Key result
Sleep apnea is not associated with increased risk of incident peripheral artery disease.
Why the study?
The association between sleep apnea and peripheral artery disease is debatable, and no clinical tool exists to predict incident PAD in sleep apnea patients.
Does sleep apnea increase the risk of incident peripheral artery disease, and can clinical risk scores predict this risk?
Cohort (n=224,742)
Does sleep apnea increase the risk of incident peripheral artery disease, and can clinical risk scores predict this risk?
Hazard Ratio: 0.9 (95% CI 0.79–1.02)
p-value: p=0.1093
While sleep apnea itself is not an independent risk factor for peripheral artery disease, clinical risk scores like CHADS2, CHA2DS2-VASc, and the novel ABCD score can effectively predict incident PAD in these patients.
Sleep apnea should not alter PAD risk stratification in AF; extends CHADS2/CHA2DS2-VASc utility to incident PAD but requires prospective validation.
The association between sleep apnea (SA) and peripheral artery disease (PAD) remains debatable, and there is no clinical tool to predict incident PAD in SA patients. The CHADS₂ score has been found useful in predicting PAD risk. This study was designed to investigate the association between these diseases and the usefulness of CHADS₂ and CHA₂DS₂ASc scores in predicting subsequent PAD in SA patients. From a population-based database of one-million representative subjects, adult patients with SA diagnosis were enrolled as the suspected SA group, and those having SA diagnosis after polysomnography were further extracted as the probable SA group. Twenty sex- and age-matched control subjects were randomly selected for each SA patients. The occurrence of PAD after SA was taken as the primary endpoint. Totally, 10,702 and 4242 patients were enrolled in the suspected and probable SA groups, respectively. The cumulative incidence of PAD was similar between SA patients and the corresponding control groups. Multivariable Cox regression analyses showed that SA was not an independent risk factor for subsequent PAD. Sensitivity analyses using propensity score-matched cohorts showed consistent results. Furthermore, in stratifying the SA patients by CHADS₂, CHA₂DS₂ASc, or a newly-proposed ABCD (composed of Age, high Blood pressure, Cerebral vascular disease, and Diabetes mellitus) score, patients with higher scores predicted higher risks of subsequent PAD, while the ABCD score appeared to be the most robust. Aggressive risk modification is suggested to reduce the subsequent PAD risk in SA patients with a higher CHADS₂, CHA₂DS₂ASc, or ABCD score.
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Wu et al. (2019) conducted a cohort in Sleep Apnea (n=224,742). Sleep apnea vs. Matched control subjects without sleep apnea was evaluated on Development of peripheral arterial disease (PAD) (HR 0.90, 95% CI 0.79-1.02, p=0.1093). Sleep apnea was not an independent risk factor for developing subsequent peripheral arterial disease (HR 0.90), though higher CHADS2, CHA2DS2ASc, and ABCD scores predicted increased PAD risk in these patients.
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