Key result
OSA is linked to ~26% lower inpatient mortality in acute ischemic stroke and AMI.
Why the study?
Obstructive sleep apnea can cause cardiovascular changes increasing the risk of complications such as acute myocardial infarction and acute ischemic stroke.
Does obstructive sleep apnea affect mortality risk and what are the associated risk factors in patients admitted for acute myocardial infarction or acute ischemic stroke?
Observational (n=1,215,915)
Yes
Does obstructive sleep apnea affect mortality risk and what are the associated risk factors in patients admitted for acute myocardial infarction or acute ischemic stroke?
Odds Ratio: 0.738 (95% CI 0.691–0.789)
Absolute Event Rate: 2.5% vs 3.8%
p-value: p=<0.01
Paradoxically, patients with obstructive sleep apnea admitted for AMI or AIS had lower mortality rates compared to non-OSA patients, though specific arrhythmias increased mortality risk.
OSA-associated lower mortality in acute stroke/MI admissions challenges expected risk elevation; leaves open confounding versus protective effect in observational data.
Introduction: Obstructive sleep apnea (OSA) can cause several cardiovascular changes that increase the risk of various complications such as acute myocardial infarction (AMI) and acute ischemic stroke (AIS). Material and methods: We used the 2019 National Inpatient Sample (NIS) from the Healthcare Cost and Utilization Project (HCUP), the Agency for Healthcare Research and Quality (AHRQ), and their many collaborators to study the differences in characteristics and outcomes of OSA patients following AMI or AIS and the presence of several cardiac arrhythmias and their associated mortality risks. Results: A lower mortality rate was seen among OSA patients with AIS (2.5% compared to 3.8% in non-OSA), and AMI (2.8% compared to 4.7% in non-OSA). OSA patients with AIS had a higher risk of dying if they were aged 66 or over, of Hispanic origin, or if they reported ventricular tachycardia, or paroxysmal atrial fibrillation. For those with OSA and admitted for AMI, they were more at risk of dying if they were aged 66 or over, not classified as "White, Black, or Hispanic", with a history of diabetes, reported ventricular tachycardia, or ventricular fibrillation. Lower adjusted odds ratios were noted among OSA patients with hypertension in both AMI and AIS cases. Conclusions: Further studies comparing these characteristics based on the severity of OSA are therefore encouraged.
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Ramphul et al. (2022) conducted an observational in Acute myocardial infarction or acute ischemic stroke (n=1,215,915). Obstructive sleep apnea vs. No obstructive sleep apnea was evaluated on Inpatient mortality (Acute ischemic stroke cohort) (aOR 0.738, 95% CI 0.691-0.789, p=<0.01). Obstructive sleep apnea was associated with a lower risk of inpatient mortality among patients admitted for acute ischemic stroke (aOR 0.738) and acute myocardial infarction (aOR 0.672).
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