Estimates of 10-year risk of cardiovascular death and adherence to cardiovascular risk factor management in Danish patients investigated for obstructive sleep apnea.

OBJECTIVE: Obstructive sleep apnea (OSA) increases the risk of cardiovascular disease (CVD) in both morbidity and mortality. We used the risk chart of Systemic Coronary Risk Evaluation (SCORE) from European Society of Cardiology (ESC) to determine the 10-year risk of cardiovascular death, and adherence to cardiovascular risk factor management in Danish patients investigated for obstructive sleep apnea. RESEARCH DESIGN AND METHODS: In a prospective cohort study, 303 patients with mild, moderate and severe OSA were investigated for cardiovascular risk factors before initiating CPAP therapy. Primary outcome was estimates of 10-year risk of cardiovascular death assessed from the ESC risk chart SCORE based on sex, age, smoking status, systolic blood pressure and s-total cholesterol. Furthermore we analyzed treatment indication with statins in patients with mild (apnea-hypopnea index, AHI <15), moderate (AHI 15-29.9) and severe OSA (AHI ≥30). RESULTS: Patients with mild OSA predominately had low or moderate 10-year risk of CVD (low risk 55.4%, moderate risk 30.8%) while patients with moderate and severe OSA were more likely to have high or very high risk of 10-year CVD (p = 0.001). The large majority of included OSA patients had dyslipidemia, 235 (77.6%) and of those, only 27.4% were treated with cholesterol lowering drugs while additional 27.7% were eligible for oral statin supplement as risk-estimated by the ESC SCORE. In multiple regression analysis among statin naive patients, AHI was positively associated with statin eligibility when adjusted for age and sex. CONCLUSION: Patients with moderate and severe OSA had an elevated 10-year risk of fatal CVD and were undertreated with CVD risk lowering agents such as statins.

Prevalence of silent atrial fibrillation and cardiovascular disease in patients with obstructive sleep apnea.

OBJECTIVE: Patients with silent and undiagnosed atrial fibrillation (AF) have increased risk of ischemic stroke. Patients with obstructive sleep apnea (OSA) have an increased risk of both AF and ischemic stroke. Our aim was to investigate the prevalence of silent AF and associated risk factors in patients investigated for OSA or with known OSA. METHODS: This prospective observational study was performed in two sites; one outpatient sleep-clinic at Zealand University Hospital and one private Ear-Nose- and Throat clinic. Patients were investigated with a type-3 portable sleep-monitoring device, while heart rhythm was home-monitored for 7 days with an event-triggered loop recorder. Patients were stratified in groups of mild, moderate and severe OSA based on Apnea-Hypopnea-Index (AHI). RESULTS: In a cohort of 303 patients, 238 (78.5%) were diagnosed with moderate/or severe OSA and 65 (21.5%) with no/mild OSA who constituted the control group. In 238 patients with moderate and severe OSA, AF was detected in 21 patients (8.8%) vs. 1 patient (1.5%,[p=0.045]) with mild OSA. Candidates for anticoagulation therapy were referred for further cardiovascular treatment. The majority of patients had known hypertension (n = 200,66%) and dyslipidemia (n = 235,[77.6%]) In patients with moderate/or severe OSA (AHI≥15), hypertension was more dysregulated (p=0.005) and more patients suffered from unknown prediabetes (n = 36, 3.1% vs. 14.3%[p<0.001]). CONCLUSION: Undiagnosed AF and undertreated cardiovascular modifiable risk factors are common in a cohort of patients with OSA. With this study we propose that long-period home-monitoring in these patients is useful for identifying candidates for preventive anticoagulation, cardiovascular treatment and possibly prevent future ischemic stroke.

Tonsillotomy in children with sleep-disordered breathing is safe and results in high parent satisfaction.

INTRODUCTION: Sleep-disordered breathing in children is often associated with tonsillar hypertrophy. For many years, total tonsillectomy (TE) was the treatment of choice, but performing an intracapsular tonsillotomy (TT) is becoming increasingly widespread. In this Danish study, we have investigated the long-term results on efficacy and parent satisfaction after TT performed on children. METHODS: This was a retrospective study based on a questionnaire that was sent to the parents of 335 children who underwent TT due to sleep-related obstructive symptoms. RESULTS: A total of seven children had unilateral re-TT due to tonsillar regrowth, leaving a total of 342 operations performed. The response rate was 71% and the median follow-up was 90 months. None of the patients in this study ex-perienced post-operative bleeding requiring medical assistance. A total of 97% of parents reported total or partial relief of all symptoms, whereas 3% experienced no effect of treatment on preoperative symptoms. A total of 5% of the children later underwent tonsillectomy after their primary TT. The majority of parents (89%) would choose the operation again in a similar situation. CONCLUSIONS: TT has previously been shown to have a lower morbidity and risk of post-operative bleeding and a better recovery than TE. In this study, we found it to be a long-term efficient and safe treatment for children with obstructive symptoms during sleep and it was associated with a high degree of parent satisfaction. FUNDING: none. TRIAL REGISTRATION: This was a retrospective study.