Characterisation of Symptom and Polysomnographic Profiles Associated with Cardiovascular Risk in a Sleep Clinic Population with Obstructive Sleep Apnoea

Abstract

Aim

Recent data have identified specific symptom and polysomnographic profiles associated with cardiovascular disease (CVD) in patients with obstructive sleep apnoea (OSA). Our aim was to determine whether these profiles were present at diagnosis of OSA in patients with established CVD and in those with high cardiovascular risk. Participants in the Sydney Sleep Biobank (SSB) database, aged 30–74 years, self-reported presence of CVD (coronary artery disease, cerebrovascular disease, or heart failure). In those without established CVD, the Framingham Risk Score (FRS) estimated 10-year absolute CVD risk, categorised as “low” (<6%), “intermediate” (6–20%), or “high” (>20%). Groups were compared on symptom and polysomnographic variables.

Results

629 patients (68% male; mean age 54.3 years, SD 11.6; mean BMI 32.3 kg/m², SD 8.2) were included. CVD was reported in 12.2%. A further 14.3% had a low risk FRS, 38.8% had an intermediate risk FRS, and 34.7% had a high risk FRS. Groups differed with respect to age, sex and BMI. OSA severity increased with established CVD and increasing FRS. The symptom of waking too early was more prevalent in the higher FRS groups (p=0.004). CVD and FRS groups differed on multiple polysomnographic variables; however, none of these differences remained significant after adjusting for age, sex, and BMI.

Conclusion

Higher CVD risk was associated with waking too early in patients with OSA. Polysomnographic variations between groups were explained by demographic differences. Further work is required to explore the influence of OSA phenotypic characteristics on susceptibility to CVD.

Keywords:

• obstructive sleep apnoea
• cardiovascular disease

Sydney Sleep Biobank Investigators

University of Sydney - Peter Cistulli, Philip de Chazal, Kate Sutherland, Nina Sarkissian, Yu Sun Bin, Chin Moi Chow; Royal North Shore Hospital - Andrew Chan, Aimee Lowth, Jacob Graham, William Wood, Gary Cohen, Callum Bennett, Mohammad Ahmadi; Westmead Hospital - John Wheatley, Kristina Kairaitis, Stephen Lambert, Rita Ginn, Tracey Burns; Royal Price Alfred - Brendon Yee, Amanda Piper, Keith Wong, Kerri Melehan, Margaret Chan, David Wang, Gislaine Gauthier.

Acknowledgments

The authors acknowledge the work of all those that have contributed to the Sydney Sleep Biobank (SSB) data collection. The authors would additionally like to thank all the SSB participants for contributing their data to this effort.

Disclosure

Dr Andrew Chan reports personal fees from SomnoMed Limited, outside the submitted work. Dr Amanda Piper reports personal fees from Phillips, personal fees from Up to Date, outside the submitted work. Professor Peter Cistulli holds an academic chair that was funded by ResMed; also a consultant to ResMed, with fees being paid to the University; in addition reports personal fees from Somnomed, from Signifier Medical, and from Sunrise Medical, outside the submitted work. The authors report no other conflicts of interest in this work.

The abstract of this paper was presented at the Sleep Down Under Conference 2022 as a conference talk with interim findings. The abstract was published in Sleep Advances, Volume 3, Issue Supplement 1, October 2022: https://doi.org/10.1093/sleepadvances/zpac029.011.

Additional information

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.