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Diego R. Mazzotti, PhD, on CV Outcomes in Patients With OSA

Although symptom subtypes of obstructive sleep apnea (OSA) have been described, it is unclear whether they are associated with adverse cardiovascular (CV) outcomes. A new study, led by Diego R. Mazzotti, PhD, further investigated OSA symptom subtypes and their associated CV outcomes.1

Dr Mazzotti is a research associate in the Division of Sleep Medicine, Department of Medicine, at the University of Pennsylvania Perelman School of Medicine in Philadelphia, Pennsylvania.

PULMONOLOGY CONSULTANT: Which subtypes of OSA predicted CV outcomes?

Diego Mazzotti: In our study, we identified 4 subtypes of OSA based on symptoms:

  1. Excessively Sleepy, characterized by severe daytime sleepiness complaints;
  2. Disturbed Sleep, characterized by symptoms related to insomnia;
  3. Moderately Sleepy, with some degree of daytime sleepiness but not as severe and prevalent as the Excessively Sleepy; and
  4. Minimally Symptomatic, with relatively lower prevalence of sleep complaints in general.

When we looked at the relationship between OSA symptom subtypes and future CV outcomes, Excessively Sleepy was the only subtype associated with increased risk. In addition, when OSA symptom subtypes were compared with subjects without OSA, patients with moderate to severe OSA, who were characterized as Excessively Sleepy, were the only group that showed increased risk.

PULM CON: How might the results of your study affect clinical practice and how OSA is treated?

DM: While it is generally recognized that sleepy OSA patients are at increased risk of adverse health outcomes, this study highlighted the importance of effectively identifying these patients and prioritizing the treatment of their sleep disorder. While our study could not prove that treating OSA in patients with the Excessively Sleepy subtype can prevent CV disease, it certainly indicated that more attention to sleepier OSA patients should be drawn.

PULM CON: What is the key take-home message for pulmonologists?

DM: I believe that it is very important that pulmonologists evaluate sleep-related symptoms in their patients and take the necessary precautions to identify a potential sleep disorder, particularly OSA. Also, it is very important to recognize that OSA is a very heterogeneous disease, and only looking at standard metrics of severity (such as the apnea-hypopnea index) might not tell the complete story about the patient’s disease progression or risk to develop adverse health outcomes.

Reference:

  1. Mazzotti DR, Keenan BT, Lim DC, Gottlieb DJ, Kim J, Pack AI. Symptom subtypes of obstructive sleep apnea predict incidence of cardiovascular outcomes. 2019;200(4):493-506. https://doi.org/10.1164/rccm.201808-1509OC.