OSA and Prognosis After Acute Cardiogenic Pulmonary Edema The OSA-CARE Study

Author(s):Show less -

Uchoa, Carlos Henrique G. ^{[1, 2]} ; Pedrosa, Rodrigo P. ^[3] ; Javaheri, Shahrokh ^{[4, 5]} ; Geovanini, Glaucylara R. ^[2] ; Carvalho, Martinha M. B. ^[3] ; Torquatro, Ana Claudia S. ^[3] ; Leite, Ana Paula D. L. ^[3] ; Gonzaga, Carolina C. ^[6] ; Bertolami, Adriana ^[6] ; Amodeo, Celso ^[6] ; Petisco, Ana Claudia G. P. ^[7] ; Barbosa, Jose Eduardo M. ^[7] ; Macedo, Thiago A. ^[1] ; Bortolotto, Luiz A. ^[1] ; Oliveira, Jr., Mucio Tavares ^[8] ; Lorenzi-Filho, Geraldo ^[2] ; Drager, Luciano F. ^{[1, 9]}

Affiliation

^[1] Univ Sao Paulo, Med Sch, Heart Inst InCor, Hypertens Unit, Cardiol Div, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Med Sch, Heart Inst InCor, Sleep Lab, Pulm Div, Sao Paulo - Brazil

^[3] Univ Pernambuco, Pronto Socorro Cardiol Pernambuco PROCAPE, Sleep & Heart Lab, Recife, PE - Brazil

^[4] Univ Cincinnati, Coll Med, Bethesda North Hosp, Cincinnati, OH - USA

^[5] Ohio State Med Sch, Div Cardiol, Columbus, OH - USA

^[6] Dante Pazzanese Inst Cardiol, Sleep Lab & Hypertens Unit, Sao Paulo - Brazil

^[7] Dante Pazzanese Inst Cardiol, Echocardiog Dept, Sao Paulo - Brazil

^[8] Univ Sao Paulo, Med Sch, Heart Inst InCor, Emergency Dept, Cardiol Div, Sao Paulo - Brazil

^[9] Univ Sao Paulo, Med Sch, Hypertens Unit, Nephrol Div, Sao Paulo - Brazil

• Document type: Journal article
• Source: CHEST; v. 152, n. 6, p. 1230-1238, DEC 2017.
• Web of Science Citations: 9

Abstract

BACKGROUND: Acute cardiogenic pulmonary edema (ACPE) is a life-threatening condition. OSA may be a modifiable risk factor for ACPE recurrence. This study was designed to evaluate the impact of OSA on the incidence of cardiovascular events following ACPE recovery. METHODS: Consecutive patients with confirmed ACPE from 3 centers underwent a sleep study following clinical stabilization. OSA was defined as an apnea-hypopnea index (AHI) >= 15 events/h. The mean follow-up was 1 year, and the primary outcome was ACPE recurrence. RESULTS: A total of 104 patients were included in the final analysis; 61% of the patients had OSA. A higher rate of ACPE recurrence (25 vs 6 episodes; P = .01) and a higher incidence of myocardial infarction (15 vs 0 episodes; P = .0004) were observed in patients with OSA than in those without OSA. All 17 deaths occurred in the OSA group (P = .0001). In a Cox proportional hazards regression analysis, OSA was independently associated with ACPE recurrence (hazard ratio {[}HR], 3.3 {[}95% CI, 1.2-8.8]; P = .01), incidence of myocardial infarction (HR, 2.3 {[}95% CI, 1.1-9.5]; P = .02), cardiovascular death (HR, 5.4 {[}95% CI, 1.4-48.4]; P = .004), and total death (HR, 6.5 {[}95% CI, 1.2-64.0]; P = .005). When the analysis was limited only to patients with OSA, levels of AHI and hypoxemic burden and rates of sleep-onset ACPE were significantly higher in those who presented with ACPE recurrence or who died than in those who did not experience these events. CONCLUSIONS: OSA is independently associated with higher rates of ACPE recurrence and both fatal and nonfatal cardiovascular events. (AU)

• FAPESP's process: 12/02953-2 - Impact of obstructive sleep apnea and sleep duration on the progression of cardiovascular diseases
• Grantee: Luciano Ferreira Drager
• Support Opportunities: Research Grants - Young Investigators Grants