In Annals of the American Thoracic Society ; h5-index 57.0
RATIONALE : Central sleep apnea (CSA) is associated with high mortality. Current knowledge stems from studies with limited sample size (<100 subjects) and in homogeneous populations such as heart failure (HF).
OBJECTIVES : To address this knowledge gap, we compared the mortality pattern and time to death between the CSA and obstructive sleep apnea (OSA) patients in the large Veterans Health Administration patient population, utilizing the big data analytic approach.
METHODS : This is a retrospective study using national Veterans Health Administration electronic medical records from October 1, 1999, through September 30, 2020. We grouped the patients with underlying sleep disorders into CSA and OSA, using ICD9 and ICD10 codes. We applied Cox regression analysis to compare the mortality rate and hazard ratio (HR) among the two groups and adjusted (aHR) by gender, race, body mass index (BMI), age, and Charlson comorbidity index. In CSA groups, a machine-learning algorithm was used to determine the most important predictor of time to death. Further subgroup analysis was also performed in patients that had comorbid heart failure.
RESULTS : Evaluation of patients resulted in 2961 grouped as CSA and 1,487,353 grouped as OSA. Patients with CSA were older (61.8±15.6 years) than those with OSA (56.7±13.9 years). A higher proportion of CSA (25.1%) patients died during the study period when compared to the OSA cohort (14.9%). The aHR was 1.53 (95 % CI 1.43, 4.65). Presence of HF history of cerebrovascular disease, hemiplegia, and having BMI <18.5 were among the highest predictors of mortality in CSA. The subgroup analysis revealed that the presence of HF was associated with increased mortality both in CSA (HR 7.4; 95% CI 6.67,8.21) and OSA (HR 4.3; 95% CI 4.26,4.34) groups.
CONCLUSIONS : Clinically diagnosed CSA was associated with a shorter time to death from the index diagnostic date. Almost one fifth of CSA patients died within five years of diagnosis. The presence of HF, history of cerebrovascular disease and hemiplegia, male sex, and being underweight were among the highest predictors of mortality in CSA. CSA was associated with higher mortality than OSA, independent of associated comorbidity.
Agrawal Ritwick, Sharafkhaneh Amir, Gottlieb Daniel J, Nowakowski Sara, Razjouyan Javad
2022-Nov-14
