accounting for age, BMI, and apnea index at entry into the study. In the same study, Partinen and Guilleminault20 also examined vascular accidents, defined as new stroke, myocardial infarction, or repeated blood pressure ≥ 165/95 mm Hg. Vascular morbidity at 7 years was significantly lower in the tracheostomy group compared with conservative treatment (OR, 2.3 [95% CI, 1.5-3.6]), despite a higher mean BMI and more severe OSA in the surgical group.

  • Atrial Fibrillation and Sleep Apnoea: Guilt by Association?

    2017, Heart Lung and Circulation
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    When Willem Einthoven first presented an atrial fibrillation (AF) recording in 1906 from his then newly invented electrocardiogram [10,11], he probably did not realise that this supraventricular tachyarrhythmia with uncoordinated atrial activation was the most common pathological cardiac arrhythmia [12], and that it would reach epidemic proportions across the globe and contribute to significant cardiovascular morbidity and mortality [13–17]. Since the 1970s, an association between OSA and cardiovascular disease (CVD) has been recognised [18–23]. In 1998, Wilcox et al. suggested the term “Syndrome Z” to draw attention to the clustering of central obesity, OSA, systemic hypertension, dyslipidaemia and their interaction in promoting cardiovascular morbidity and mortality[24].

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This work was supported by grant AC07772 from the National Institute of Aging; by the Miina Sillanpaä and Sigrid Juselius Foundations of Helsinki, Finland; and US Public Health Service International Research Fellowship 1 FO 5TW03648-01.

Manuscript received January 9; revision accepted May 17.

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