Hypoxic Burden is Associated with Cardiovascular Events : A Risk Stratification Analysis of the RICCADSA Cohort
(2025) In Chest- Abstract
BACKGROUND: The Apnea-Hypopnea Index (AHI), the standard measure of obstructive sleep apnea (OSA), has limitations in reflecting disease severity.
RESEARCH QUESTION: Is high hypoxic burden (HB) more strongly associated with major cardiovascular and cerebrovascular adverse events (MACCEs) than AHI≥ 30/h?
STUDY DESIGN AND METHODS: This secondary analysis of the RICCADSA observational cohort included 368 adults with OSA (AHI≥15/h), with (n=155) and without (n=244) excessive daytime sleepiness, defined as an Epworth Sleepiness Scale≥10. HB was calculated as the total area under respiratory event-related desaturations divided by total sleep time. Patients were classified as high or low HB based on the median (60.7%min/h). The... (More)
BACKGROUND: The Apnea-Hypopnea Index (AHI), the standard measure of obstructive sleep apnea (OSA), has limitations in reflecting disease severity.
RESEARCH QUESTION: Is high hypoxic burden (HB) more strongly associated with major cardiovascular and cerebrovascular adverse events (MACCEs) than AHI≥ 30/h?
STUDY DESIGN AND METHODS: This secondary analysis of the RICCADSA observational cohort included 368 adults with OSA (AHI≥15/h), with (n=155) and without (n=244) excessive daytime sleepiness, defined as an Epworth Sleepiness Scale≥10. HB was calculated as the total area under respiratory event-related desaturations divided by total sleep time. Patients were classified as high or low HB based on the median (60.7%min/h). The primary outcome was the incident of the first MACCE. Cox proportional hazard models assessed associations in the full cohort and by CPAP allocation/adherence (nonadherent or no-PAP group: n=262; adherent [adjusted PAP usage≥ 4 h/night/all nights at 1-year follow-up]: n=106). In an exploratory analysis, participants were grouped into four categories based on median AHI and HB (low/low, low/high, high/low, high/high).
RESULTS: Over a median follow-up of 4.7 years, high HB was associated with MACCEs (adjusted hazard ratio [HR] 1.87; 95% CI 1.17-2.98; p=0.009), particularly among untreated or non-adherent patients and those with baseline EDS. AHI ≥30/h was not significantly associated with MACCEs (p=0.366). When modelled continuously, HB and AHI were each associated with MACCEs, respectively; however, compared to low AHI/low HB, only high HB, irrespective of AHI level, was linked to increased risk. In contrast, high AHI/low HB was not associated with MACCEs.
INTERPRETATION: High hypoxic burden, but not AHI ≥ 30/h, was associated with MACCEs in adults with moderate to severe OSA. Although AHI was associated with outcomes when modelled continuously, elevated risk appeared to be driven primarily by high hypoxic burden.
(Less)
- author
- Peker, Yüksel LU ; Celik, Yeliz ; Zinchuk, Andrey ; Sands, Scott A ; Redline, Susan and Azarbarzin, Ali
- organization
- publishing date
- 2025-08-14
- type
- Contribution to journal
- publication status
- epub
- subject
- in
- Chest
- publisher
- American College of Chest Physicians
- external identifiers
-
- pmid:40818776
- ISSN
- 1931-3543
- DOI
- 10.1016/j.chest.2025.07.4081
- language
- English
- LU publication?
- yes
- additional info
- Copyright © 2025. Published by Elsevier Inc.
- id
- ce33bde7-54e5-46b5-a311-4ce18f7c7947
- date added to LUP
- 2025-08-18 12:05:08
- date last changed
- 2025-08-18 12:07:58
@article{ce33bde7-54e5-46b5-a311-4ce18f7c7947,
abstract = {{<p>BACKGROUND: The Apnea-Hypopnea Index (AHI), the standard measure of obstructive sleep apnea (OSA), has limitations in reflecting disease severity.</p><p>RESEARCH QUESTION: Is high hypoxic burden (HB) more strongly associated with major cardiovascular and cerebrovascular adverse events (MACCEs) than AHI≥ 30/h?</p><p>STUDY DESIGN AND METHODS: This secondary analysis of the RICCADSA observational cohort included 368 adults with OSA (AHI≥15/h), with (n=155) and without (n=244) excessive daytime sleepiness, defined as an Epworth Sleepiness Scale≥10. HB was calculated as the total area under respiratory event-related desaturations divided by total sleep time. Patients were classified as high or low HB based on the median (60.7%min/h). The primary outcome was the incident of the first MACCE. Cox proportional hazard models assessed associations in the full cohort and by CPAP allocation/adherence (nonadherent or no-PAP group: n=262; adherent [adjusted PAP usage≥ 4 h/night/all nights at 1-year follow-up]: n=106). In an exploratory analysis, participants were grouped into four categories based on median AHI and HB (low/low, low/high, high/low, high/high).</p><p>RESULTS: Over a median follow-up of 4.7 years, high HB was associated with MACCEs (adjusted hazard ratio [HR] 1.87; 95% CI 1.17-2.98; p=0.009), particularly among untreated or non-adherent patients and those with baseline EDS. AHI ≥30/h was not significantly associated with MACCEs (p=0.366). When modelled continuously, HB and AHI were each associated with MACCEs, respectively; however, compared to low AHI/low HB, only high HB, irrespective of AHI level, was linked to increased risk. In contrast, high AHI/low HB was not associated with MACCEs.</p><p>INTERPRETATION: High hypoxic burden, but not AHI ≥ 30/h, was associated with MACCEs in adults with moderate to severe OSA. Although AHI was associated with outcomes when modelled continuously, elevated risk appeared to be driven primarily by high hypoxic burden.</p>}},
author = {{Peker, Yüksel and Celik, Yeliz and Zinchuk, Andrey and Sands, Scott A and Redline, Susan and Azarbarzin, Ali}},
issn = {{1931-3543}},
language = {{eng}},
month = {{08}},
publisher = {{American College of Chest Physicians}},
series = {{Chest}},
title = {{Hypoxic Burden is Associated with Cardiovascular Events : A Risk Stratification Analysis of the RICCADSA Cohort}},
url = {{http://dx.doi.org/10.1016/j.chest.2025.07.4081}},
doi = {{10.1016/j.chest.2025.07.4081}},
year = {{2025}},
}